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Study Guide for Exam 1

by: Lydia

Study Guide for Exam 1 HSC 210

GPA 4.0
Intro to Health Information Management
Jennifer Peterson

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Exam 1 study guide
Intro to Health Information Management
Jennifer Peterson
Study Guide
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This 25 page Study Guide was uploaded by Lydia on Tuesday September 8, 2015. The Study Guide belongs to HSC 210 at Illinois State University taught by Jennifer Peterson in Fall 2015. Since its upload, it has received 30 views. For similar materials see Intro to Health Information Management in Nursing and Health Sciences at Illinois State University.


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Date Created: 09/08/15
HSC 210 Exam 1 Study Guide 1 Know the basic structure of a hospital including the governing board CEOs CFOs etc and how physicians fit into that The medical staff does not report to the CEO Medical staff reports to the governing board and so does the CEO The people underthe CEO CNO CCO CFO COO report to the CEO if you re a nurse or an HIM professional you ultimately report to the CEO 2 Know the types of physician appointments within a hospital and the process for credentialing Active can admit patientssee patients Associate work there sometimes or new positions Consulting specialist called in by admitting physician Courtesy special option or special doctors who actually comes down to see patients Honorary or Emeritus no longer practicing or admitting just come in to hang out Medical Staff Committees Executive staff above credentials committees gives credential reviews amp reports to governing board Credentials where they start reviews new physicians amp gives permission for physician to practice Joint Conference medical committee between the medical staff amp governing board For physician appointments a new physician comes in they turn in their application for membership to the credentials committee the credentials committee reviews them and say quotyea I think their fine their goodquot it goes to the executive committee these are both medical staff committees so their over here under the medical staff they send it to the executive committee they say yes we want this physician practicing here well recommend that to the governing board goes to the governing board the governing board makes the physician appointments they grant the membership it goes through this process 3 Know about AHIMA their Code of Ethics continuing Ed accreditation bodies history elected bodies and their function the education levels and credentials available AHIMA traces its history back to 1928 when the American College of Surgeons established the Association of Record Librarians of North America ARLNA to quotelevate the standards of clinical records in hospitals and other medical institutionsquot This farsighted recognition of the importance of medical record quality to patient care and research underlies the organization today Since its formation the organization known now as AHIMA has undergone several name changes that reflect the evolution of the profession In 1938 the Association changed its name to the American Association of Medical Record Librarians AAMRL for a more succinct representation of the membership AAMRL moved forward with the creation of standards and regulations that established its members as medical record experts When the Association became the American Medical Record Association in 1970 medical record professionals had increased their involvement in hospitals community health centers and to other health service facilities outside the hospital They had also begun to play a critical role at their institutions in the administration of federal programs such as Medicare As the healthcare industry underwent restructuring and decisionmaking became increasingly driven by data the Association changed its name in 1991 to the American Health Information Management Association Its current name captures the expanded scope of clinical data beyond the single hospital medical record to health information comprising the entire continuum of care AHIMA American Health Information Management Association They work to help shape healthcare policies advocates for legal and regulatory changes advances confidentiality and privacy concerns recognizes wide variety of HIM roles shapes health care policies advocates for legal and regulatory changes advances confidentiality and privacy concerns works with changes in technology EMR recognizes wide variety of HIM roles Business process engineer clinical research protocol designer and manager clinical trials manager clinical vocabulary manager consumer advocate data analysis data facilitator datainformation broker datainformation presenter data sets nomenclature and classification standards developer data miner data navigator data quality and integrity manager data resource manager data security privacy confidentiality manager data translator information systems designer work and data flow analyst embraces lifelong learning They work to help shape healthcare policies advocates for legal and regulatory changes advances confidentiality and privacy concerns recognizes wide variety of HIM roles Code of ethics 1 Advocate uphold and defend the individual39s right to privacy and the doctrine of confidentiality in the use and disclosure of information 2 Put service and the health and welfare of persons before selfinterest and conduct oneself in the practice of the profession so as to bring honor to oneself their peers and to the health information management profession 3 Preserve protect and secure personal health information in any form or medium and hold in the highest regards health information and other information of a confidential