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Definition of Terms Essay

AMR- Ambulatory Medical Record- An ambulatory medical record (AMR) is an electronically stored file of a patient’s outpatient medical records, which includes all surgeries and care that do not involve being admitted to a hospital.

The importance of AMR’s is that they only apply to outpatient medical records. Outpatients procedures or services are performed so frequently that at times it can be tedious to keep track of them. These records allow a physician to review a patient’s COMPLETE medical history. CMR- Computerized Medical Record- Computerized medical records are the digital counterparts to patient medical records kept in paper files and folders in health care offices.

The importance of CMR’s is they allow for less paper storage or use. A patient’s medical records can be an extensive file. The longer the file gets the harder it is to keep up with it. Keeping a computerized copy of what is on paper in a patient’s medical record is more than convenient, it is a more efficient method of documentation. CMS – Centers for Medicare and Medicaid- The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program (SCHIP), and health insurance portability standards.

CMS is an important entity to US healthcare, without it, the medical coverage for children whose parents do not have the luxury of commercial coverage and the elderly who have reached the age of retirement would not have health benefits. Medicare and Medicaid do not only supply benefits to children and the elderly but there are those citizens who are considered disable in some way, shape, fashion or form. CMS-1500 – A universal claims billing form used by physicians and other healthcare practitioners to bill payers for professional services.

The CMS 1500 form assists physicians especially in receiving reimbursement for the services provided. The development of a form for physicians eliminates confusion for insurance companies when processing claims. The companies need not worry about whether the charges were submitted by a physician or facility, which makes for easier and more efficient processing. CPT – Current Procedural Terminology (CPT) is a code set that is used to report medical procedures and services to entities such as physicians, health insurance companies and accreditation organizations. CPT is used in conjunction with ICD-8-CM or ICD-10-CM numerical diagnostic coding during the electronic medical billing process.

From a billing standpoint, a world without CPT codes is almost like a world without people. The genius idea to use a universal language of numbers to determine services an individual had performed alleviates chaos. CPT codes also give a shorter description of the services rendered. Some procedures are so extensive, all the information appearing on a claims form can cause confusion. By giving these procedures a 5 digit number which can be researched for a description creates efficiency. DRG – Diagnosis Related Group – any of the payment categories that are used to classify patients, especially Medicare patients, for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual costs incurred DRG’s prohibit a facility from receiving an outrageous reimbursement for specific provided services.

The categorization of patient cases into specific groups which allows for a set cost or billed amount places a cap on reimbursement to that facility for that case/patient. EPR – Electronic Patient (Health) Record (EHR) -an evolving concept defined as a systematic collection of electronic health information about individual patients or populations. Monitoring a patients’ health information in an electronic manner is a win/win for all involved. It allows the patient faster access to their records and the physician or hospital a faster method for reviewing or receiving those same records. The EPR has evolved into the EHR. The development of tracking patient health information in an electronic monitor has produced a more effective, accurate method for organizing something as lengthy as a person’s health history.

HL7 – Health Level Seven (HL7) – a non-profit organization involved in the development of international healthcare informatics interoperability standards. HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. The 2.x versions of the standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world.

The development of this organization is the foundation for the ability to transfer and track health information safely and without violation of a person’s personal information. Without HL7, the above mentioned term (EPR) would not exist. This organization’s importance is beyond measure in terms of convenience involved in the healthcare field. The standards set forth are a necessity in order for health information to be exchanged or shared, they provide peace of mind to the patients and physicians. ICD-9 – International Classification of Disease, 9th edition – A standardized classification of disease, injuries, and causes of death, by etiology and anatomic localization and codified into a 5-digit number, which allows clinicians, statisticians, politicians, health planners and others to speak a common language, both US and internationally. A 3 to 5-digit number code describing a diagnosis or medical procedure.

The International Classification of Disease 9th edition is as important to billing as CPT codes. The universal language for identifying a patients diagnosis assists not only for purposes in billing but for physician and hospital communication with insurance companies. Physicians attend school to learn and become familiar with the formal name for specific diseases, injuries and other medical conditions. On the other hand, insurance companies may not be as familiar or educated as to the formal names for these medical conditions, which is where ICD-9’s come into play. They allow for easier and more understanding within the communication aspect of physician to insurance or facility to insurance company.

UB-92 – Uniform/Universal Billing form 92 Managed care The official HCFA/CMS form used by hospitals and health care centers when submitting bills to Medicare and 3rd-party payors for reimbursement for health services provided to Pts covered. UB-92 billing forms have since been replaced with UB-04 billing forms. Needless to say, a universal billing form creates an efficient, more precise method of billing for hospitals. Once again it eliminates the time that would be consumed by insurance companies attempting to determine if a claim is for a facility or physician. Eliminating this step assists in jump starting the processing of reimbursement to a facility for rendered services.


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