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40 Cards in this Set

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  • Back
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what term is used in reference to objective descriptions of processes, procedures, people and other observable objects and activities
DATA
provide vital clinical and administrative support services to patients, medical staff, visitors and employees
ANCILLARY SUPPORT SERVICES
ancillary function of the health record
BIOMEDICAL RESEARCH
used in reference to electronically accessed information the provides physicians with pertinent health information
CLINICAL PRACTICE GUIDELINES
systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances
CLINICAL PRACTICE GUIDELINES
To what authority do hospitals report vital statistics?
The National Vital Statistics System
An attempt to contain hospital inpatient costs and improve quality by restructuring services
PATIENT-FOCUSED CARE
Level of skilled care needed by patients with complex medical conditions, typically Medicare patients who have multiple medical problems
SUB-ACUTE CARE
Quality components
ACCESSIBILITY, APPROPRIATENESS, TECHNICAL EXCELLENCE AND ACCEPTABILITY
T or F: Turnaround times are examples of qualitative standards and error rates are examples of quantitative standards
FALSE
Specify the level of service quality expected from a function: Accuracy Rate and Error Rate
Qualitative Standard
Specify the level of measurable work or productivity expected for a specific function: Number of units of work for a specified period of time or turnaround time
quantitative
Mechanisms that record and examine activity in information systems
Audit Controls
Protects medical records and other individually identifiable health information from being used or disclosed in any form
Privacy Rule
Average Daily Census
Total service days for the unit for the period
_______________________________
Total number of days in the period
Percentage of Occupancy
Total service days for a period
___________________________X 100
Total bed count days in the period
Hospital Death Rate (GROSS)
Number of deaths of inpatients in period
__________________________x 100
Number of discharges (including deaths)
Gross Autopsy Rate
Total inpatient autopsies for a given period
___________________________X 100
Total inpatient deaths for the period
Net Autopsy Rate
Total inpatients for a given period
___________________________X 100
Total inpatient deaths minus unautopsied coroners’ or medical examiners’ cases
Hospital Autopsy Rate (adjusted)
Total hospital autopsies
___________________________X 100
Number of deaths of hospital patients whose bodies are available for hospital autopsy
Fetal Death Rate
Total number of intermediate and/or late fetal deaths for a period
_________________________X 100
Total number of live births + intermediate and late fetal deaths for the period
Neonatal Mortality Rate
Total number of newborn deaths for a period
_________________________X 100
Total number of newborn infant discharges (including deaths) for the period
Maternal Mortality Rate
Total number of direct maternal deaths for a period
___________________________X 100
Total number of obstetrical discharges (including deaths) for the period
Caesarean Section Rate
Total number of caesarian sections performed in a period
_________________________X 100
Total number of deliveries in the period (including caesarian sections)
groups that classify patients into clinically cohesive groups that demonstrate similar consumption of hospital resources and LOS patterns
DRG
based on the grouping of procedures by CPT/HCPCS codes that have similar costs or resource inputs
APC-Ambulatory Payment Classification
the exchange standard for laboratory results, enabling standards to be developed and adopted relatively quickly
LOINC- Logical Identifier Names and Codes
Diagnosis described as "possible", "probable", "likely" and "rule out" are reported as if present for which type of patient records
Inpatient
Infectious and Parasitic Diseases
001-039
The Federal physician self-referral statute is known as....
Stark Law
Responsible for ensuring the quality of health record documentation
provider
Codes assigned to a patient who is seeking health services but is not necessarily sick
v codes
Insufficient and missing documentation and __________ are two areas that the OIG says is responsible for 70 percent of bad claims
Failure to document medical necesity
If the nonPar physician chooses to accept assignment, he or she is paid ___ of the MFS.
95%
reimburses phyicians according to a fee schedule based on predetermined values assigned to specific services
RBRVS -Resource-Based Relative Value Scale
a number used to multiply each RVU so that it better reflect a geographical area's relative costs
GPCI
Geographic Pricing Cost Index
converts RVUs into payments
National Conversion Factor
method of grouping patients according to a predefined set of characteristics
Case mix
average DRG weight for the patients discharged from the hospital
case-mix index
a measure of the resources used in treating patients in each or group of hospitals
CMI ( case mix index)