Definitions of Commonly-Used Terms in Healthcare Delivery

Definition of Terms

HCS 533
July 18, 2011

Definition of Terms
The health information systems environment is complex and unique. To understand how it works, it is important to important to understand the basics first. A good starting point will be to understand and define important terms commonly used in health care delivery. In this paper, the following terms will be examined: AMR, CMR, CMS, CMS-1500, CPT, DRG, EPR, HL7, ICD-9, and UB-92.
AMR is the acronym for Automated Medical Record. It is a paper- based record with some computer generated documents. AMR, or Automated Medical Record, is defined as a collection of electronic health information about a patient. It is electronic access of a person’s information by authorized users. In simplest terms, instead of having all of a person 's medical record written down or kept in filing cabinets, the information is stored on a computer. The most important aspect of AMR is that a nurse does not have to go through filing cabinets; it is as simple as inputting a name into the computer, access the record, and print a copy for the physician. CMR is the acronym for computerized medical records. It is the digital version to patient medical records kept in paper files and folders in health care offices (Wisegeek, 2003). Paper medical records are scanned and put into electronic medical records. It is the same exact version as the paper chart. The most important aspect of a CMR is saving money and time for the facility. The facility can expand with using storage space for retaining medical records. It is safe and reliable. A person does not have to stand and look for the paper chart. It is as easy as using one’s computer mouse and clicking on the information in the computer.
CMS is the acronym for The Center for Medicare and Medicaid Service. It is part of the Health and Human Service program. It is part of the Federal government. The center provides Medicare, Medicaid, and related quality assurance programs. The most important aspect of the CMS is the center provides regulations for Medicare and Medicaid to the people of the United States and makes sure that the states are in compliance. It makes certain that its beneficiaries are aware of the services for which they are eligible, what services are accessible, and that the services are provided in an effective and safe way (Healthfinders.gov, 2011). CMS is also responsible for overseeing of HIPAA administrative functions, health identifiers, and security standards.
According to Department of Health & Human Services (2011), “CMS-1500 is the standard paper claim form used by health care professionals and suppliers to bill Medicare carriers and medical equipment Medicare administrative contractors” (para.1). It is the only form accepted by Medicare. All health care professionals or organizations are responsible to file the claim if payment is to be release. Patients cannot be charged to have this claim filed by the facility. Any claim must be done within one year of services. The most important aspect of the CMS-1500 form is that hospitals or health care professionals cannot claim whatever they wanted to. There are certain codes and regulations they must follow.
CPT is the acronym for Current Procedural Terminology. The American Medical Association (AMA) sets a medical code for physician and other services. A set of code is used to do this. It is the naming system used to list medical procedures and services performed by physicians (Open Clinical, 2010). Updates are done annually. The most important aspect of this is that it is the uniform language used by medical professional for claims and procedures. All professionals will use the same codes for their services and procedures, which makes it easier for everyone.
DRG is the acronym for diagnosis-related group. It is a way to classify patients by diagnosis, average length of hospital stay, and therapy received. At the end of the hospital stay, it is use to determine how much money the hospital will be given to cover future procedures and services delivered to the patient. The most important aspect of DRG is that it is primary used in an inpatient setting so that the case managers and social worker will know exactly what to expect and how much payment will be received for procedures done or will be done.
EPR is the acronym for electronic patient record. It is also known as electronic medical record (EMR). The electronic patient record is an electronic record of health information on a patient. EPR is created, gathered, and managed by authorized medical staff or clinicians within one health care organization. The most important aspect of the EPR is the record is ready on hand when it is needed. A staff member can pull it up to look at it while another staff member can use another computer or portal to look at the same record. It is designed for fast and accurate access to online records for clinicians. It saves time and health care can be deliver faster to the patient.
HL7 is the acronym for Health Level 7. According to Health Level 7 ( 2011), “HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients” (para. 1). The most important aspect of HL7 is that it is the standard healthcare communication. It is also a non- profit organization that is interested in developing health care standards internationally.
ICD-9 is the acronym for International Classification of Disease. The International Classification of Diseases, ninth revision, is developed by the World Health Organization to classify diseases. It is used in the United States to code diseases and procedure information (Wagner, Lee, & Glaser, 2009). The most important aspect of the ICD-9 is that it has become the major part in reimbursements for hospitals. All the codes are the same. It does not matter where it is used or how it is used, the codes are the same and it makes it easy to use. UB-92 is the acronym for Universal/Uniform Billing of 1992. UB-92 or Universal/Uniform Billing, form 92 is the form used by hospitals and health care centers when submitting bills to Medicare and third-party payers for reimbursement for health services provided to patients. The most important aspect of this form is that it is exactly what it says it is, universal. It is the same form for billing everywhere you go. All medical organizations use it to bill for reimbursement without having to guess or add to it. It is electronic and health care professionals are able to pull it up online and fill it out.
The United States health care system is so complex and to understand it, basic terminology is critical to master before a health care professional can go on to deliver care to patients. There are standards and regulations that are written with the above acronyms and understanding what those are and mean will help in providing the best care to patients.

REFERENCES
Department of Health & Human Services. (2011). Form CMS-1500-At a glance. Retrieved from http://cms.gov/MLNProducts/downloads/form_cms-1500_fact_sheet.pdf
Healthfinders.gov. (2011). Center for Medicare and Medicaid Services. Retrieved from http://www.healthfinder.gov/orgs/HR0033.htm
Health Level 7. (2011). Health level 7 and policy. Retrieved from http://www.hl-7.org/
Open Clinical. (2010). CPT: Current procedural terminology. Retrieved from http://www.openclinical.org/medTermCPT.html
Wager, K. A., Lee, F. W., & Glaser, J. P. (2009). Health care information systems: A practical approach for health care management. John Wiley & Sons, Inc.
Wisegeek. (2003). What are computerized medical records?. Retrieved from http://whealthfinders.gov.

References: Department of Health & Human Services. (2011). Form CMS-1500-At a glance. Retrieved from http://cms.gov/MLNProducts/downloads/form_cms-1500_fact_sheet.pdf Healthfinders.gov. (2011). Center for Medicare and Medicaid Services. Retrieved from http://www.healthfinder.gov/orgs/HR0033.htm Health Level 7. (2011). Health level 7 and policy. Retrieved from http://www.hl-7.org/ Open Clinical Wisegeek. (2003). What are computerized medical records?. Retrieved from http://whealthfinders.gov.