Term
| do facilities have to be licensed or accredit? if so by whom? |
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Definition
| mandatory licensure by the State and Federal government. the facility is in accreditation is voluntary accreditation agencies (TJC-etc.) |
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Term
| DEFINE CMS AND EXPLAIN WHO THEY ARE |
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Definition
| CENTERS FOR MEDICARE AND MEDICAIDE SERVICES. A FEDERAL AGENCY RESPONSIBLE FOR SETTING UP THE TERMS OF MEDICARE PART OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. A DIVISION OF HHS THAT ADMINISTERS MEDICARE AND MEDICAID SERVICES. |
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Term
| DEFINE COP AND EXPLAIN WHAT IT IS |
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Definition
| CONDITIONS OF PARTICIPATION: STANDARDS PUBLISHED BY CMS THAT ESTABLISH THE MINIMUM THAT ORGANIZATION MUST MEET TO BE ELIGIBLE TO RECEIVE REIMBURSEMENT FOR PROVIDING CARE TO MEDICARE BENEFICIARIES. TO PARTICIPATE IN THE MEDICARE PROGRAM, HEALTHCARE PROVIDERS MUST COMPLY WITH THE FEDERAL REGULATIONS KNOWN AS COP |
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Term
| 8 BASIC PARTS TO TJC SURVEY |
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Definition
| OPENING CONFERENCE, DOCUMENT REVIEW, INTERVIEWS WITH HOSPITIAL LEADERS, VISITS TO PATIENT CARE SETTINGS, FUNCTION INTERVIEWS, OTHER ASSESSMENT ACTIVITIES, FEEDBACK SESSION, SUMMATION CONFERENCE, *FINAL DETERMINATION |
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Term
| EXAMPLES OF INTERNAL USAGE OF DATA |
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Definition
INTERNAL: USED IN THE FACILITY
RESEARCH, REIMBURSEMENT, PERFORMANCE IMPROVEMENT/ QUALITY IMPROVEMENT, GRANT ACCREDITATION |
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Term
| EXAMPLES OF EXTERNAL USAGE OF DATA |
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Definition
| EXTERNAL: MEDIA RELATIONS, FEDERAL EPIDEMIOLOGY STUDIES, INSURANCE SEVERITY OF ILLNESS ANALYSES, LEGAL PROCEEDINGS |
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Term
| THE OFFICIAL DAILY PUBLICATION FOR RULES,PROPOSED RULES AND NOTICES OF FEDERAL AGENCIES AND ORGANIZATIONS, AS WELL AS EXCUTIVE ORDERS AND OTHER PRESIDENTAL DOCUMENTS.(CONTAINS PHYSICIAN FEE SCHEDULE AND GPI) |
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Definition
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Term
| CODE OF FEDERAL REGULATIONS IS THE CODIFICATION OF WHAT? |
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Definition
| THE GENERAL AND PERMANENT RULES PUBLISHED IN THE FEDERAL REGISTER BY THE EXECUTIVE DEPARTMENTS AND AGENCIES OF THE FEDERAL GOVERNMENT. |
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Term
| OREGON ADMINISTRATIVE RULES (OARs) |
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Definition
| PUBLIC RECORDS OF THE STATE OF OREGON |
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Term
| OREGON REVISED STATUES ARE THE STATUTORY LAWS ENACTED BY |
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Definition
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Term
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Definition
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Term
| WHAT IS THE MAIN FUNCTION OF TJC |
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Definition
| IMPROVING SAFETY AND QUALITY OF CARE BY PROVIDING STANDARDS, SURVEYS EVALUTIONS, SENTINEL EVENT ALERTS, AND PROFESSIONAL CONSULTING SERVICES. |
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Term
| NAME DIFFERENT TYPES OF FACILITIES ACCREDITED BY TJC. (BESIDES HOSPITAL--NAME TWO) |
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Definition
| LONG TERM CARE FACILITIES, HOSPICE, PATHOLOGY AND CLINICAL LABS, PHARMACIES, AMBULATORY CARE NETWORKS, EMERGENCY TRAUMA CENTER |
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Term
| TJC SURVEY TEAM CONSISTS OF HOW MANY PEOPLE |
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Definition
| 2-6 TEAM MEMBERS DEPENDING ON FACILITIES SIZE |
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Term
| WHO MUST BE MEMBERS OF THE TJC TEAM |
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Definition
| ONE PHYSICIAN, NURSE AND OR HOSPITAL ADMINISTRATOR, ADDITIONAL MEMBER ( SUCH AS MEDICAL TECHNICIAN) |
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Term
| OSHA AND OCR MONITOR SAFETY AND HEALTHCARE OF FEDERAL FACILITIES NAME TWO MORE |
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Definition
| FDA, CMS AND CDC. FOOD AND DRUG ADMINISTRATION, CENTERS FOR MEDICARE AND MEDICAIDE SERVICES AND CENTERS FOR DISEASE CONTROL AND PREVENTION |
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Term
| WHEN IS AN ORGANIZATION PUT ON ACCREDITATION WATCH |
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Definition
| WHEN AN EVENT HAS OCCURRED AND A THOROUGH AND CREDIBLE ROOT CAUSE ANALYSIS OF THE EVENT AND AN ACTION PLAN HAVE NOT BEEN COMPLETED WITHIN SPECIFIED TIME FRAME |
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Term
| DEFINE THE "DO NOT USE LIST" AND DOES IT APPLY TO EVERY HEALTHCARE FACILITY |
