C-RHI flashcards
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32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Data Governance
- The framework of decision rights, policies, and accountability that determines how health data are defined, captured, accessed, protected, and used across the enterprise.
- Data Steward
- The role responsible for the day-to-day quality, definition, and appropriate use of a defined data domain, enforcing governance policy at the point of capture and use.
- Designated Record Set
- The HIPAA-defined group of records a patient may inspect and copy, including medical and billing records used to make decisions about the individual.
- Legal Hold
- A directive that suspends routine destruction of records because of pending or reasonably anticipated litigation, audit, or investigation.
- Master Data Management
- A discipline that creates a single trusted source of reference data, such as patient, provider, and facility identities, to prevent duplicates and inconsistencies.
- Data Dictionary
- A reference that documents each data element's name, definition, format, allowed values, source, and owner to ensure consistent interpretation across systems.
- Sensitivity Formula
- Sensitivity equals true positives divided by the sum of true positives and false negatives; it measures a test's ability to identify those who have the condition.
- Specificity Formula
- Specificity equals true negatives divided by the sum of true negatives and false positives; it measures a test's ability to correctly identify those without the condition.
- Predictive Analytics
- Analytics that use historical data and statistical models to estimate the likelihood of future events, such as readmission risk or disease onset.
- Interoperability Standards
- Common data exchange standards including HL7 messaging, FHIR application programming interfaces, and CDA clinical documents that allow systems to share information.
- LOINC
- A standardized terminology used to identify laboratory tests and clinical observations, enabling consistent exchange and aggregation of result data.
- Population Health Registry
- A defined cohort of patients identified by specific criteria and tracked over time to monitor gaps in care against evidence-based measures.
- Clean Claim Rate
- The number of claims accepted on first submission divided by total claims submitted, expressed as a percentage; a key revenue cycle efficiency measure.
- Days in Accounts Receivable
- The accounts receivable balance divided by average daily charges, indicating the average time needed to collect outstanding patient and payer balances.
- Chargemaster
- The internal list of charges for services and supplies that must be maintained for coding changes, new services, and annual price updates.
- Case Mix Index
- The average diagnosis-related group relative weight of a patient population, reflecting acuity and resource use rather than quality of care delivered.
- Net Patient Revenue
- Gross charges reduced by contractual allowances, discounts, and bad debt; the amount actually expected to be collected and reported on financial statements.
- Minimum Necessary Standard
- A HIPAA requirement limiting uses and disclosures of protected health information to the least amount reasonably needed to accomplish the intended purpose.
- Breach Notification Deadline
- Affected individuals must be notified of a breach of unsecured protected health information without unreasonable delay and no later than 60 days after discovery.
- Anti-Kickback Statute
- A federal law prohibiting knowingly offering or receiving remuneration to induce referrals of items or services reimbursed by federal health care programs.
- Stark Law
- A federal statute restricting physician self-referral for designated health services reimbursed by Medicare, unless a specific exception applies.
- Valid Authorization
- A patient permission for release of information that identifies the patient, the purpose, the scope of data, an expiration, and the signature.
- FTE Calculation
- Full-time equivalents equal total paid productive hours divided by standard full-time hours, commonly 2,080 hours per year for one position.
- Span of Control
- The number of employees directly reporting to one manager; narrower spans are appropriate for complex, high-skill, or highly supervised work.
- Lewin Change Model
- A change framework of unfreezing existing behavior, implementing the change, and refreezing new practices so they become the standard.
- PDSA Cycle
- A performance improvement method of plan, do, study, and act used to test changes on a small scale before broader implementation.
- ICD-10-PCS Structure
- A seven-character inpatient procedure code in which each character represents section, body system, root operation, body part, approach, device, or qualifier.
- Principal Diagnosis
- The condition established after study to be chiefly responsible for the inpatient admission, sequenced first on the inpatient claim.
- Excludes1 Note
- A coding convention indicating that two conditions are mutually exclusive and should never be reported together on the same record.
- MS-DRG Assignment
- Inpatient payment grouping based on the principal diagnosis, performed procedures, and the presence of major complications or comorbidities.
- Hospital Mortality Rate
- Inpatient deaths divided by inpatient discharges, multiplied by 100, for a defined reporting period and population.
- Average Length of Stay
- Total inpatient days divided by total discharges for a period, indicating the typical duration of an inpatient stay.