A

| B | C

| D

| E

| F | G | H

| I

| J | K | L | M

| N | O | P

| Q | R | S | T | U

| V | W | X | Y | Z


A

ABN
Advanced Benificiary Notice – A written notice that providers must give the patient before they furnish a service or item that is not covered by Medicare. This document is also referred to as a waiver.

Allscripts
Allscripts is a company that develops and supports EHR / EMR and Practice Management systems for hospitals, and medical practices of all sizes. Allscripts primarily has 3 versions of EHR software; enterprise, professional and MyWay. MD Tech Pro provides Allscripts support.

AMA
American Medical Association

C

CCR
Continuity of Care Record – A standard specification being developed to foster and improve continuity of patient care, to reduce medical errors, and to assure at least a minimum standard of health information transportability when a patient is referred or transferred to, or is otherwise seen by, another provider. The development is in response to the need to organize and make transportable a set of basic patient information consisting of the most relevant and timely facts about a patient’s condition. Ideally the EMR will both import and export all relevant data to and from the CCR document (via memory drive, CD, etc) and enable automated transmissions with minimal workflow disruption for individual caregivers. Briefly, these include patient and provider information, insurance information, patient’s health status (e.g., problems, procedures, medications, allergies, lab results, immunizations), and recent chart notes. CCR in Misys EMR is currently slotted for version 8.0 as part of the Release of Information development. {jointly by ASTM International, the Massachusetts Medical Society (MMS), the Health Information Management and Systems Society (HIMSS), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics}

CDA
Clinical Document Architecture – A proposed standard for the exchange of patient summary information. This one is supported by HL7 and many EHR vendors. Much of the current interest in standards harmonization is driven by these two seemingly competing standards.

CMS
Centers for Medicare and Medicaid Services – Formerly HCFA (Health Care Financing and Administration) is a federal agency within the US Department of Health and Human Services that runs the Medicare and Medicaid programs, two national health care programs that benefit about 75 million Americans. CMS also regulates all laboratory testing (except research) performed on humans in the US.

Co-payment
A predetermined fee that an individual pays for health care services, in addition to what the insurance covers.

Coinsurance
Money that an individual is required to pay for services after a deductible has been paid. Co-insurance is often specified by a percentage.

CPT
Current Procedural Terminology – Set of five-digit codes describing medical services delivered that are used for billing by professional providers. CPT codes set a standard that can be used for billing and insurance claims throughout the medical industry.


D

Deductible
The amount an individual must pay for health care services before insurance covers any of the costs. Deductibles are most frequently charged on an annual basis rather than on a per incident basis.

Denial of Claim
Refusal by an insurance company to honor a request by an individual (or his or her provider) to pay for health care services obtained from a health care professional.

DICOM
Digital Imaging and Communications in Medicine – An FDA-approved file format used in capturing and transporting digital images, including x-rays, MRI’s, etc. The federal Consolidated Healthcare Informatics initiative has identified DICOM as the standard that enables images and associated diagnostic information to be retrieved and transferred from various manufacturers’ devices as well as medical staff workstations.

Disease Management
A system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant. Disease management supports the physician or practitioner/patient relationship and plan of care, emphasizes prevention of exacerbations and complications utilizing evidence-based practice guidelines and patient empowerment strategies, and evaluates clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.

DME
Durable Medical Equipment – Wheel chair, crutch. Items a patient might buy. Encounter Form (also called Fee Slip, Super Bill, Route Slip or Charge Ticket) Ticket or form utilized in the communicating of actual services rendered during a patient visit. These are used for chart documentation, as well as posting of charges to the patient’s account for billing and reimbursement.

DOQ-IT
Doctors’ Office Quality Information Technology – Funded by CMS, (the Centers for Medicare and Medicaid Services), the biggest division of the Department of Health and Human Services. It promotes the adoption of EMR systems and information technology in small-to-medium sized physician offices with a vision of enhancing access to patient information, decision support, and reference data, as well as improving patient-clinician communications. By educating physician offices on EMR system solutions and alternatives, as well as providing implementation and quality improvement assistance, DOQ-IT aims to assist physician offices in migrating easily from paperbased health records to EMR systems that suit the needs of their office. DOQ-IT does not endorse any particular vendor product or service.


E

EHR
An Electronic Health Record (EHR) is a cumulative health record of an individual which is gathered across different healthcare institutions and maintained by licensed professionals involved in the person’s health.

EHR Support
EHR support is typically provided by the EHR company and / or an IT vendor that specializes in supporting healthcare facilities. EHR support includes implementation, training and ongoing work to maintain the software application. In a typical EHR environment periodicaly updates and software patches must be installed in order to keep a system running effectively.

EMR
Electronic Medical Records (EMR) is a computerized health record of a patient maintained in a hospital or a clinic, including the patient’s demographics, medical history, treatment details etc.

An Electronic Health Record (EHR) is a cumulative health record of an individual which is gathered across different healthcare institutions and maintained by licensed professionals involved in the person’s health.

Evaluation and Management Codes (E&M)
Services refer to visits and consultations provided by physicians or residents under their supervision. Each of these services is assigned a CPT (Current Procedure Terminology) code for billing purposes.

Explanation of Benefits (EOB)
Detailed description of the components of payment supplied by the payor showing precisely what monies are distributed where in the payment of a claim.


