What is best practice for discharge planning initiation?
100
False Claims Act
What provides oversight of all payers to ensure that services are provided only when necessary and fines may be attached if found guilty of abusing this.
100
What is a DRIP?
What is data rich, information poor?
100
Payer based, Physician based, Unit/Service Line based
What are the models of Case Management?
200
What was an important healthcare initiative occurring in the 60s?
Medicare & Medicaid
200
Simple or Complex
What is a type of discharge stratification that uses resources more wisely in discharge planing?
200
The clock starts with the physician order and ends when clinical interventions, nursing care, etc. end.
What is meant by observation hours?
200
What is meant by aggregated?
What is data that shows the big picture called?
200
Hospital, insurance, home health, managed care organizations
What are the settings for case managers?
300
What is the value that tells us the acuity level of a hospital?
What is Case Mix?
300
Easily transitioned without delays and last minute changes.
The best environment for patient post acute
Decreases need for a readmission
What is meant by smooth, safe and sustained discharge?
300
A new ruling that provides inpatient status within certain parameters?
What is the two midnight rule?
300
It splits reimbursement upon transfering patient to a certain location post acute.
What is a transfer DRG?
300
Financial Management, Utilization Review, Care Coordination, Transition Management
What are components of Case Management?
400
Per Diem, Capitated, Fee for Service, Global,
What are 4 types of contracts for payers?
400
Lack of standard of processes, lack of patient engagement, ineffective clinical information provided, insufficient tools at the right grade level
What are the components of readmissions?
400
Avoidable Day
What is it called when late lab results delay discharge?
400
A target to signify acceptable range and or comparable ranges?
What is Benchmarking?
400
Duty, Breach of Duty, Causation, Damages
What is Negligence?
500
A component of payment determination for a DRG and is calculated based on the median.
What is GLOS and how is it calculated
500
A process required for all Medicare admissions by CoPs and reguired for all admissions by the Joint Commission.
What is Dishcarge Planning?
500
Physician Documentation and Clinical Review
What are two critical components to ensure medical necessity?
500
ALOS VERSUS GLOS
What is important for case managers to manage and is derived from two different statistical methods.
500
Utilization of Polices and Protocols, Guidelines, Critical Pathways to ensure standard of care is followed.
What are key features protecting against legal actions?