Principles of Documentation:
Survey Process:
Complaints:
IJ:
NLTC:
100
This statement includes references to sources of information e.g. interview, observation, record review.
What is the deficient practice statement?
100
It is important to include the Hospice’s list of contracts on this form.
What CMS form 417?
100
In the case of this type of ASC complaint survey, the RO identifies and authorizes the conditions that will be surveyed for compliance in advance of the onsite investigation.
What is deemed?
100
A complaint was received alleging the hospice never sends a nurse when family calls for pain management because they do not have enough staff, nurses, counselor or a doctor to provide services. In order to consider immediate jeopardy, these components must be present.
What are harm (actual or potential), immediacy and culpability?
100
This type of provider may provide no more than 25 inpatient beds.
What is a CAH?
200
The answers to these key questions are used in information gathering and provide relevant facts during an investigation.
What are who, what, when, where and how questions?
200
You arrived at the facility and find no one onsite. However, you called and discovered that they are on the way. During the entrance, you learn that the facility has had no clients for the past 6-12 months and the provider wishes to relinquish their Medicare number. The provider gives you this to validate the interview.
What is a voluntary termination letter?
200
This form should be completed and submitted to the supervisor prior to conducting the complaint investigation. The form should include an outline of the survey agenda such as which COP will be reviewed, documents, interviews and visits if any.
What is form CMS 801
200
The exit date for an ASC recertification survey where an IJ was identified was Thursday April 13, 2017. The SOM requires that the completed survey is uploaded and the RO is notified by this date.
What is Monday April 17, 2017?
200
You completed record reviews for this survey type and find that the facility violated one or more of the antidumping provisions and may be subject to termination of its provider agreement and/or the imposition of civil monetary penalties (CMPs).
What is EMTALA survey?
300
This style of writing used in deficiency citation is clear, objective, and easily understood.
What is plain language?
300
The objective of this survey task is to determine the hospital’s compliance with the Medicare CoP through observations, interviews, home visit, and document review.
What is Task 3 Information Gathering?
300
Complaints with this priority must be investigated within 45 days.
What is a Non IJ High complaint?
300
Harm or potential harm is likely to occur in the very near future to this individual or others in the entity, if immediate action is not taken.
What is immediacy?
300
During an ASC recertification, the surveyor has just observed the completion of an endoscopic procedure. In terms of the endoscopy reprocessing steps, according to the Infection Control Worksheet Section 3A, Reprocessing of Semi Critical equipment, this step should take place at the point of use.
What is Pre-cleaning?
400
You determined that an IJ exists. These two dates must be the same in the Initial Comments tag on the 2567.
What are the date for IJ determination and date of IJ announcement?
400
The purpose of the ASC on-site revisit survey is to determine the ASC’s current compliance with these, which were previously cited for noncompliance.
What are CfC requirements (or conditions out)?
400
This type of survey requires authorization by CMS for review of a condition(s) when a complainant alleges violation.
What is a complaint validation survey for deemed providers?
400
When a provider is aware of a deficient practice that has the potential or causes harm, but allows the deficient practice to continue, the provider is considered this.
What is culpable (culpability)?
400
After a patient dies while on Hospice Service the Hospice provides emotional, psychosocial and spiritual support for a 12 month period under this requirement.
What is bereavement counseling.
500
This is located at 42 CFR 416 Subpart C for ASCs, and must be met in order to participate in the Medicare and Medicaid programs.
What are Conditions for Coverage (CfCs)?
500
The objective of this task is to analyze information about the provider in order to identify areas of potential concern to be investigated during the survey and to determine if those areas, or any special features of the provider (e.g. provider-based clinics, specialty units, services offered, etc.) require the addition of any specialty surveyors to the team.
What is Task 1- Off-Site Survey Preparation?
500
This tag is cited when the surveyor observes a PCT fail to wear gowns or masks while cleaning dialysis stations and an isolation room during an ESRD complaint investigation. During the interview, the PCT states that he never wears either one and no one at the facility has ever corrected him.
What is V-110 for Infection Control?
500
DAILY DOUBLE
What is cite the Immediate Jeopardy at the Condition level?
500
During this type of survey, the surveyor determines the Agency’s compliance with standards under the following HH COPs: 484.10 Patients’ Rights, 484.12 Compliance with Federal/State Local Laws, Disclosure of Ownership Information and Accepted Professional Standards, 484.14 Organization Services and Administration, 484.18 Acceptance of Patients, POC and Medical Supervision, 484.30 Skilled Nursing Services, 484.32 Therapy Services, 484.36 Home Health Aide, 484.48 Clinical Records and 484.55 Comprehensive Assessment.
What is a standard survey.
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