Concurrent reviews Study guides, Class notes & Summaries

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...

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...

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...

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...

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...

CDIP Toolkit Question and answers already pass 2023/2024recent 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 he

Risk Adjustment Data Element - Age, Gende, Socioeconomic status, Disability status, Insurance status(Medicaid, dual-eligible,) Claims data elements such as procedure codes, place of service codes, special patient-specific conditions hospice, ESRD RAF - Risk Adjustment Factor Scores Three main types of reviews - Retrospective, Concurrent and prospective Retrospective - reviews are performed after the information has been reported and in risk adjustment these are prior years dos Concurre...