What are the components of a health care database?
Comprehensiveness: Data Elements as a Critical Dimension of Health Care Databases. Demographic data consist of facts such as age (or date of birth), gender, race and ethnic origin, marital status, address of residence, names of and other information about immediate family members, and emergency information.
What information is included in the Medicare health information survey?
The survey includes demographic and behavioral data, health status and functioning, insurance coverage, financial resources, family support, source of payment, use of Medicare and non-Medicare services, and access and satisfaction. Information from the survey can be linked to Medicare claims and other administrative data.
What data is used to measure hospital quality?
Many hospital quality measures are created using hospital administrative discharge data. These data sets provide information on: Patient demographics. Diagnoses. Procedures. Admission source. Discharge status. Length of stay. Charges.
Who maintains a health data Database?
Such databases may be maintained by a variety of entities, including: the Department of Insurance (North Carolina), a freestanding health data commission (Iowa and Pennsylvania), a rate-setting commission (Massachusetts), or the Department of Health (Minnesota, New Jersey) (NAHDO, 1993).
How to contact Medicare for help?
Call us at 1-800-MEDICARE (1-800-633-4227). Help from Medicare is available 24 hours a day, 7 days a week, except some federal holidays. TTY users can call 1-877-486-2048.
What is extra help?
Get Extra Help - If you meet certain income and resource limits, you may qualify for Extra Help. This program helps pay for your Medicare drug coverage, such as plan premiums, deductibles, and costs when you fill your prescriptions, called copays or coinsurance.
Why is it important to have computer based patient records?
The committee acknowledges the importance of computer-based patient records with uniform standards for connectivity, terminology, and data sharing if the creation and maintenance of pooled health databases is to be efficient and their information accurate and complete. The committee urges HDOs to anticipate the development of CPRs and to contribute to the development and adoption of these standards. HDOs should take a proactive stance, by joining efforts by the CPR Institute and other organizations working to facilitate implementation of CPRs, helping in standards-setting efforts, and otherwise becoming full participants in the multidisciplinary effort that is now under way.
What is a database?
As commonly used and meant in this report, a database (or, sometimes, data bank, data set, or data file) is ''a large collection of data in a computer, organized so that it can be expanded, updated, and retrieved rapidly for various uses" (Webster's New World Dictionary, 2nd ed.).
Why use HDO information?
Payers are likely to use HDO information in strategic planning for more than just the health insurance portion of their business. For instance, some health insurers may be part of conglomerates that offer life, disability, workers' compensation, and other forms of insurance. In theory, HDOs might provide information on individuals, or groups in a geographic area, that would be of considerable interest to those managing other activities of an insurance company. Such data might be helpful in devising nonhealth insurance packages that are attractive (or not attractive, as the case may be) to certain individuals or populations in those locales.
How can HDOs improve quality of care?
HDOs can also contribute to improvements in quality of care by making information available to institutions and groups of practitioners for their use in quality assurance and quality improvement (QA/QI) programs and for regional health planning.
How to curb health care expenditures?
Curbing health care expenditures includes placing global limits on spending and linking fees to changes in the volume of services. For such efforts to be effective and equitable, however, those directing them will have to understand better the geographic variations in services and the reasons for these variations (Welch et al., 1993). Equally significant will be documenting the true economic costs of delivering health care as a means of understanding patterns of health expenditures and, secondarily, the efficiency of different plans and systems of care. To the extent that HDOs acquire reliable and valid information on services rendered and on charges and payments for those services (however questionable the actual relationship between billed charges and true costs), they will be in a position to clarify cost and expenditure issues.
Why is access to health care important?
Understanding the economic, geographic, and transportation barriers to health services, variations in, and access to health services is essential in the evaluation of the effects of ongoing or changing health care delivery systems. Several recent studies have examined the relationship between insurance, socioeconomic status, and race, on the one hand, and access to and use of health services, on the other (Bravemen et al., 1989; Burstin et al., 1992; Patrick et al., 1992; Adler et al., 1993); racial and gender differences in disease incidence and survival have also been examined (Ayanian and Epstein, 1991; Hannan et al., 1991b; Ayanian, 1993; Becker et al., 1993; Whittle et al., 1993). At the level of regions of the country, unmet health needs may be especially significant for minorities or other groups such as pregnant women or poor children; users of HDO information may need to pay special attention to such groups.
What is secondary database?
Secondary databases facilitate reuse of data that have been gathered for another purpose (e.g., patient care, billing, or research) but that, in new applications, may generate new knowledge.
What is MEDPAR data?
MEDPAR data sets constitute primarily an older section of the population, which tends to consume health care services more often than the population as a whole. Learn more at: Medicare Provider Analysis and Review (MEDPAR) File: ...
What is HCUP database?
HCUP is a family of health care databases and tools sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases, which contain data elements from inpatient and outpatient discharge records, bring together the data collection efforts of State data organizations, hospital associations, private data organizations, ...
What is a care provider?
care provider or practice that contracts with insurance companies to provide care to their subscribers at a reduced rate
What is consolidated clinical data?
consolidated clinical data that includes specific, demographic, or patient identifying information in the printout
What chapter is Medical Office Simulation?
Start studying Medical office Simulation chapter 9. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Who administers Medicare?
Medicare is administered by the federal agency.
What is Medicare coverage?
Medicare coverage plans offered by private insurance companies to Medicare beneficiaries. A temporary limit on what a Medicare drug plan will cover. A list of covered drugs kept by each Medicare drug plan. A document by Medicare explaining the decision made on a claim for services that were paid.
What is the fee that Medicare decides a medical service is worth?
The fee that Medicare decides a medical service is worth, is referred to as the: c. approved amount. Physicians who are nonparticipating with the Medicare program are only allowed to bill the limiting charge to patient, which is: d. 115% of the Medicare fee schedule allowed amount.
How many times must a Medicare patient be billed for a copayment?
c. NPI. According to regulations, a Medicare patient must be billed for a copayment: c. at least three times before a balance is adjusted off as uncollectible. All patients who have a Medicare health insurance card have Part A hospital and Part B medical coverage.
How long does Medicare Part A last?
It also ends if a patient has been in a nursing facility but has not received skilled nursing care there for 60 consecutive days.
What is national coverage determination?
National Coverage Determinations are coverage guidelines that are mandated: a. at the federal level. A decision by a Medicare administrative contractor (MAC) whether to cover (pay) a particular medical service on a contractor-wide basis in accordance with whether it is reasonable and necessary is known as a/an: a.
What age do you have to be to get Medicare?
An individual becomes eligible for Medicare Part A and B at age. 65. Supplemental Security Income (SSI) The program of income support for low-income, aged, blind, and disabled persons established by the Social Security Act. Illegal Immigrants. An individual who is not a citizen of the United States.