nature obtained in an official capacity taking into account the applicable statutes and regulations 4 Refuse to participate in or conceal unethical practices or procedures and report such practices 5 Advance health information management knowledge and practice through continuing education research publications and presentations 6 Recruit and mentor students peers and colleagues to develop and strengthen professional workforce 7 Represent the profession to the public in a positive manner 8 Perform honorable health information management association responsibilities either appointed or elected and preserve the confidentiality of any privileged information made known in any official capacity 9 State truthfully and accurately one39s credentials professional education and experiences 10 Facilitate interdisciplinary collaboration in situations supporting health information practice 11 Respect the inherent dignity and worth of every person Education programs Health Information Technology HITassociate degree programs Health Information Management HIM bachelor degree programs Masters39 degree HIM programs Professional Certi cation Registered Health Information Administrator RHIA 4 yr degree approved program passage of the national exam CE39s 30 hours per 2yr cycle 10 CE hrs in ICDlO coding Registered Health Information Technician RHIT 2 yr degree approved program passage of the national exam CE39s 20 hrs per 2yr cycle Additional credentials CCS Certified Coding Specialist CCSP Certified Coding SpecialistPhysician Office CCA Certified Coding Associates CHP Certified in Healthcare Privacy CHS Certified in Healthcare Security CHPS Certified in Healthcare Privacy and Security CHDA Certified Health Data Analyst All need passage of national exam 10 CE hrs must be maintained for each additional credential beyond the RHIA amp RHIT additional dues for additional credentials annual selfassessment exam with fee can hold credential without an RHIA or RHIT Accreditation of Educational Programs CAHIIM Commission on Accreditation for Health Informatics and Information Management EducationIndependent accrediting organization that establishes and enforces quality accreditation standards for all 3 levels of AHIMA Educational Programs for HI and HIM educational programs CCHIIM Commission on Certification for Health Informatics and Information Management Serves the public by establishing implementing and enforcing standards and procedures for certification and recertification of health informatics and information management HIIM professionals Through certification CCHIIM assures the competency of professionals practicing health informatics and information management worldwide AHIMA Organizations House of Delegates state associationselected by the states 2yr elected terms Vote on changes to the bylaws at the annual convention The House of Delegates HoD is a deliberative assembly comprised of delegates elected or appointed from each of the 52 Component State Associations CSA and the AHIMA Board of Directors Delegates serve as a grassroots member forum of AHIMA governing the health information management HIM profession The HoD is chaired by the Speaker of the House an AHIMA official elected by delegates Delegates work virtually yearround operating on a July 1June 30 term advocating for the profession the members and the Association These leaders help keep our profession strong and moving forward by contributing or recommending action on issues affecting the industry Board of Directors all numbers of AHIMAelected by the membership atlarge Staggered elected terms President is a 3 yr commitment The authority of the Director derives from serving as a voting member of the Board of Directors Individual Directors have no special privileges prerogatives or authority apart from the whole At the same time being a Director of AHIMA and member of its Board of Directors is a special trust and individual directors are expected to meet high standards of personal conduct on behalf of AHIMA CEO staff Hired by Board 4 Know about Joint Commission its history who it accredits and what that accreditation means The JC is a private nonprofit organization that establishes guidelines and standards for the operation and management of health care facilities with emphasis on the health care functions crucial to patient care Mission to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations Based on standards showing high quality care and effective as in cost effective use of resources The joint commission used to be called the JCAH Joint Commission on Accreditation of Hospitals which was adopted the Hospital Standardization Program for the ACS The JCAH changed its name to JAHCO The Joint Commission on Accreditation of Healthcare Organizations They accredit numerous types of HCOs Some examples of the HCOs for which standards are developed include hospitals large amp small behavioral health care organizations mental amp substance longterm care organizations home care organizations ambulatory care organizations Surgical Center pathology and clinical laboratory services officebased surgery practices MultiSpecialty Clinics and MCOs Managed Care Organizations Accreditation is a private agency performs review and grants recognition to programs or institutions based on their standards Why May need for reimbursement for some payors validates quality provided and give competitive edge That accreditation means different thing to different groups Ex ambulatory surgery facilities may get accreditation that may be more meaningful for them than others 5 Know the history behind accreditation organizations why they were started and what function they served ie AHA AMA ACS etc AHA American Hospital Association ensures that members39 perspectives and needs are heard and addressed in national health policy development