Introduction To Radiologic Sciences And Patient Care Ch. 23

Front 1

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Back 1

You know

Front 2

Prospective Payment System (PPS)

Back 2

System for Medicare patients by which a predetermined level of reimbursement is established before the services are provided

Front 3

Diagnosis Related Groups (DRGs)

Back 3

System that categorizes into payment groups patients who are medically related with respect to diagnosis and treatment and statistically similar with regard to length of stay.

Front 4

Coding

Back 4

Involves converting diagnoses and procedures into a numeric classification system. The numbers are reported to Medicare and insurance companies.

Front 5

Health Records

Back 5

Must be designed so the physician can easily provide patient info and provide comprehensive recording of patient diagnoses and procedures at discharge
Must also be complete and readily accessible to anyone who has a right to info. and the need to use it
The record is used for patient care, hospital stats and research, and for activities such as quality management and risk and utilization management.

Front 6

Health Information Management Practitioners (i.e. registered health information technician (RHITs) and Registered Health Information Admins (RHIAs)

Back 6

Must communicate needed data to departments such as radiology. Radiology may also make requests them.

Front 7

Joint Commission on the Accreditation of Healthcare Organizations (formerly The Joint Commission) and the American Osteopathic Association via its "Healthcare Facilities Accreditation Program" (HFAP)

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Set standards for the maintenance and adequacy of health records. One of the responsibilities of the health info management practitioner is to keep abreast of the standards for info management

Front 8

Health Record Content per the Joint Commission

Back 8

Must contain sufficient info to identify: the patient, support the diagnoses, justify the treatment, document the course and results, and facilitate continuity of care.

Front 9

Inpatient Record Requirements

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Patient ID
Medical History of the patient, including chief complaint, present illness or injury, relevant family and social histories, and inventory by body system
Report of relevant physical exam findings
Diagnostic observations, including results of therapy
Reports of diagnostic and therapeutic procedures and tests as well as their needs
Evidence of appropriate informed consent (if no consent say why)
Conclusions at termination of hospitalization or evaluation of treatment, including any pertinent instructions for follow up care

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Informed Consent

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Joint Commission requires evidence of informed consent. Involves explanation of risks, procedure, and possible consequences to the patient.

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Authoritarianism of Treatment

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Signed at the time of admission.

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Incident Reports

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Must be completed after event, report shouldn't be part of patient record. Only a description of what went wrong. Report itself should describe equipment failure and what happened to patient b/c of failure

Front 13

Health Record in Radiology

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Before procedure is performed, a radiology order for service is completed. Includes patient demographic(name, bday, health record number, etc). Ordering physician.
Reason for exam must accompany order or else the exam will be delayed.

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Billing Requirments

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Required medical necessity before a procedure is performed. If medicare doesn't cover it then the patient must sign an Advanced Beneficiary Notice (ABN). The patient then is responsible for payment after denial from Medicare

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Requirements of Health Care Entries

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All records must be dated and authenticated and their authors identified.
Use of Pencil is Illegal
All entries made to the Patient health record are in ink
Person who makes error is responsible for correcting it. Dated and signed.
Not documented, not done.

Front 16

Prospective Payment System (PPS)

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Health record data serve as the basis for hospital reimbursement in the PPS using the DRG system in the inpatient setting and Ambulatory Patient Classifications (APC) in the outpatient setting.

Front 17

Diagnosis-Related Groups (DRGs)

Back 17

System that categorizes into payment groups patients who are medically related with respect to diagnosis and treatment and statistically similar with length of stay
A program called "Grouper" computes the patients DRG. The hospital hopes to receive this DRG amount as payment.
The numeric ICD-9-CM codes are the basis for the DRG to which the patients are classified

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International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM)

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Universal statistical classification system used throughout the United States and the world for coding and reporting diagnosis and procedures.

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Current Procedural Terminology, 4th edition (CPT-4)

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Comprehensive listing of medical terms and codes for the uniform designation of diagnostic and therapeutic procedures, used in the US for coding for physician reimbursement

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Coding Function

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ICD-9-CM classification is used for inpatient reporting.
For outpatients, hospitals must report the diagnosis using the ICD-9-CM codes and the CPT-4 codes for the procedures.
Physician offices use the ICD-9-CM for diagnosis and the CPT for procedures.
Radiology dept. may use the Index of Radiologic Diagnosis (IRD)

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Performance Improvements

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A process by which the quality of the care and services provided to patients within a health care facility are monitored and evaluated. The terms quality assurance, quality assessment, and performance improvement are all used to encompass activities related to performance improve.

Front 22

Performance Improvement Standards

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The joint comm. requires a written plan as a separate document, or it can be incorporated into other planning documents with in an organization
Items included are:
Statement of mission or vision
Objectives
Values
Leadership
Organizational structure
Methodologies
Performance Measures
Communication
Annual Plan Review

Front 23

Examples of data collected

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Patient waiting times, doing timely reporting reviews, and doing equipment quality control

Front 24

Dimensions of Performance

Back 24

Efficacy
Appropriateness
Availability
Timeliness
Effectiveness
Continuity
Safety
Efficiency
Respect and Caring