Non-Clinical Operations
28%of exam
Clinical Operations
32%of exam
Revenue Cycle/Finance
15%of exam
Regulatory Compliance
15%of exam
Reporting
10%of exam
Quick Facts
- Exam owner
- National Healthcareer Association
- Exam time
- 125 minutes
- Total items
- 125
- Scored items
- 100
- Unscored pretest items
- 25
- Passing score
- 390 scaled; maximum 500
- Current exam launched
- June 17, 2020
- Renewal
- 2 years; 10 CE credits; fee
Search, Match, Then Enter
Search first, match twice, enter once.
Search existing chartsVerify two identifiersConfirm encounter
Duplicate vs Overlay
Duplicate
- One patient, multiple records
- Fragmented history
Overlay
- Multiple patients, mixed data
- Wrong-person documentation
Confirm identity before any correction
Chart Match Picker
- Returning patient→Search MPI before creating chart(Verify two approved identifiers)
- Possible duplicate charts→Route for authorized reconciliation(Do not merge by guesswork)
- Mixed patient data→Escalate suspected overlay(Stop entering data)
- External document arrives→Match patient and encounter(Verify source before indexing)
- Portal account access problem→Verify identity before account help(Follow portal policy)
Patient Identity
- Medical record number (MRN)
- Patient identifier within assigning system
- Master patient index (MPI)
- Demographic index for patient matching
- Encounter identifier
- Identifies one visit
- Two identifiers
- Example: name and birth date
- Duplicate record
- Multiple charts for one patient
- Overlay
- Different patients’ data mixed
- Face sheet
- Encounter demographics and coverage
Front Desk Flow
- Scheduling template
- Provider slots by visit type
- Registration
- Verify demographics and coverage
- Check-in
- Confirm arrival and identifiers
- Check-out
- Arrange follow-up and instructions
- Guarantor
- Party responsible for account payment
- Provider directory
- Locate specialty and contact details
- Patient portal
- Secure access to health information
Imports and Support
- Internal data
- Provider or financial database
- External data
- Outside lab or facility records
- Scanned document
- Verify chart, type, legibility
- Interface import
- Validate patient, fields, source
- Hardware inventory
- Track devices and locations
- Training log
- Record attendance and skills covered
- Software update
- Share changes and workflow impacts
- Unresolved device issue
- Escalate with approved diagnostic details
SOAP Recall
Patient says; exam shows; clinician assesses; plan follows.
S: subjective reportO: objective findingsA: assessmentP: plan
CPOE vs Decision Support
CPOE
- Captures electronic orders
- Routes orders to receiving systems
Clinical decision support
- Presents warnings and reminders
- Informs clinician decisions
Order entry vs decision guidance
Clinical Workflow Picker
- Record current blood pressure→Use structured vitals field(Confirm units and encounter)
- Conflicting clinical entries→Ask responsible clinician to clarify(Preserve original documentation)
- Clinician needs electronic order entry→Support CPOE workflow(Stay within authorized scope)
- Order triggers allergy alert→Route to ordering clinician(Do not bypass alert yourself)
- Send records to known provider→Use approved directed exchange(Verify recipient and authority)
- Need records from connected sources→Use authorized query-based exchange(Confirm patient match)
- Abnormal result without follow-up→Follow escalation protocol(Notify responsible clinical staff)
Charting Formats
- Subjective
- Patient-reported symptoms and historySOAP
- Objective
- Vitals, exam findings, resultsSOAP
- Assessment
- Clinician interpretation or diagnosisSOAP
- Plan
- Treatment and follow-up actionsSOAP
- POMR
- Records organized by patient problem
- SOAPIER
- SOAP plus implementation, evaluation, reassessment
- Clinical template
- Prompts for required encounter fields
- Structured field
- Searchable, reportable data value
- Historical data
- Prior surgeries, medications, immunizations
- Signed note correction
- Keep original; date and attribute
Orders and Results
- CPOE
- Computerized provider order entry
- CDS
- Clinical decision support
- Allergy alert
- Flags potential order conflict
- Medication reconciliation
- Compare lists and resolve discrepancies
- Electronic prescribing
- Transmit prescription to pharmacy
- Order status
- Tracks order progress
- Results routing
- Send to responsible care team
- Results follow-up
- Track review and needed action
Health Data Exchange
- Interoperability
- Systems exchange and use data
- HIE
- Health information exchange
- Directed exchange
- Send to known recipient
- Query-based exchange
- Request records from connected sources
- Consumer-mediated exchange
- Patients control their information sharing
- FHIR
- HL7 standard for data exchange
- Secure transmission
- Verify destination; use approved channel
- Patient education
- Select approved materials within scope
Medical Word Parts
- Tachy-
- Fast
- Brady-
- Slow
- Hyper-
- Above normal or excessive
- Hypo-
- Below normal or deficient
- Cardi-
- Heart
- -itis
- Inflammation
Claim Out, Advice In
837 sends claims; 835 explains payer decisions.