legislative and regulatory debates and judicial matters Our advocacy efforts include the legislative and executive branches and include the legislative and regulatory arenas Mission promote public welfare provide better care in hospitals Action funds and conducts research and educational programs maintains data for hospital profiles represents hospitals in legal and legislative matters MMmerican Medical Association seeks to promote the art and science of medicine the medical profession and the betterment of public health Its purposes include obtaining synthesizing integrating and disseminating information about health and medical practice setting standards for medical ethics practice and education and being an influential advocate for physicians and their patients Response to poor ethics in medical practice and poor education Mission promotes science and art of medicine improving public health Action health care policymaking servicing needs of members accrediting medical schools Abraham Flexner Report poor medical education Led to AMA accreditation processranking ACS American College of Surgeons dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment Goal develop hospitals standards to improve patient care set minimum standard including health record for every patient HillBurton Act provided funding for hospitals and other health care facilities Joint Commission on Accreditation of Hospitals JCAH was founded took over hospital standards from ACS Medicare federal elderly and Medicaid state indigent developed led to state regulatory code CMS Centers for Medicare Services are also a regulatory body and a payer as well Providers must comply with Conditions of Participation COP to get reimbursement for CMS states regulate compliance of COP if accredited by Joint Commission deemed to be in compliance deemed status also has met the COP conditions as well Meeting COP means facility is certified 6 Know the role of nurse practioners and physician assistants as well as clinical nurse specialists and other nurses Director of Nursing DON usually a BSN or higher Nursing Levels Head Nurse managers Staff Nurse Nurses under head nurse Clinical Nurse Specialist More advance amp usually have masters degree Nursing Care Assessment assess health vitals etc Administration give medications Observation observe patients Outcome quotdid any of the medications that were given make fever go downquot questions like that Maintains Effectiveness Planning Implementation Evaluation Education Graduation from approved program pass boards Specialists BSN or MSN amp clinicals OB ICU etc BSN 4 years and clinicals RN approved 2 year program amp clinicals LPN 1 year amp clinicals PA39s can prescribe controlled scheduled medications such as opiates like Percocet morphine and Fentanyl NP39s Nurse practitioners can prescribe medication in every state and in the District of Columbia NPs can practice independently without physician collaboration or supervision Many NPs have their own practices and can be reimbursed by Medicare Medicaid or other third parties DO vs MD The main difference between the two types of physicians is that DOs have been specially trained to perform osteopathic manipulations on patients They view the patient as a quottotal personquot and focus on preventative care They view the whole body rather than treat specific symptoms or illness Difference between an MD and DO they are both physicians but have had different types of training They have to same rights as an MD but they can be board certified by the AMA or American osteopathic association 7 Know the documents that a hospital operates under mission statement bylaws etc Mission statement The definition of a mission statement is a formal summary of values and goals to clearly outline who the company group or person is and what it wants to do An example of a mission statement is a formal written summary prepared by a company as part of its business plan outlining what the company stands for and what its goals are Why they39re there What they39re there to do o Defines the present state or purpose of an organization o Answers three questions about why an organization exists W HAT it does WHO it does it for and HOW it does what it does Vision statement Defines the optimal desired future state the mental picture of what an organization wants to achieve over time o Provides guidance and inspiration as to what an organization is focused on achieving in five ten or more years o Functions as the quotnorth starquot it is what all employees understand their work every day ultimately contributes towards accomplishing over the long term and o Is written succinctly in an inspirational manner that makes it easy for all employees to repeat it at any given time Is what they are wanted to do for the future what they see as their vision for the future Bylaws Regulations ordinances or rules enacted by a private corporation for its own government Bylaws are the rules What are they for How things operate so bylaws for the hospital physicians medical staff bylaws are the rules for the physicians Joint Commission Documentation Standards Mission Statement guiding philosophy Organizational charts Meeting minutes Governing Body Bylaws Rules amp Regulations Planning documents strategic plan Reports QRM quality review management RM risk management UR utilization review 8 Know insurance terms remember when we wrote on the board and talked about the terms Claim bill request for payment Copayment what insurance does not pay Deductible amount of cost incurred by the patient before insurance will Pay Exclusion not covered by insurance Outofpocket what the patient pays directly Policy insurance plan Premium amount paid to purchase an insurance plan Beneficiary patient Benefit period time frame that the plan covers the patient Coverage terms