Abx:
Abbreviation for antibiotics
Allopathic Medicine:
The thinking that chemistry is the root
of most problems and that the use of drugs
to restore normal chemistry levels will
help cure illnesses. Most M.D.s are more
allopathic than osteopathic (taking note
of some specialties), but the two disciplines
are definitely not mutually exclusive.
Alternative Therapy:
Therapies that are not accepted by "traditional"
medicine. This would include acupuncture,
herbal remedies, meditation, etc. Most
physicians recognize at least some alternative
therapies as being valid.
ASP:
Application Service Provider (a.k.a. -
Web based) – a remotely hosted program
and database.
Advantages – Reduced initial investment
in hardware. Reduced responsibility in
maintenance of server and data.
Disadvantages – Completely dependent on
internet connectivity. Completely dependent
on the server host. Speed to access images,
scanned documents, etc. Long term cost
is frequently greater.
Balance Forward:
An accounting reference for the amount
outstanding on an account transferred
from another billing system. Primarily
used during data migration from your legacy
system to your new Medinformatix system.
BMI (Body Mass
Index): Calculation based on
height and weight. This is similar to
percent body fat and demonstrates how
much effect a person's weight is on their
health.
Book View:
A provider's specific schedule for seeing
patients (i.e. number of appointments
in a day, duration of each appointment
slot, or request for specific appointment
types at certain times).
Capitated Insurance
Plans (Capitation): Some insurance
plans do not pay providers based on the
specific services rendered (with some
exceptions). These plans pay the providers
a set amount per month per patient (called
the per member per month). This is called
capitation. These patients will only owe
a nominal copay at the time of service.
Capitation creates risk for a practice
because it is then up to the provider
to make sure they manage their patients
problems within the amount they are receiving.
They can be penalized for referring patients
out to more expensive specialists, so
the emphasis is very much on preventive
care. Capitation is usually associated
with HMO plans, and the physician writes
off the charges after the copay, although
"carve-outs" can be negotiated
for procedures that a provider can perform,
but are more expensive and may be less
commonly seen.
Chief Complaint
(CC:): In the patient's own words,
why they are being seen for the visit
today.
Chronic Medical
Problems: A list of a patient's
ongoing long term medical problems (i.e.
diabetes).
CLIA (Clinical
Laboratory Improvement Act): "CLIA"
is the common term for the laws governing
laboratory tests and the facilities in
which they are conducted. The laws are
very strict and CLIA certification is
usually required for a lab to be reimbursed.
The CLIA number assigned to a lab will
need to be included for billing of certain
lab tests and can be auto-populated wherever
necessary once input.
Client/Server:
A hardware and network configuration by
which all workstations are connected to
the main server for data.
Copay: A
set amount that an insurance sets that
is the patient's portion of the office
visit (due at the time of service). The
copay can change depending on the type
of visit. E.g. a standard office visit
will require payment of the usual amount,
a blood draw or nurse visit may not require
a copay, and a surgical procedure may
have a higher copay.
Conversion Factor: A dollar value to 4
decimal places used as a multiplier by
HCFA when calculating reimbursement rates.
The CF is updated annually to allow for
inflation. Many payors will base their
reimbursement rates on a CF slightly different
from Medicare's but maintain the other
multipliers.
CPT (Current Procedural
Terminology): Procedure codes
(i.e. EKG).
Current Medications:
All medications a patient takes regularly.
Deductible:
The amount a patient must meet in a covered
(insured) year before insurance starts
to pay claims. Most group plans only have
a deductible or copay for normal office
visits. Deductibles are almost always
due for hospital and other visits.
Dx: Abbreviation
for diagnosis
Differential Diagnosis
(ddx): List of possible diagnoses.
For example, if a patient was given a
general diagnosis of chest pain, but the
provider had ordered additional tests
to rule out other more specific diagnoses,
they would list the differential diagnosis
as a way of notating that they are considering
several possibilities. Differentials for
chest pain may include pneumonia, pleurisy,
GERD or cardiac problems. Documenting
differential diagnoses helps substantiate
higher coding for medical decision-making.