837 claim835 remittanceEFT moves funds
Billing Transaction Picker
- Check current insurance benefits→Use 270 and 271(Verify service date)
- Payer requires service review→Follow prior authorization workflow(Track decision and reference)
- Send encounter charges as claim→Submit 837(Check documented codes)
- Check submitted claim status→Use 276 and 277(Status is not payment)
- Post payer adjustments→Review 835 remittance(Match claim and amounts)
- Reconcile actual payer deposit→Match EFT to remittance(Use payment trace information)
Coverage and Coding
- Eligibility
- Check plan and benefits
- Prior authorization
- Payer review before specified services
- Cost estimate
- Projected patient cost before care
- Superbill
- Encounter charge capture form
- ICD-10-CM
- Diagnosis codes
- CPT
- Procedure and service codes
- HCPCS Level II
- Supplies, drugs, services beyond CPT
- Code linkage
- Diagnosis supports billed service
EOB vs Remittance
EOB
- Patient-facing benefit explanation
- Shows plan-calculated patient responsibility
Remittance advice
- Provider-facing adjudication details
- Supports posting and adjustments
Read recipient and purpose
Claims and Payments
- EDI
- Electronic data interchange
- X12 270 and 271
- Eligibility inquiry and response
- X12 276 and 277
- Claim status inquiry and response
- X12 278
- Health care services review
- X12 837
- Electronic claim submission
- X12 835
- Electronic remittance advice
- EOB
- Payer’s benefit explanation for patient
- EFT
- Electronic funds transfer
- Patient statement
- Provider’s bill for patient balance
Protect PHI by Purpose
Privacy governs sharing; security protects electronic records.
Check disclosure basisScope staff accessReview audit activity
Privacy Rule vs Security Rule
Privacy Rule
- Governs PHI uses and disclosures
- Applies across PHI formats
Security Rule
- Protects electronic PHI
- Administrative, physical, technical safeguards
Identify the action and medium
Privacy and Security Picker
- Patient asks for own records→Route as access request(Verify identity)
- Third party requests chart→Verify permitted disclosure basis(Obtain authorization when required)
- Billing needs clinical details→Apply minimum necessary(Limit applicable PHI)
- Staff member changes roles→Review and update permissions(Remove unneeded access)
- Unexpected chart access→Escalate and review audit trail(Preserve activity records)
- EHR becomes unavailable→Activate approved downtime workflow(Reconcile entries after restoration)
HIPAA and Release
- Protected health information (PHI)
- Identifiable health information under HIPAA
- Privacy Rule
- Governs PHI use and disclosure
- Security Rule
- Safeguards electronic PHI
- HITECH Act
- Strengthened HIPAA; added breach notification
- TPO
- Treatment, payment, health care operations
- Minimum necessary
- Limit PHI where rule applies
- Disclosure to provider for treatment
- Minimum necessary does not apply
- Access request
- Verify requester; route for fulfillment
- Authorization
- Permission for specified PHI disclosure
- Safe Harbor
- Remove listed identifiers; no known reidentification
- Expert Determination
- Document very small reidentification risk
Audit Trail vs Access Control
Audit trail
- Shows past system activity
- Supports incident investigation
Access control
- Restricts permitted system actions
- Can grant permissions by role
Trace activity; restrict access
EHR Safeguards
- Administrative safeguard
- Workforce training and risk analysis
- Physical safeguard
- Control workstation and facility access
- Technical safeguard
- Authentication and audit controls
- Role-based access
- Grant access by job duties
- Audit trail
- Records who did what, when
- Business associate agreement
- Requires business associate PHI safeguards
- Suspected exposure
- Report through incident procedure
- Downtime plan
- Use fallback; reconcile after restoration
- Abbreviation policy
- Spell out unsafe abbreviations
Report Before Release
Count the right cases, then check the total.
Set datesDefine counting unitVerify against source
Standard vs Ad Hoc
Standard report
- Preset fields and layout
- Repeatable reporting
Ad hoc report
- Custom filters and fields
- Answers a specific question
Recurring template vs custom query
Report Picker
- Need monthly open balances→Run standard aging report
- Need custom diagnosis cohort→Build ad hoc clinical report(Define codes, dates, counting unit)
- Need quality performance rate→Follow measure calculation specifications(Check exclusions and denominator)
- Report count unexpectedly doubles→Check joins and duplicate rows(Compare patient and encounter counts)
- External quality submission due→Verify program format and period(Reconcile totals before release)
Report Types
- Standard financial report
- Recurring balances or collections
- Aging report
- Balances by time outstanding
- Standard clinical report
- Recurring patient or care metrics
- Ad hoc clinical report
- Custom cohort and fields
- Quality improvement report
- Tracks performance over time
- External submission
- Use program specifications and format
- QPP
- CMS Quality Payment Program
Report Validation
- Reporting period
- Confirm dates before running
- Cohort
- Patients or encounters meeting criteria
- Counting unit
- Patient, encounter, or episode
- Numerator
- Cases meeting performance criteria
- Denominator
- Eligible cases per measure definition
- Exclusions
- Remove cases as specifications direct
- Proportion performance rate
- Adjusted numerator ÷ adjusted denominator
- Source reconciliation
- Check totals against source records
- Missing field
- Distinguish blank from true zero
Common Traps
Identity
Room number ≠ Patient identifier
Chart integrity
Same patient in two charts ≠ Two patients’ data mixed
Charting
Template defaults ≠ Verified patient findings
Orders
Order submitted ≠ Result reviewed
Billing
Payer authorization ≠ Guaranteed payment
Payment
EOB ≠ Patient bill
Privacy
Removing names only ≠ HIPAA de-identification
Security
Shared login ≠ Traceable individual access
Reporting
Number of visits ≠ Number of distinct patients
Last Minute
- 1.Verify identifiers before charting
- 2.Escalate overlays without merging records
- 3.SOAP: subjective, objective, assessment, plan
- 4.CPOE enters orders; CDS advises
- 5.ICD-10-CM diagnoses; CPT services
- 6.Eligibility and authorization differ
- 7.837 sends claims; 835 explains adjudication
- 8.Privacy governs PHI; Security safeguards ePHI
- 9.Provider treatment disclosures: minimum-necessary exception
- 10.Audit trails show access history
- 11.Reconcile entries after EHR downtime
- 12.Validate report dates, counts, exclusions
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