that the plan covers disease conditions services Preexisting condition disease injury or condition that occurred before plan was purchased Rider amendment that can either increase or decrease benefits Eligibility patient who qualifies for an insurance plan Sliding scale amount based on patient39s ability to pay Prospective payment system predetermine amount based on patient39s diagnosis Capitation paid by the company based on number of subscribers rather than type of service or paid by type of services through a contractual agreement regardless Discounting agreement to accept payment of members to a specific plan 9 Know the sources of documentation from lab HampP are only done by physicians PANA can do HampP39s they may have to be signed off on by a physician m ADMITI39ING NURSING PHYSICIAN SURGICAL ANESTH ESIA Informed Pre anesthesia Insurance Ca rd Ca re Map Discharge Summary Consent Evaluation Intra operative HIPPA Privacy Intake amp Output Record Physician Orders Record General Consent to Operative Treatment Nursing Assessment Progress Notes Report Face Sheet Post operative demo gra phics Progress Notes HampP Exa m Notes Pre operative Advanced Directives Shift Progress Notes Consultation Reports Checklist Medication Administration Record Charting Patient Assessment Flow Chart Shift Progress Notes Trigage Report Automatic Stop Order Echocardiogram Report Pathology Report Patient Assessment Pharmaogenic Consult Radiology Report Urinalysis Monitor Settings Blood Work Chemistry Profile Electrocardiogram Dieta ry Respiratory Ca re Report Assessment Discharge Plan Progress Notes Record Pulmonary Function Sleep Study Progress Notes Test Progress Notes Menu Plan Progress Notes Electroencephalogram Diabetic Education Echoca rdi ogra m Report Progress Notes Cookie Swallow Study Charting Progress Notes Speech Assessment 10 Know the difference between house staffquot ER docs hospitalists etc and outside physicians House staff The physicians and surgeons in specialty training at a hospital who care for patients under the direction and responsibility of attending staff They are physicians that are hired by and are located in the hospital House staff are physicians that work in the hospital are employed by the hospital hospitalists Emergency Room doctors anesthesiologists as opposed to a general practitioner internal medicine specialist surgeon don t see patrons outside of hospital 11 Know what those receiving care are called in different settings hospitals LTC etc Patients are called patients hospitals outpatient settings are people who are seen in like psych or substance abuse settings are called clients LTC Long Term Care such as nursing home are for residents 12 Know the difference between types of hospitals ownership profit status etc Nonprofit hospital means the facility does not pay either state or local property taxes or federal income taxes because it is considered a charity and proves certain community benefits in accord with state and federal guidelines Forprofit hospital means the facility is either owned by private investors or is owned publicly by shareholders and is part of a company that issues shares of stock to raise revenue to expand the hospital activities Govern mentowned hospitals are operated by the United States government They enjoy several tax exemptions Regardless of their ownership all hospitals offer similar types of basic services hire staff with similar levels of training operate under the same rules and regulations and accept similar health insurance Proprietary which is for profit statue to make money voluntary not for profit status exempt from paying taxes government owned at the federal state level 13 Know the difference between licensure and accreditation Licensure mandatory requirement to legally operate It39s required to practice you have to be licensed Accreditation voluntary participation in an external review program to meet certain predetermined standards Its voluntary you don t have to be accredited 14 Understand the HMO model and what makes it unique gatekeeper etc HMO Health Maintenance Organization 0 Gatekeeper primary care physician who you have to see first before you can see a specialist or go for special procedures 0 Managed care model and how the HMO fits into that 0 Subscribers enroll in plan pay premiums small copayments o No papenNork or claims submission 0 Must use gatekeeper 0 Provides contract with HMO to service subscribers for a fixed prepaid amount 0 Providers receive rewards for limiting care 0 Services may not be covered if subscribers go outside the HMO 0 Lots of negotiations amp appeals phone calls letters approvals etc o Fairly beurocratic An ALERNATIVE traditional to group health insurance coverage and provides healthcare services voluntary enrolled members on a PREPAID basis 15 Know the physician specialties from lab Allergist or Immunologist conducts the diagnosis and treatment of allergic conditions Anesthesiologist treats chronic pain syndromes administers anesthesia and monitors the patient during surgery Cardiologist treats heart disease Dermatologist treats skin diseases including some skin cancers Gastroenterologist treats stomach disorders HematologistOncologist treats diseases of the blood and bloodforming tissues oncology including cancer and other tumors Internal Medicine Physician treats diseases and disorders of internal structures of the body Nephrologist treats kidney diseases Neurologist treats diseases and disorders of the nervous system Neurosurgeon conducts surgery of the nervous system Obstetrician treats women during pregnancy and childbirth Gynecologist treats diseases of the female reproductive system and genital tract NurseMidwifery manages a woman39s health care especially during pregnancy delivery and the postpartum period Occupational Medicine Physician