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Definition
| ABBREVIATIONS, ACRONYMS, SYMBOLS AND DOSE DESIGNATIONS, THAT ARE NOT TO BE USED DUE TO MISINTERPRETATION AND MISUSE. IT APPLIES TO EVERY HEALTH CARE FACILITY |
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Term
| DEFINE ROOT CAUSE ANALYSIS |
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Definition
| A PROCESS FOR IDENTIFYING THE BASIC OR CAUSE FACTORS THAT UNDERLIE VARIATION IN PERFORMANCE, INCLUDING THE OCCURENCE OR POSSIBLE OCCURENCE OF A SENTINEL EVENT |
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Term
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Definition
| AN UNEXPECTED OCCURENCE INVOLVING DEATH OR SERIOUS PHYSICIAL PSYCHOLOGICAL INJURY, OR THE RISK THEREOF |
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Term
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Definition
| A VOLUNTARY PROCESS BY WHICH A PRIVATE NON-GOVERNMENTAL ANGENCY PERFORMS AN EXTERNAL REVIEW AND GRANTS RECOGNITION THAT AN ORGANIZATION MEETS CERTAIN PREDETERMINED STANDARDS |
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Term
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Definition
| A REVIEW OF THE PATIENT RECORD THAT ASSESSES HOW WELL A STANDARD IS BEING MET. TYPICALLY REQUIRES TRAINING AND JUDGEMENT ON THE PART OF THE ASSESSOR, FREQUENTLY USED TO ASSESS DOCUMENTATION STANDARDS. |
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Term
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Definition
| A REVIEW OF THE PATIENT RECORD TO ASSESS WHETHER AN ITEM OR REQUIRED DOCUMENTATION IS PRESENT OR ABSENT. THIS ANALYSIS MAY ALSO APPLY TIME REQUIREMENT TO THE EXPECTATION OR REQUIRED DOCUMENTATION. |
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Term
| DEFINE ONGOING RECORD REVIEW |
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Definition
| A CONTINUOUS HEALTH RECORD QUALITY REVIEW PROCESS. |
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Term
| TJC TIMELINE FOR COMPLETED MEDICAL RECORD IS HOW MANY DAYS AFTER DISCHARGE |
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Definition
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Term
| If you receive deemed status from CMS is the state allowed to do unannounced surveys at your facility? |
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Definition
| CMS may grant the accrediting organization "deeming" authority and "deem" each accredited health care organization as meeting the Medicare and Medicaid certification requirements. The healthcare organization would have "deemed status" and would not be subject to the Medicare survey and certification process. |
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Term
| A DOCTORS PRIVILEGES CAN BE SUSPENDED BY WHAT |
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Definition
| NON COMPLIANCE WITH MEDICAL STAFF BYLAWS, AND RULES AND REGULATIONS, FAILURE TO FOLLOW POLICIES AND PROCEDURES, MISCONDUCT, CARE BELOW STANDARDS, VIOLATION OF PROFESSIONAL ETHICS, IMPROPER USE OF FACILITY RESOURCES |
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Term
| DEFINE CLINICAL PRIVILEGES |
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Definition
| PERMISSION GRANTED BY THE APPROPRIATE AUTHORITY TO PRACTITIONER TO PROVIDE WELL-DEFINED PATIENT CARE SERVICES IN THE GRANTING INSTITUTION ON THE BASIS OF LICENSURE, EDUCATION, TRAINING EXPERIENCE, COMPETENCE, HEALTH STATUS, AND JUDGMENT. |
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Term
| HOW DO YOU GET CLINICAL PRIVILEGES |
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Definition
| PHYSICIANS HAVE TO APPLY FOR CLINICAL PRIVILEGES. AFTER VERIFICATION OF THE PHYSICIAN'S CREDENTIALS THEY CAN BE GRANTED CLINICAL PRIVILEGES BY A FACILITY. |
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Term
| WHAT ARE CLINICAL PRIVILEGES LIMTED TO? |
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Definition
| Individuals who do not meet the threshold criteria in a particular specialty may still qualify for certain limited clinical privileges in that particular specialty by providing evidence that they possess training and experience to perform the procedures requested. |
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Term
| IS HIT ALWAYS REQUIRED TO BE THE COORDINATOR OF MEDICAL STAFF? |
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Definition
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Term
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Definition
| The process of granting or renewing certain privileges to practice medicine to a prospectiveor existing of a medical staff at a facility |
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Term
| CAN YOU ACESS THE NPDB (National practitioner databse) |
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Definition
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Term
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Definition
| RECOVERY AUDIT CONTRACTORS |
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Term
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Definition
UNDER CONTRACT VIA CONTINGENCY TO CMS: REVIEW ALL CLAIMS SUBMITTED TO MEDICARE IN ORDER TO IDENTIFY IMPROPER PART A AND PART B PAYMENTS.