DME (Durable Medical
Equipment): Medical equipment
that can withstand repeated use and is
used primarily to serve a medical purpose.
For example, wheelchairs, crutches or
nebulizers. These are specific billed
using specific HCPCS codes called E codes.
D.O. (Doctor of
Osteopathy): Similar training
to M.D., but focus on the body structure
(bones, nerves and muscles) in the belief
that problems with these are often the
causes of illness and manipulation can
be a cure. They attend specific osteopathic
schools that cover much the same information
as traditional medical schools, in addition
to manipulative therapy, and are qualified
to treat the same illnesses. Most D.O.s
specialize in primary care disciplines
and practice exactly like M.D.s while
others concentrate on herbal and alternative
remedies.
E Codes:
Specific HCPCS codes used for DME.
E&M (Evaluation
and Management) Codes: Visit
codes (i.e. level 3 office visit, newborn
initial evaluation, etc.). E&M codes
are a subset of CPT codes.
EMR: Electronic
Medical Record (a.k.a. – EHR)
- An EMR system is an electronic platform
that facilitates the needs of a medical
practice and automates the overall workflow
to the greatest extent possible to achieve
the maximum amount of practice efficiency.
EPSDT (Early
and Periodic Screening, Diagnosis and
Testing): Medicaid term referring
to well visits, immunizations and other
standard childhood wellness standards.
Family History:
A list of the patient's family
medical history including the chronic
medical problems of parents, siblings,
grandparents, etc.
Fee Schedules:
A list of all CPT and HCPCS codes
and their corresponding charges. Can be
variable based on insurance. Fee schedules
are usually associated with a particular
payor and reflect the reimbursement rates
negotiated under the contract.
Firewalls:
Firewalls come in two varieties, hardware
and software. A firewall is designed to
sit between a PC or LAN (Local Area Network)
network and the outside world (the internet)
and intercept malicious content or potential
hacking.
GPCI (Geographic
Practice Cost Index): A regional
weight assigned to a Medicare locality
that takes into account the cost of delivering
services in that area. It stands to reason
that GPCI weights are higher for urban
and east coast areas than for rural areas
(higher office rents, etc.). Each RVU
component (Work, PE, MP) is given a weight,
with 1.00 being the mean (therefore .9
would reflect a lower cost base, and 1.1
would be higher). GPCIs are a multiplier
in the equation used to calculate Medicare
allowable reimbursement rate.
Guarantor: The
final responsible party on a bill after
insurance (if applicable). It is essentially
the person responsible for paying the
balance due.
HCFA (Health Care
Financing Administration): Referred
to as "hicfa", it is the government
body that controls and directs legislation
for government sponsored health coverage
(Medicare, Medicaid). They are responsible
for much of the direction in reimbursement
including forms such as the HCFA-1500,
as well as reimbursement rates upon which
other payors will base theirs.
HCFA (1500) Form: The standard insurance
claim form used by most insurances to
submit paper claims. However, some have
their own forms such as Medicaid in Illinois
and Massachusetts.
HCFA-1450:
More commonly known as the UB-92 (Universal
Bill). This is also an insurance claim
form, but is used for hospital visits
and rural health claims. It is characterized
by including more procedure level reporting
lines, as well as place for information
such as hospital days.
HCPCS (HCFA Common
Procedural Coding System): Codes
for supplies, materials and injections
(i.e. bandages, rubber gloves, penicillin).
These are reported in the same parts of
insurance forms as CPT codes (HCPCS as
Level II CPT codes). There are specialized
HCPCS codes such as E, J and L codes used
for specific procedures or services.
HL7 – Health Level
7: (a.k.a. – Health Language
7) – a HIPAA required industry standard
communications protocol. HL7 is simply
a file format with over 3,000 predefined
field names. Labs, hospitals, and equipment
manufacturers are using HL7 to output
data to each other and others in a uniform
format.
