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31 Cards in this Set
- Front
- Back
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What are 4 areas of concern in regards to Quality Assurance?
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Overuse, underuse, misuse, variations
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4 ways in which health care data might be used?
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Drug research, quality healthcare, planning pt care, tracking pts with same diagnosis
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4 reasons a person would be ineligible for disability benefits
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mental conditions, worker's comp, AIDS/HIV, war disability
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circumvent
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to manage to get around (finding loop holes)
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disparities
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fundamentally different; elements that are marked distinct in quality or character
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Erroneous
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containing or characterized by error or assumption
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validity
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accuracy
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reliability
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must be able to rely on the data presented
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claimant
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insured person
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waiting period
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from the beginning of disability to receiving the 1st payment of benefits
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exclusion
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provisions written into the insurance contract denying coverage or limiting the scope of coverage
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benefit period
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maximum amount of time that benefits will be paid for disability
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supplemental benefits
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increases monthly indemnity
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Accidental death benefits
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sight, lose a limb, or die, family beneficiaries will be paid
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Residual benefits
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partial benefits when the insured is not totally disabled
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HIPPA
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Health Insurance Portability and Accountability Act - confidentiality
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JCAHO
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Joint Commision of Accreditation of Healthcare Organizations - provides accreditation services
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NCHS
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National Center for Health Statistics - all health statistics
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QA
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Quality Assurance
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SSDI
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Social Security Disability Insurance Program - disabled before 22, or under 65
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VA
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Veterans Affairs Disability Program - service connected disability
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CSRS
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Civil Service Retirement System -for federal employees who have been employed for 5yrs who have become totally disabled while on the job
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FERS
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Federal Employees Retirement System - for employees with disabilities (not from work), combo of SSDI and Federal Disability
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SDI
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State Disability Insurance - for workers suffering a wage loss because of off the job illness or injury
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Who was W. Edward Deming?
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created the 14 points of Total Quality Management Concept
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what are the benefits based on for Armed Services Disability?
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years of service, base pay and severity of disability
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How many consecutive days of disability must a person go through before State Disability Insurance benefits kick in?
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7 calendar days
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How long can a person draw temporary disability benefits/ long-term disabililty benefits?
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Temp- less than 2 yrs
Long- until your 65 yrs old |
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Who owns the medical record?
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the physician
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What report must accompany all disability claims?
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medical report and supplemental medical report
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When submitting disabiltiy claims, what information must be included in a medical report accompanying the claim?
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Date disability, return to work date, description, treating physician, how it prevents working, medical history, symptoms, objective findings phys exam, severity, photocopies of tests, x-rays, discharge report, medications, treatment dates, diagnosis, prognosis
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