The Medicare Recovery Audit Contractor (RAC) program was established to identify improper Medicare payments and recoupment of both overpayments and underpayments. |
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Term
| TWO MAIN PURPOSES OF THE RAC |
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Definition
| IDENTIFY AND RECOVER IMPROPER MEDICARE PAYMENTS. OVERPAYMENTS/UNDERPAYMENTS |
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Term
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Definition
| MEDICARE ADMINISTRATIVE CONTRACTORS |
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Term
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Definition
| CREATED TO HAVE A SINGLE CLAIMS PROCESSING INTERFACE TO MORE ACCURATELY PROCESS PART A AND B CLAIMS AND TO INCREASE THE ACCURACY OF CLAIMS PAYMENTS AND CONSISTENCY IN PAYMENT DECISIONS. (WANT TO HELP YOU GET IT RIGHT THE FIRST TIME) |
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Term
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Definition
| MEDICAID INTEGRITY CONTRACTORS |
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Term
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Definition
| DEFICIT REDUCTION ACT OF 2005, REQIURES CMS TO ENTER INTO CONTRACTS TO PERFORM, 4 KEY PROGRAMS ACTIVITIES ON PAYMENT INTEGRITY AND QUALITY CARE, REVIEW PROVIDER ACTIONS, AUDIT CLAIMS, IDENTIFY OVERPAYMENTS, EDUCATE |
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Term
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Definition
| ZONE PROGRAM INTEGRITY CONTRACTORS |
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Term
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Definition
| MAIN GOAL--IDENTIFY FRAUD AND ABUSE, REPLACING THE PROGRAM SAFEGUARD CONTRACTORS-PROMOTING INTEGRITY OF CMS. ZONE BASED-A,B,C,D.. ARE LOOKINF MORE AT "HOT SPOTS" |
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Term
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Definition
| CALIFORNIA, FLORIDA, ILLINOIS, NEW YORK, TEXAS....OTHER TWO ZONES CONSIST OF STATES WITH LESS INCIDENCE OF FRAUD |
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Term
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Definition
| ACCREDITATION ASSOCIATION FOR AMBULATORY HEALTH |
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Term
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Definition
| AMERICAN OSTEOPATHIC ASSOCIATION |
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Term
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Definition
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Term
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Definition
| COMMISSION ON ACCREDITATION FOR HEALTH INFORMATICS AND INFORMATION MANAGEMENT |
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Term
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Definition
| COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES |
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Term
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Definition
| COMMUNITY HEALTH ACCREDITATION PROGRAM |
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Term
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Definition
| NATIONAL COMMITTEE FOR QUALITY ASSURANCE |
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Term
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Definition
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Term
| PRIVELEGES AND SUSPENSIONS: |
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Definition
| SUSPENSION PROCESS: INCOMPLETE MEDICAL RECORDS,20-30 DAYS OUT A WRITTEN WARNING IS SENT TO THE PHYSICIAN TO ADDRESS THE COMPLETION OF DEFICIENT RECORDS AFTER 30 DAYS PHYSICIAN IS SUSPENDED |
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Term
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Definition
| IF SUSPENDED THE PRIVELEGES ARE REVOKED CAN NOT SEE PATIENTS, WILL LOSE PRIVELEGES FOR ADMITTING PATIENTS,SURGICALLY TREATED PATIENTS AND CONSULTING WITH PATIENTS,PHYSICAN WILL BE FINED.ALL PRIVELEGES ARE DENIED UNTIL MEDICAL RECORDS ARE COMPLETED AND FINE PAID. |
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