CMS
Medicare patients receive this letter at least 2 days prior to an inpatient admission and up to 48 hours before a discharge order is placed
What is the Important Message of Medicare
What should be a patients admission time?
When care begins in the ED or on a unit
What status is utilized to evaluate if a possible inpatient admission is warranted?
Observation
AIDET Stands for:
Acknowledge, Introduce, Duration, Explain, Thank
Explain the RAACE procedure for a fire
R - Remove everyone from the immediate area
Alarm - Activate the alarm by pulling the nearest pull station
Alert - call out 'Code Red' to your co-workers and make sure someone calls the emergency number for your facility
Confine - Close all of the doors in the area affected
Extinguish - If safe initiate PASS from a safe distance and leave yourself a way to escape
Medicare patients receive this notification when they are placed in Observation status
What is the Medicare Outpatient Observation Notice (MOON)?
If we have a patient that is a Medicare recipient with an inpatient status, but the patient does not meet IP criteria, has not discharged, the attending is in agreement, and the Utilization Review committee/PA agrees, what condition code do we apply in order to convert to observation?
What is Condition Code 44?
What is the patient satisfaction metric utilized within the health care industry?
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
BPCI is an initiative that is linking payment reimbursement to quality outcomes and the shared responsibility of patient care. What does BPCI stand for?
Bundle Payments for Care Improvement
Explain how to use a fire extinguisher
P - Pull the pin
A - Aim at the base of the fire
S - Squeeze the handle
S - Sweep from side to side
An inpatient Medicare recipient has appealed their discharge to KEPRO. What is KEPRO?
What is Quality Improvement Organization (QIO)?
What list do we utilize in order to determine if we are eligible to receive Medicare Part A reimbursement for certain procedures?
What is the CMS Inpatient Only List?
What is the rule required for all diagnostic or outpatient services observed the day of and three days prior to an admission (with related DRG) to be bundled within the inpatient services for Medicare billing?
DRG 3 Day Window OR 72 Hour Rule
We do not use the terminology 'Preferred Provider List' because we want to ensure we are abiding by which act?
IMPACT Act
Where is the fire alarm pull in your area?
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A Medicare recipient has appealed their discharged to KEPRO and KEPRO has agreed with the Hospital. The patient must be delivered a letter. What's the letter called and what's the numbers following it?
What is Hospital Issued Notice of Non-Coverage (HINN) 12
Are inpatient discharges in the denominator or the numerator of the Observation equation?
Denominator
Outpatient, non-diagnostic services during the payment window, for Medicare patients, that are unrelated (and not on the day of admission), are reimbursed through what?
Medicare Part B (outpatient reimbursement)
Which law is in place in an effort to ensure all patients are provided emergent care in the EDs? Abbreviation and title.
Emergency Medical Treatment and Active Labor (EMTALA) law.
What do you do before you start CPR on a person
Assess scene safety
Check for responsiveness
Look for normal breathing
Call 9-1-1
A patient enters the hospital and is being treated for PNA with pneumonitis due to toxoplasmosis. The attending MD orders a PET scan due to patient request to determine if the patient has breast cancer. What letter should be ordered and delivered to the patient?
What is the Hospital Issued Notice of Non-Coverage (HINN) 11?
What is the relative value that is assigned to a diagnosis-related group (DRG) of patients in a medical environment? (HINT: We want this to be higher, which means we're being reimbursed more for managing more clinically dense patients)
Case Mix Index (CMI)
In healthcare, we assign a medical code that reports medical, surgical, and diagnostic services. We primarily focus on these when we are doing UR for the ortho unit...what are these called? Acronym and what does it stand for.
Current Procedural Terminology (CPT)
In order to participate in Medicare reimbursement a hospital must follow federal regulations, what are these called according to CMS?
While performing CPR - what is the ratio between compressions to breaths for all patients?
30/2