The Accredited Standards Committee X12 is a standards organization. Chartered by the American National Standards Institute (ANSI) in 1979, it develops and maintains the X12 Electronic data interchange (EDI) and Context Inspired Component Architecture (CICA) standards along with XML schemas which drive business processes globally. The membership of ASC X12 includes technologists and business process experts, encompassing health care, insurance, transportation, finance, government, supply chain and other industries.
Medical privacy or health privacy is the practice of maintaining the security and confidentiality of patient records. It involves both the conversational discretion of health care providers and the security of medical records. The terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility. Modern concerns include the degree of disclosure to insurance companies, employers, and other third parties. The advent of electronic medical records (EMR) and patient care management systems (PCMS) have raised new concerns about privacy, balanced with efforts to reduce duplication of services and medical errors.
Medical billing is a payment practice within the United States health system. The process involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. The same process is used for most insurance companies, whether they are private companies or government sponsored programs: Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly. Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS Exam, RHIA Exam, CPB Exam and others. Certification schools are intended to provide a theoretical grounding for students entering the medical billing field. Some community colleges in the United States offer certificates, or even associate degrees, in the field. Those seeking advancement may be cross-trained in medical coding or transcription or auditing, and may earn a bachelor's or graduate degree in medical information science and technology.
Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice including veterinarians. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports.
Supplier enablement is the process of electronically connecting suppliers to a company's supply chain. Supplier enablement is achieved when suppliers of goods and services are connected to a company's back-office systems to exchange critical business documents such as purchase orders, invoices and other information. Suppliers can be connected, or "enabled," using a variety of means including Electronic Data Interchange (EDI), Extensible Markup Language (XML), Web forms, RFID chips, or other e-commerce tools.
In banking, a lock box is a service offered by commercial banks to organizations that simplifies collection and processing of account receivables by having those organizations' customers' payments mailed directly to a location accessible by the bank.
Protected health information (PHI) under the US law is any information about health status, provision of health care, or payment for health care that is created or collected by a Covered Entity, and can be linked to a specific individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history.
WEDI, pronounced "wee dee", is a not-for-profit user group in the United States for users of Electronic Data Interchange (EDI) in public and private healthcare. The organization is sometimes referred to by other names that include some or all of the words: Workgroup for Electronic Data Interchange.
Patient portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers, such as physicians and hospitals. Typically, portal services are available on the Internet at all hours of the day and night. Some patient portal applications exist as stand-alone web sites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record (EMR) system. What all of these services share is the ability of patients to interact with their medical information via the Internet. Currently, the lines between an EMR, a personal health record, and a patient portal are blurring. For example, Intuit Health and Microsoft HealthVault describe themselves as personal health records (PHRs), but they can interface with EMRs and communicate through the Continuity of Care Record standard, displaying patient data on the Internet so it can be viewed through a patient portal.
Council for Affordable Quality Healthcare, Inc. is a non-profit organization incorporated in California as a mutual benefit corporation. It was first incorporated under the name Coalition for Affordable, Quality Healthcare, Inc., and then was renamed the Council for Affordable Quality Healthcare, Inc. on July 22, 1998. It is based in Washington, D.C.. Previously a 501(c)6 tax-exempt organization, CAQH changed its tax status in 2016, although it remains a non-profit. Its mission is to accelerate the transformation of business processes in healthcare through collaboration, innovation and a commitment to ensuring value across stakeholders, including healthcare providers, trade associations, and health plans.
The Virginia Workers' Compensation Commission (VWC) is an agency of the U.S. state of Virginia that oversees the resolution of workers' compensation claims brought in that state, in accordance with the Virginia Workers' Compensation Act. The Commission has exclusive jurisdiction to adjudicate such claims. Its decisions may be appealed to the Virginia Court of Appeals. The Commission is headed by three Commissioners and an Executive Director. The Commissioners are chosen by the Virginia General Assembly and serve staggered six-year terms. R. Ferrell Newman, Wesley G. Marshall, and Robert A. Rapaport currently serve as Commissioners. The Commissioners elect a Chairman for a term of three years. Mr. Newman is currently the Chairman and Evelyn McGill is the Executive Director. The Commission is headquartered in Richmond, Virginia, but has offices and hearing locations at various places around the state.
An explanation of benefits is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf.
The Healthcare Common Procedure Coding System is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).
The National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers. The NUBC was formed by the American Hospital Association (AHA) in 1975. All the major national provider and payer organizations participate in discussions and decisions on policy and guidelines.
The ANSI 834 EDI Enrollment Implementation Format is a standard file format in the United States for electronically exchanging health plan enrollment data between employers and health insurance carriers.
Revenue cycle management is the process used by healthcare systems in the United States to track the revenue from patients, from their initial appointment or encounter with the healthcare system to their final payment of balance. The cycle can be defined as, "all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." It is a cycle that describes and explains the life cycle of a patient through a typical healthcare encounter from admission (registration) to final payment.
Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic health records. The US Congress included a formula of both incentives and penalties for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the, American Recovery and Reinvestment Act of 2009.
UNIDOC is an XML-based standard to support electronic data interchange (EDI) in business transactions between trading companies. Unlike other XML-based EDI formats, such as ebXML, RosettaNet or openTRANS, UNIDOC relies one a single structure. The first idea of such a universal format was published in 2014, its first specification in 2016 in the journal of the Chamber of Commerce and Industry Swabia. The current specification can be found in the UNIDOC XML Schema Definition.