H

HCFA-1500
Billing form designed by the Health Care Financing Administration; universal billing from accepted by most insurance companies; used by providers to file professional charges to insurance carriers.

Health Information Technology
Health information technology (HIT) provides the umbrella framework to describe the comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities, and insurers. Health information technology (HIT) is in general increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.

HEDIS
Healthplan Employer Data and Information Set – It is the performance measurement tool of choice for more than 90% of the nation’s managed care organizations. It is a set of standardized measures that specifies how health plans collect, audit and report on their performance in important areas ranging from breast cancer screening, to helping patients control their cholesterol to customer satisfaction. Most HEDIS guidelines are measured through the Preventive Health Maintenance (PHM) module in Misys EMR and pre-loaded in your sales demo database.

HIPAA
Health Insurance Portability and Accountability Act of 1996 – The Centers for Medicare & Medicaid Services (CMS) is responsible for implementing various unrelated provisions of HIPAA, therefore HIPAA may mean different things to different people. HIPAA compliance refers to a standardized accounting and documentation set of procedures established by the government in an effort to simplify the documentation, accounting and fraudulent aspects of the healthcare industry. Covers security, integrity and authentication of confidential health records.

HL 7
Health Language Seven – A data interchange protocol for health care computer application that simplifies the ability of different vendor-supplied IS systems to interconnect. Although not a software program in itself, HL7, requires healthcare software vendors to program an HL7 interface for their products.


I

ICD-9 CM
International Classification of Diseases, version 9, Clinical Modification – Also referred to as diagnosis codes. ICD-9-CM is the official system of assigning codes to medical diagnoses. It consists of: a tabular list containing a numerical list of the disease code numbers in tabular form, an alphabetical index to the disease entries, and a classification system for surgical, diagnostic, and therapeutic procedures.

Interoperability
The ability to exchange and use information. The ability of software and hardware on multiple machines from multiple vendors to communicate. An initiative to develop a national health infrastructure: Based on open standards for data exchange created without a central database of health records from a decentralized and federated network approach. Creates a “Network of Networks” connected over the Internet linked only by directories pointing to the sources of records. The Directory system knows where records are kept, but not what information the records contain. The records are stored locally and can be shared electronically if authorized. Leaves decisions regarding the sharing of health information with Patients and their healthcare providers.


L

LMRP
Local Medical Review Policy – An administrative and educational tool to assist providers, physicians and suppliers in submitting correct claims for payment. Local policies outline how contractors will review claims to ensure that they meet Medicare coverage requirements. The Centers for Medicare & Medicaid Services (CMS) requires that LMRPs be consistent with national guidance (although they can be more detailed or specific), developed with scientific evidence and clinical practice, and are developed through certain specified federal guidelines. Contractor Medical Directors develop these policies.


M

Medicaid
A jointly-funded, Federal-State health insurance program for certain low-income and needy people. Medicaid covers approximately 36 million individuals including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments.

Medical Practice IT Support
Medical practice IT support is the application of IT support services within a medical practice environment. Medical practice IT support companies such as MD Tech Pro have experience and skill sets that are necessary in providing the most value and best support in a healthcare environment. Medical practices that are supported by traditional IT services are typically at a disadvantage or do not receive the quality of support that is available by a medical practice IT expert.

Medicare
The nations largest health insurance program, covering over 39 million Americans. Medicare provides health insurance to people age 65 and over, those who have permanent kidney failure, and certain people with disabilities.

Mid-Level Provider
Mid-level providers usually refer to Physician’s Assistants (PA), Nurse Practitioners (NP, CRNP), and Nurse Midwives.


P

Patient / Subscriber Relationship
This indicates the relationship of the main person assigned to the insurance policy. An example might be “spouse of subscriber”.

Patient Web Portal
Think of the patient web portal as an extension of the practice’s current communication methods with their patients. Web portals among EMR vendors encompass various features: online appointment scheduling, lab result posting/review, email communication between providers and patients, online prescription refill requests, online documentation of past medical history information, etc.

Pay For Performance
(P4P) is an approach to enhance healthcare quality and efficiency by giving providers financial incentives for improved clinical outcomes, cost containment and patient satisfaction. These incentives are based upon outcomes data that are generated by provider assessment and that yield measurable results. Incentives can take many forms, most often as a bonus or withhold.

Primary Care Provider (PCP)
A health care professional (usually a physician) who is responsible for monitoring an individual’s overall heath care needs. Typically, a PCP serves as a “gatekeeper” for an individual’s medical care, referring the individual to more specialized physicians for specialist care. Family Practice, internal Medicine, Pediatrics and sometimes females consider their OB/Gyne.

Provider
A term used for health professionals who provide health care services. Sometimes, the term refers only to physicians. Often, however, the term also refers to other health care professionals such as Physician’s Assistant, Nurse Practitioners, Chiropractors, Physical Therapists (PT), and others offering specialized health care services and are billable.


S

Scribe
This could be any person taking notes or dictation from a physician for documentation purposes.


U

UB-92
Claim form used to file hospital charges to insurance carriers.

UPIN
Universal Physician Identification Number – A number given by the insurance company to identify the referring doctor.


W

Workers Compensation
A program established to aid persons injured while working on the job. It is managed at the state and national levels and operates much like Medicare.