Health Summary:
Summary of a patient's medical history
including chronic medical problems, current
medications, drug allergies and past medical,
family and social history.
HPI (History of
Present Illness): The patient's
account of related symptoms for today's
visit. The HPI is generated with the use
of problem focused templates, handriting,
voice dictation or handwriting and voice
recognition.
HTN: Abbreviation
for hypertension (high blood pressure)
Hx: Abbreviation
for history or history of
ICD-9 (International
Classification of Diseases) Codes:
Diagnosis codes. For example, 401.1 represents
benign hypertension. These codes have
been color coded in Medinformatix to represent
the degree of specificity of the code.
For example, red codes should be made
more specific by adding more digits. In
order to get the best reimbursement, the
code should be carried out to the 4th
or 5th digit whenever possible.
IDDM: Abbreviation
for Insulin Dependent Diabetes Mellitus
Interface:
Interfaces come in two types - Unilateral
- a one way transfer of data; and Bilateral
- a two way transfer of data. Interfaces
can also be designed to be manually triggered,
scheduled, or real time. Interfacing involves
the development of a custom program to
act as a bridge between two programs,
two devices, a device and a program, etc.
Each interface represents a separate,
custom program. Because Medinformatix
is a single application that combines
your complete workflow, the need to interface
is reduced dramatically.
J Codes:
Specific HCPCS codes used for drugs administered
other than oral method. For example, J0530
is and injection of penicillin.
LMP:
Abbreviation for Last Menstrual Period
M.A. (Medical
Assistant): If certified, is
referred to as CMA. Some clinics have
similar positions known as Clinical Assistants.
Used in most offices as a part of the
nursing staff with responsibilities including
working up patients, triaging and returning
patient calls and assisting the provider
in general.
MD: Medical
Doctor
Medicare Locality:
A region within the US defined by HCFA
as having a particular cost structure.
This affects reimbursement of fees because
each is assigned a different GPCI weight.
Localities are often major metropolitan
areas and other, and are classified by
state.
Mid-level Practitioner:
Refers to the group of providers considered
to be one-level below M.D.s and D.O.s.
Physician assistants (P.A.s) and Nurse
Practitioners (N.P.s) are examples.
Modifier: A
two-character code added to a CPT or HCPCS
code that is used to help in the reimbursement
process. For example, a modifier can be
used to explain that a procedure not normally
covered when billed on the same day as
another is actually a separate and significant
process, or that it is a rural health
procedure that gets higher reimbursement.
Up to 4 modifiers can be attached to each
CPT, although in most cases only 1 or
2 are used.
NIDDM:
Abbreviation for Non Insulin Dependent
Diabetes Mellitus
NKDA (NDA): Abbreviation
for No Known Drug Allergies
N.P. (Nurse Practitioner):
A mid-level provider. They are required
to have a Bachelor's degree and then attend
a rigorous 3-year training program mainly
instructed by advanced nurses. Must be
supervised by a physician. NPs can specialize
much like physicians can, but are somewhat
limited (i.e. pediatrics, family medicine,
etc.).
NPI (National
Provider Identifier): Fairly
new 8 digit alphanumeric identifier given
to all medical facilities. Most M.D.s
and DOS do not have NPIs at this time
(they still use UPIN numbers). However,
mid-level practitioners usually do.
NSF (National Standard Format): Standard
format for electronic filing.
OCR – Optical
Character Recognition: The process
of converting scanned text into actual
data. OCR continues to improve, but is
still highly dependent on the quality
of the original document. Many faxed documents,
for example, do not retain the clarity
for successful OCR.
Office Visit Levels:
Otherwise know as E&M codes,
the code varies from Level I to V depending
on complexity with V being the most complex.
P.A. (Physician
Assistant): A mid-level provider.
