Concurrent reviews - Study guides, Class notes & Summaries

What are the roles of physician advisor? - Regulatory oversight, cost containment, Medicare audits and denials, commercial insurance denials, length of stay management, clinical documentation improvement, and ICD-10 implementation. Done with concurrent reviews, daily MDR rounds, patient quality and safety initiatives, compliance, coding, CDI and physician education. PSROs- Professional standards review organizations - Created to review the quality, quantity, and cost of hospital care provided...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 ACA - ANSWER-Affordable Care Act HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...

CDIP Toolkit (Clinical Documentation Improvement Toolkit AHIMA) with Complete Solutions CDIP Toolkit (Clinical Documentation Improvement Toolkit AHIMA) with Complete Solutions CDIP Toolkit (Clinical Documentation Improvement Toolkit AHIMA) with Complete Solutions recent drivers of CDI (p2) - ANSWER-- MS-DRGs 2007 to reflect SOI/ROM - POA indicators 2008 - Medicare Advantage/Part C (capitated, HCC) - some payers moving to APR DRGs - compliance reviews: RAC, Zone Program Integri...

Chapter 04: Community-Based Nursing Practice Potter: Essentials for Nursing Practice, 8th Edition MULTIPLE CHOICE 1. A student nurse is beginning the community-based primary care rotation. The student nurse anticipates that the assignment in community-based health care will most likely be at which organization? a. An acute care hospital b. A rehabilitation hospital c. A nursing home d. A high school ANS: D High schools focus on primary rather than acute care and provide kno...

Psychiatric Mental Health Nursing 8th edition by Shelia Videbeck||ISBN NO-10 2,ISBN NO-13 978-8|| All Chapter Covered 1-24 | Complete Guide A+. Psychiatric Mental Health Nursing 8th edition by Shelia Videbeck Test Bank , All Chapter Covered 1-24 | Complete Guide A+: UNIT 1 Current Theories and Practice • 1. Foundations of Psychiatric–Mental Health Nursing • 2. Neurobiologic Theories and Psychopharmacology • 3. Psychosocial Theories and Therapy • 4. Treatment Settings and Therapeutic Pr...

Evidence-based medicine (EBM) is - Answer-the integration of the best research evidence with clinical expertise and patient values There are two main categories of research: - Answer-basic research and applied research 4 Sources of Evidence-Based Medicine - Answer-- clinical expertise - research evidence - information from the practice context - client's values and circumstances How to determine the strength of the evidence: - Answer-First, classify the type of information as primary or...

CDIP Toolkit Study Quiz 2024. recent drivers of CDI (p2) - correct answer - MS-DRGs 2007 to reflect SOI/ROM - POA indicators 2008 - Medicare Advantage/Part C (capitated, HCC) - some payers moving to APR DRGs - compliance reviews: RAC, Zone Program Integrity Contractors, Medicaid Integ Contractors purpose of CDI program (p2) - correct answer to initiate concurrent and, as appropriate, retrospective reviews of health records for conflicting, incomplete, or nonspecific provider documentati...

A method of documenting nurses' progress notes by recording only abnormal or unusual findings or deviations from the prescribed plan of care is called: a. Problem-oriented progress notes b. Charting by exception c. Consultative notations d. Open charting - B A 65-year-old white male was admitted to the hospital on 1/15 complaining of abdominal pain. The attending physician requested an upper GI series and laboratory evaluation of CBC and UA. The x-ray revealed possible cholelithiasis, an...

TEST BANK CLINICAL NURSING SKILLS AND TECHNIQUES, 10TH EDITION BY ANNE GRIFFIN PERRYChapter 01: Using Evidence in Nursing Practice Perry et al.: Clinical Nursing Skills & Techniques, 10th Edition MULTIPLE CHOICE 1. Evidence-based practice is a problem-solving approach to making decisions about patient care that is grounded in: a. the latest information found in textbooks. b. systematically conducted research studies. c. tradition in clinical practice. d. quality improvement and risk-mana...

Separation of Power - ANSWER What prevents Congress and the President from unilaterally making laws and treaties? Article 1, Section 8 of the Constitution - ANSWER What give Congress the authority to make laws? Supreme Court - ANSWER Who reviews the constitution for interpretation of the constitution? Congress (Legislative Branch) - ANSWER Who has the power to raise taxes given in Article 1 of the Constitution? Senate (6 yrs); House (2 yrs) - ANSWER What does the Congress of the US c...