diagnoses and treats workrelated disease or injury Ophthalmologist treats eye defects injuries and diseases Oral and Maxillofacial Surgeon surgically treats diseases injuries and defects of the hard and soft tissues of the face mouth and jaws Orthopaedic Surgeon preserves and restores the function of the musculoskeletal system Otolaryngologist Head and Neck Surgeon treats diseases of the ear nose and throat and some diseases of the head and neck including facial plastic surgery Pathologist diagnoses and treats the study of the changes in body tissues and organs which cause or are caused by disease Pediatrician treats infants toddlers children and teenagers Plastic Surgeon restores reconstructs corrects or improves in the shape and appearance of damaged body structures especially the face Podiatrist provides medical and surgical treatment ofthe foot Psychiatrist treats patients with mental and emotional disorders Pulmonary Medicine Physician diagnoses and treats lung disorders Radiation Onconlogist diagnoses and treats disorders with the use of diagnostic imaging including Xrays sound waves radioactive substances and magnetic fields Diagnostic Radiologist diagnoses and medically treats diseases and disorders of internal structures ofthe body Rheumatologist treats rheumatic diseases or conditions characterized by inflammation soreness and stiffness of muscles and pain in joints and associated structures Urologist diagnoses and treats the male and female urinary tract and the male reproductive system 16 Understand licensing for professionals as well as facilities PhysiciansMD DO NP PA the nurses are licensed Professionals or individuals can be licensed and they have to be licensed to practiced just like you have to have a license for a facility in order to see patients Ex Pharmacists are licensed but were not licensed as HIM were credential it depends on the area 17 Understand Medicare and Medicaid Medicare covers 65 and older the elderly some dependents and disabled persons Regulated by the federal government Medicaid covers low income persons indigent patients Regulated by the states They are both payers they pay healthcare facilities and providers tto treat their patients but they39re also regulators they set a lot of regulations conditions of participation in order to treat Medicare and Medicaid patients to get paid for those they have to meet the conditions of participation Deemed status it you have a joint commission accreditation you39re considered deemed status to meet the conditions of participation 18 Know national laws as well as state laws and agencies that affect healthcare COBRA Consolidated Omnibus Budget Reconciliation Act management of indigent patients OBRA Omnibus Budget Reconciliation Act focus on development and dissemination of information on quality cost and effectiveness Patient Self Determination Act patients choose endoflife care HIPPA Health Insurance Portability and Accountability Act portability and privacy and security Health care facilities facilities planning board a state law that looks at whether or not we need a new health care facility or piece of equipment 19 Know the different types of care inpatient emergency ambulatory etc Hospitalbased Ancillary Services lab amp xray Emergency Department ED Ambulatory Surgery same dayOP Clinics urgent post care rehab Physician Practice Groupclinic Individual Managed Care Neighborhood Centers Ethnic Economic Geographic rural Urgent Care Centers Walkins Prompt Care DocintheBox Contractual Services Institutional Student Health Center PrisonJail BusinessIndustry Inpatient you spend the night 24hrs or more Outpatient 23 hour observation they don t intend for you to stay Emergency care emergency room Ambulatory care Outpatient physician visits ambulatory surgery PT that you go and are treated and then you go home Ex A patient that comes into the ER at 9pm and spends the night in the ER and leaves at 7am they would be considered outpatient mother that stays in a room with a child mother visitor infant inpatient patient that has ambulatory surgery that s not doing well at 5pm when the ambulatory surgery area closes so they put them in an inpatient bed to watch them overnight to make sure they can keep the fluids down and keep food in them maybe to conclude and observe would be considered OP 23hr release An outpatient surgery patient they39re in the area and they have extreme bleeding that they can39t get under control so they send them to an inpatient bed to get that under control they don t have any plan or discharge date they would become an inpatient because they could be there a say or more and go back for surgery Doctor admits the patient it39s considered an inpatient if the doctor says he want to keep them for a 23hr observation then that s considered an outpatient 20 Know the essential characteristics of a hospital 1 Diagnostic and therapeutic services medical and surgical 2 Inpatient beds 3 Governing board legally responsible for the conduct of the institution 4 Administrator delegated by the governing board to maintain fulltime operations ofthe facility according to hospital bylaws 5 Organized medical staff delegated by the governing board to maintain proper standards of medical care 6 Patient admitted by a member of the organized medical staff 7 Nursing services underthe direction of a fulltime registered professional nurse 8 Registered professional nursing supervision and nursing care are continuous 9 Medical Record is maintained for each patient 10 Pharmacy services are maintained and supervised by a licensed pharmacist 11 Diagnostic xray services 12 Clinical laboratory services with pathology services available 13 Operating room services 14 Food served meeting nutritional requirements of patient and modified diets


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