They are required to have a Bachelor's
degree and then attend a rigorous 3-year
training program mainly instructed by
physicians. They are not physicians, but
in most states have similar rights and
privileges. However, they must be supervised
by a physician.
Past Medical History:
A list of a patient's past health
problems, surgeries and specialists.
Patient Demographics:
All the patient's pertinent information
such as first and last name, SSN, DOB,
insurance, etc.
Payor:
Any party responsible for payment of services
rendered, usually an insurance company.
PC Based:
A program designed to run on an individual
PC. This typically means data is not shared
in real time among other PCs (users).
PCN: Abbreviation
for penicillin
PCP (Primary Care
Physician): Term used by insurance
companies to describe the provider that
will manage a patient's health. In most
cases this is a family practitioner, internist,
general practitioner or pediatrician.
The PCP is responsible for obtaining referrals
to specialists as needed.
PEFR: Abbreviation
for Peak Expiratory Flow Rate. Usually
known as Peak Flow
Posting: The
process by which charges are generated
and payments are noted.
Private Pay:
Refers to patients without insurance.
Progress Note:
The documentation of a patient
visit or encounter including all or part
of the SOAP format.
Provider: General
title for MD, D.O., NP, or P.A.. A provider
of service. Most M.D.s and DOS don't like
to be referred to as providers. Other
providers are mental health professionals,
chiropractic, etc.
RAID 5: RAID
stands for Redundant Array of Interlaced
Data. The technology consists of several
(most often 4) hard drives. The data as
it is being written is broken into 3 data
elements, each going to one of three drives.
The fourth drive is active as a “hot spare”,
ready to engage in the event another drive
fails. In the event of a failure, the
fourth drive uses the remaining two active
drives to rebuild the data that was residing
on the crashed drive. The concept allows
for improved reliability, fault tolerance,
and availability. The entire process is
typically transparent to users- i.e. no
down time, no lost data.
RAID 1 (a.k.a.
– Mirroring): Another popular
redundancy method. Requires a minimum
of two hard drives that store exactly
the same data. If one drive fails the
array is broken but no data is lost.
RBRVS (Resource
Based Relative Value Scale):
This is a scale of "weights"
assigned to particular CPT codes that
takes account of the relative amount of
effort taken to perform a procedure based
on the cost of supplies, the risk or difficulty
and the time spent. For instance, brain
surgery will have more RVUs than a wart
removal. The RBRVS is controlled by HCFA.
Real Time: The
instantaneous sharing of data among a
user group. Common to a client/server
database configuration.
Referral:
Some insurance companies require that
on specific plans a referral must be obtained
for certain procedures or visits to specialists.
The referral is acquired by the primary
care physician (PCP) by contacting the
insurance company by phone or mail. This
is a request for the service. The referral
consists of an authorization code, a number
of visits allowed (if applicable) and
an expiration date.
Referring Provider:
The provider that referred the
patient to a specialist or for a specific
procedure.
Relational Database:
A database program that stores
data in a manner similar to Excel, with
the difference being the data elements
are related (linked) to each other.
Rendering/Performing
Provider: The provider actually
treating the patient.
Risk Pool: Sometimes
a group of practices will come together
for negotiating and contractual reasons
(e.g. an IPA). A certain percentage of
each amount reimbursed is withheld from
the practice and put into a risk pool.
This is used to cover unexpected expenses,
but if it is not used, then it will be
distributed back to the practices. The
distribution structure is often based
on productivity, profitability and other
factors that make it a reward for more
efficient operations.
ROS (Review of
Systems): A series of questions
related to the system(s) that the patient
is having complaints about (i.e. respiratory
for cold symptoms).
Rural Health Clinic
(RHC): A clinic that is contracted
by HCFA to provide services to underserved
populations. RHCs are reimbursed at a
slightly higher level than the normal
Medicare allowable. As is obvious, these
are usually clinics in outlying rural
areas where the government needs to encourage
practitioners to have clinics, although
some "rural" clinics are located
in poorer parts of cities. RHCs are given
a special status and when they bill particular
procedures with QB (rural) or QU (urban)
modifiers, they will get the higher rate.
