17 terms you will hear on a Healthcare — Provider project, each with what it means, where it shows up in the business, and what QA should test.
EHR · MRN · Encounter · HL7 v2 · FHIR · ICD-10 · CPT · LOINC · LIS and PACS · Charge capture · RCM · 837 and 835 · Denial rate · Days in A/R · ABHA · PHI · Break-glass access
The patient's clinical record in a hospital or clinic: problems, medications, allergies, notes, orders and results.
Where it shows up: Every clinical step, from registration to discharge.
What QA should test: Role-based access, audit trails, allergy and drug-interaction alerts, and data shown in the right patient's chart.
The hospital's unique identifier for a patient. Every order, result, image and bill hangs off it.
Where it shows up: Created at registration, used everywhere after.
What QA should test: Duplicate patient checks, merges of two MRNs for the same person, and results never attaching to the wrong MRN.
One episode of care: an OPD visit, an admission, an emergency visit or a tele-consult.
Where it shows up: Opened at check-in or admission, closed at discharge.
What QA should test: Encounter types, transfers between wards, and charges and orders tied to the right encounter.
The pipe-delimited message standard most hospital systems use to talk to each other, for example ADT for patient movements and ORU for results.
Where it shows up: Between the HIS/EHR and the lab, radiology, pharmacy and billing systems.
What QA should test: Segment and field mapping, mandatory fields, acknowledgements, and messages arriving out of order.
The modern HL7 standard that exchanges data as web resources (Patient, Encounter, Observation) through REST APIs.
Where it shows up: Patient apps, health exchanges and national health stacks.
What QA should test: Resource validation against profiles, API security and consent, and paging through large result sets.
The coding system for diagnoses. The US uses its own extension, ICD-10-CM.
Where it shows up: Clinical documentation and medical coding, then on every claim.
What QA should test: Valid and billable codes, code-to-procedure consistency, and version updates.
The US code set for procedures and services, maintained by the American Medical Association.
Where it shows up: Coding and charge capture, then on the professional claim.
What QA should test: Charge master mapping, modifiers, and units on the claim.
Universal codes for lab tests and clinical observations, so a haemoglobin result means the same everywhere.
Where it shows up: Lab orders and results exchanged between systems.
What QA should test: Test-to-LOINC mapping, units and reference ranges carried with the result.
LIS runs the lab, from sample to result. PACS stores and shows medical images, using the DICOM standard.
Where it shows up: Diagnostics, ordered from the EHR and resulted back to it.
What QA should test: Order and result round trips, critical-value alerts, and images linked to the correct study and patient.
Recording every billable service, supply and drug against the encounter so it reaches the bill.
Where it shows up: During care, at the department level.
What QA should test: Missed charges, duplicate charges, and charges after discharge.
Everything from registration and insurance checks to coding, billing, collections and denials: how a provider gets paid.
Where it shows up: Front office to back office.
What QA should test: End-to-end flow from encounter to payment posting, and reports that reconcile.
US X12 transactions. The provider sends the claim as an 837; the payer replies with payment and adjustment details as an 835 (the remittance).
Where it shows up: Billing to the payer, then payment posting back at the provider.
What QA should test: Claim scrubbing before submission, and 835 posting that matches each line and adjustment code.
The share of claims a payer refuses or reduces. A key revenue cycle KPI.
Where it shows up: Billing and denial management.
What QA should test: Denial reason capture, work queues for appeals, and reports that match the 835s.
How many days, on average, it takes the provider to collect what it is owed.
Where it shows up: Finance and RCM dashboards.
What QA should test: The formula and its inputs, and aging buckets in reports.
India's 14-digit health ID under the Ayushman Bharat Digital Mission, used to link a person's records across providers with consent.
Where it shows up: Registration and record sharing in Indian hospitals.
What QA should test: ABHA creation and verification flows, consent handling, and linking records to the right ID.
Any health data that can identify a person. In the US it is protected by HIPAA; in India by the DPDP Act and health data rules.
Where it shows up: Everywhere patient data is stored, shown, logged or shared.
What QA should test: Masking in non-production environments, access by role, and PHI never leaking into logs, emails or URLs.
An emergency override that lets a clinician open a record they would not normally see, with the reason recorded and reviewed.
Where it shows up: Emergencies and restricted records (VIPs, staff, sensitive cases).
What QA should test: That the override is logged, the reason is mandatory and the access is reported for review.
The Healthcare — Provider track walks through the whole business end to end, and Session 01 is free in English and Telugu.
