C-RHI cheat sheet

Data governance assigns decision rights and accountability for data definition, quality, access, and use across the organization.

Data stewardship is the operational role that enforces governance policy at the point of data capture and use.

The AHIMA data quality model addresses four dimensions: data application, data collection, data warehousing, and data analysis.

Data quality characteristics include accuracy, completeness, consistency, timeliness, precision, currency, granularity, and definition.

Data definition establishes meaning, allowed values, and format; data structure establishes relationships among data elements.

The EHR is the legal record of care; the designated record set is the HIPAA-defined subset a patient may inspect and copy.

Master data management creates a single trusted source for patients, providers, and facilities to prevent duplicate identities.

Retention schedules are set by federal and state law and by organizational policy; legal hold suspends destruction.

A data dictionary documents each element's name, definition, format, source, and owner, and is the reference for consistency.

Descriptive analytics reports what happened; diagnostic explains why; predictive forecasts; prescriptive recommends action.

Common quality measures: rate = (numerator / denominator) x 100; use the same population definition for both terms.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value = true positives / (true positives + false positives) and depends on disease prevalence.

Interoperability standards: HL7 v2 messaging, FHIR for modern APIs, CDA for clinical documents, and DICOM for imaging.

Terminology systems: ICD-10-CM/PCS for morbidity coding and billing, SNOMED CT for clinical concepts, LOINC for lab observations.

Data visualization should match chart type to question: trend over time uses line charts, composition uses bar or stacked charts.

A population health registry identifies a cohort by defined criteria and tracks gaps in care against evidence-based measures.

Revenue cycle sequence: preregistration, registration, charge capture, coding, claim submission, payer adjudication, remittance, and collections.

Net patient revenue = gross charges - contractual allowances - discounts - bad debt; report net, not gross, on financial statements.

Key indicators: days in accounts receivable = (AR balance / average daily charges); a lower value generally indicates faster cash.

Clean claim rate = claims accepted on first submission / total claims submitted; denials are tracked by reason and payer.

Charge capture must link documented services to coded charges; missed charges and duplicate charges are core audit findings.

The chargemaster is the internal price list; it must be reviewed for coding changes, new services, and annual updates.

Case mix index is the average DRG relative weight of a population and reflects acuity, not quality of care.

Under the inpatient prospective payment system, MS-DRGs assign payment by principal diagnosis, procedures, and complications.

HIPAA Privacy Rule governs use and disclosure of protected health information; the Security Rule covers electronic PHI safeguards.

Minimum necessary standard limits uses and disclosures to the least information needed for the stated purpose.

The Privacy Rule permits disclosure for treatment, payment, and health care operations without patient authorization.

Breach notification: notify affected individuals without unreasonable delay and no later than 60 days after discovery.

The Anti-Kickback Statute prohibits remuneration for referrals of federally reimbursed items; the Stark Law addresses physician self-referral.

The False Claims Act imposes liability for knowingly false claims; qui tam provisions allow private relator suits.

Release of information requires a valid authorization: patient identification, purpose, scope, expiration, and signature.

The HITECH Act extended HIPAA privacy and security obligations to business associates and strengthened breach penalties.

Leadership functions include planning, organizing, staffing, directing, controlling, and evaluating departmental performance.

Span of control is the number of direct reports per manager; narrower spans suit complex, high-skill work.

FTE calculation: FTE = paid productive hours / standard full-time hours (commonly 2,080 per year).

Productivity is measured as units of work per paid hour; benchmarks come from internal trend data and external surveys.

Change management models (Lewin unfreeze-change-refreeze; Kotter's steps) structure adoption of workflow and technology changes.

A performance improvement cycle is plan-do-study-act; measure baseline, implement, remeasure, and standardize.

Job descriptions define essential functions, qualifications, and reporting relationships and support defensible hiring decisions.

Strategic plans connect organizational mission to measurable goals, and are reviewed with defined metrics at set intervals.

ICD-10-CM codes diagnoses and reasons for encounter; ICD-10-PCS codes inpatient procedures only.

ICD-10-CM structure: 3-7 characters; the 7th character in injury and obstetric codes indicates encounter type or healing stage.

ICD-10-PCS has 7 characters, each with a defined meaning: section, body system, root operation, body part, approach, device, qualifier.

Coding conventions: 'code also' requires an additional code; 'excludes1' means the two conditions are never coded together.

The principal diagnosis is the condition chiefly responsible for admission after study; the first-listed diagnosis is used in outpatient settings.

MS-DRG assignment uses the principal diagnosis, procedures, and the presence of a major complication or comorbidity.

CPT codes report physician services and procedures; HCPCS Level II covers supplies, drugs, and non-physician services.

Medical necessity requires documentation supporting the coded condition and the service performed.

Crude death rate = (deaths / population) x 1,000; age-specific rates use the corresponding age group denominator.

Hospital mortality rate = (inpatient deaths / inpatient discharges) x 100; include deaths within the defined period.

Average length of stay = total inpatient days / total discharges; exclude newborns and nursery days per policy.

Occupancy rate = (inpatient days / bed days available) x 100; bed days available = beds x days in period.

Infection rate = (infections / patient days) x 1,000, often reported per 1,000 device days.

Quality improvement uses structure, process, and outcome measures; outcomes reflect results, processes reflect delivery.

Statistical process control distinguishes common-cause variation from special-cause variation using control charts.

Risk adjustment compares providers fairly by accounting for patient severity, age, and comorbidities.