RHCs usually have to submit claims on
a UB-92.
RVU (Relative
Value Unit): The weight within
the RBRVS assigned to a particular CPT.
The Total RVU for a CPT is made up of
the Work RVU (the amount of time and effort
it takes), the Practice Expense RVU (the
overhead cost of that time), and the Malpractice
RVU (the likelihood of complications),
SOAP Note:
Progress note format utilized by Medinformatix
that consists of Subjective, Objective,
Assessment and Plan sections.
Social History:
A description of a patient's
social habits and history including marital
status, alcohol and drug use and exercise
habits.
Subjective: Section
in a progress note where a patient's account
of their current problem is documented.
Consists of chief complaint, HPI and ROS.
Superbill: Also
known as an encounter form, route slip
or fee slip. This is a paper charge capture
tool used to document coding for a specific
patient visit. It is a printed form with
patient information at the top, and a
subset of the provider's/practice's most
commonly used ICD and/or CPT codes. The
form travels with the patient through
the clinic. Providers check off items
when they see the patient, and the form
then travels to the checkout desk or billing
office where the codes are entered into
the billing system.
Supervising Provider:
The physician that is supervising
patient care for a mid-level. In some
practices, the supervising provider signs
off on every chart after a mid-level sees
a patient, while in others he is simply
available to assist if necessary. Physicians
in some rural areas do not have to be
on-site and can supervise remotely.
SQL: Sequential
Query Language – The most common database
language in the world. There are several
varieties of SQL on the market. The most
popular is Microsoft SQL.
Sx: Abbreviation
for symptoms
System Administrator:
The user group with the highest
security level.
Till Reconciliation:
A report used to balance what has been
posted in the practice management software
against the actual monies and other forms
of payment in the till/cash register.
Trial Balance:
A detailed report of invoices for a patient.
UPIN: A
standard 6 digit alphanumeric identifier
assigned to providers. Can be used for
single provider or a group/facility.
URI:
Abbreviation for Upper Respiratory Infection
(Cold)
UTI: Abbreviation
for Urinary Tract Infection (Bladder infection)
VPN:
Virtual Private Network – A VPN “tunnel”
is a secure connection, typically firewall
to firewall that provides for remote access
to your data server.
Wave Scheduling:
Scheduling patients in "waves",
i.e. scheduling several patients at the
top of the hour (in the same time slot),
and several at the bottom of the hour.
Patients rarely arrive on time, and offices
often run behind. Having blocks of busy
and catch-up time can even this out. Modified
wave scheduling is a more recent trend
where the schedule is based around the
actual time spent with patients. Most
patient visits do not require the provider
to be in the room with the patient for
100% of the time. Wave scheduling allows
more efficient scheduling by allowing
for this. For example, a patient visiting
an ophthalmologist may spend 15 minutes
of a half hour visit waiting for their
eyes to dilate. The doctor is only present
for the last 15 minutes. Thus, another
patient could be scheduled for the first
15 minutes. Thus, modified wave scheduling
refers to creating a schedule that accounts
only for the providers' time spent with
patients. This is only efficient if there
is enough nursing staff to prepare several
patients simultaneously.
Wireless Network: Wireless technology
is a communication protocol using similar
technology to your wireless home telephone,
in contrast to cellular technology. A
typical wireless network in a medical
office will consist of wireless devices
for the clinical staff and will consist
of a range of 50 to 100 yards depending
on obstructions. At this point in time
wireless networks offer reduced connection
speeds as compared to wired PCs, frequently
less than half the speed. The standard
is known as 802.11a, 802.11b, and 802.11g.
802.11a is currently the state of the
art offering connection speeds of 802.11g
(54mps) and a unique frequency resulting
in less interference from other peripherals
(portable phones, etc.)
