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52 Cards in this Set
- Front
- Back
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7 kinds of MCOs (Managed care organizations)
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1. HMO (health maintenance orgainzation)
2. PPO (Preferred provider organization) 3. EPO (Exclusive provider organization) 4. IPA (Independent Practice association) 5. GPWW (group practice without walls) 6. consolidated medical group/practice 7. PHO (physician/hospital organization) |
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HMO
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Health Maintenance Organization -- enrollees must use the participating health personnell; all types of health services
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PPO
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Preferred Provider Organization -- list of health care providers is given; patient can use others off the list but must pay higher for them
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EPO
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Exclusive Provider Organization -- regulated under insurance laws and regulations, otherwise like PPOs with a list of physicians, and like HMOs where they use only specified healthcare providers
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IPA
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Independent Practice Association -- legal entity composed of physicians who contract with the IPA; the IPA itself contracts with an HMO
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GPWW
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Group Practice Without Walls -- group of private practice physicians who practice independent of eachother
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consolidated medical group/practice
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group of physician who practice together, most traditional group practice
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PHO
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Physician/Hospital Organization -- hospital and physicians work together to negotiate with 3rd party payers
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4 types of data included in the patient medical record
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1. personal
2. financial 3. social 4. medical |
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example of personal data in the medical record
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birthdate, name, sex, marital status, occupation
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examples of financial data of the medical record
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employer and health insurance company, type of insurance
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examples of social data of the medical record
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patient race, ethnic background, family relationships, community activities
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examples of medical data of the medical record
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chief complaint, family history, course of treatment, diagnosis, path, lab, x rays
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a complete medical record means:
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all required forms and signatures are there
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accurate medical record means:
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the information is correct (transcribed reports)
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what are the regulations for Medicare and Medicaid (CMS/HCFS) called for medical records?
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Conditions of Participation
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Requirements for medical records are found in:
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state and federal laws, JCAHO (accrediation), state department of Health (licensing), CMS (regulations)
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period of time within which a party may bring a lawsuit is called?
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statute of limitations
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Medical record of a minor should be kept until?
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age of majority plus the period of the statute
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if a hospital does experimental medical research, emdical records should be kept for how many years?
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75
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AHIMA time to keep records:
adult patient health records |
10 years after most recent encounter
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AHIMA time to keep records:
minor patient health records |
age of majority plus statute of limitations
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AHIMA time to keep records:
diagnostic images |
5 years
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AHIMA time to keep records:
disease index |
10 years
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AHIMA time to keep records:
fetal heart monitory records |
10 years after infant reaches majority
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AHIMA time to keep records:
master patient index |
permanently
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AHIMA time to keep records:
operative index |
10 years
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AHIMA time to keep records:
physician index |
10 years
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AHIMA time to keep records:
register of births |
permanently
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AHIMA time to keep records:
register of deaths |
permanently
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AHIMA time to keep records:
register of surgical records |
permanently
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T/F
Total destruction does not occur until the original data and all backup data info has been destroyed |
true
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T/F
records involved in any open investigation, audit, or legal action should not be destroyed |
true
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in destroying records, what is pulping and pulverizing
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pulping uses a chemical
pulverizing is to grind and crush |
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T/F
a destruction log should be kept permanently |
true
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T/F
If destruction services are used, there should be a contract |
true
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authentication means
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signature
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What else should be in the medical record if a computer key or signature stamp is used?
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a signed statement in the hospital administrative office that indicates that they are the only person to have possession and to use the stamp or key
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auto-authentication
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a dr authenticates a report before the report is transcribed; JCAHO and CMS don't allow it
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verbal order
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a dr gives an order and a qualified person at the facility documents in the medical record
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telephone order
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a dr gives the order over the telephone and a qualified person at the facility documents in the medical record
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correcting an order involved (3)
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one line
write correct info initial correction |
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any changes made per the patients request are done as an?
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addendum
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5 types of consents
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1. expressed
2. implied 3. informed 4. emergency 5. blanket |
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expressed consent
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given by direct words, either written or oral; oral is hard to proved, most require written
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implied consent
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inferred by the patient's actions
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informed consent
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person is well informed about what they are signing for and they sign voluntarily
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emergency consent
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dr determines a life/death situation and surgery is done without consent, needs to be documented in the record
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blanket consent
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consent is signed before the information is filled in (not good ethical practice because pt needs to know what they are signing)
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3 areas where consent is needed
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1. permission for treatment
2. surgical procedures 3. release/disclosure of medical records |
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emacipated minor
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person under age of 18/21 who is either married or lives away from the parents and financially supports themselves
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T/F
patient has right to refuse treatment, examples |
true
Jehovah's Witnesses (blood transfusions) terminally ill competent adults |
