Healthcare Data Basics
This type of data is typically used to identify patients and includes information like name, date of birth, and Social Security number.
PHI (Protected Health Information)
Medicare is primarily for individuals aged 65 and older, as well as those with certain disabilities or this condition.
End-stage renal disease (ESRD)
The coding system used to classify medical diagnoses and procedures for billing and reporting.
ICD (International Classification of Diseases)
This US regulation ensures the privacy and security of health information.
HIPAA (Health Insurance Portability and Accountability Act)
The process of obtaining approval for a healthcare service before it is provided.
Prior authorization
This healthcare data format standard is used to exchange electronic health records between systems.
HL7
Medicaid is jointly funded by these two levels of government.
Federal and state governments
This type of claim is submitted after the service is provided and billed.
Fee-for-service claim
The encryption standard commonly used to secure healthcare data in transit and at rest.
AES-256
The type of health plan that requires pre-approval for certain medical services.
Managed Care Plan
The term for a collection of data from multiple sources used for analytics and reporting in healthcare.
Data warehouse
This Medicare program offers managed care plans provided by private insurance companies.
Medicare Advantage (Part C)
The standardized coding system for services and procedures performed by healthcare providers.
CPT (Current Procedural Terminology)
Before sharing healthcare data externally, this process removes identifying information from records.
Data de-identification
The process by which individuals are added to a health plan.
Enrollment
This type of data represents healthcare services provided, including charges, payments, and utilization.
claims data
CMS, the organization that oversees Medicare and Medicaid, stands for this.
Centers for Medicare & Medicaid Services
A claim that requires additional review or information before processing is typically labeled this.
Suspended claim
The security measure that verifies users’ identities using two or more methods before granting access.
Multi-factor authentication (MFA)
The process of ensuring all healthcare data conforms to required formats and definitions before analysis.
Data normalization
Medicaid eligibility and benefits can vary by state because it is administered under this type of program structure.
State-administered program
The acronym for the standardized claim form used by healthcare providers for outpatient billing in the US.
CMS-1500 form
The principle of granting users access only to the data necessary for their roles.
Principe of least privileg