ANSWERS SURE A+
✔✔Medicare Reconciliation - ✔✔Verifying med list at point of care transition to identify
what has been added, changed
✔✔nonmalificence - ✔✔acting in a way that does not inflict evil or cause harm. Not
causing avoidable or intentional harm.
✔✔Observation - ✔✔Outpatient services to help MD decide if pt needs to be admitted
or discharged. May be in ED or other parts of hospital.
Medicare allows observation for up to 48 hours
✔✔Office of the Inspector General (OIG) - ✔✔investigates abuse, fraud, waste, and
mismanagement within a government organization. Also assists residents with locating
proper agencies to address concerns and assists executive branch with identifying and
correcting operational deficiencies.
✔✔Outpatient Status - ✔✔ED, Observation, outpatient surgery, labs, X-Rays, or other
hospital services and MD has not admitted to inpatient. Considered outpatient even if
spends the night - for extended recovery time.
✔✔Patient Protection and Affordable Care Act - ✔✔"Obamacare" Decreases number of
uninsured and reducing overall costs of healthcare. Provides incentives to employers
, and unfunded to increase insurance coverage. Requires insurance to cover all
applicants and same rate regardless of preexisting conditions, age,gender.
✔✔Patient Safety Indicators - ✔✔a set of indicators providing information on potential in
hospital complications and adverse events following surgeries, procedures, and
childbirth.
✔✔Patient Self-Determination Act (PSDA) - ✔✔A federal law that mandates that every
individual has the right to make decisions regarding medical care, including the right to
execute advanced directives
✔✔pay for performance - ✔✔a strategy using financial incentives to reward providers
for achieving quality or cost measures. Includes Value Based purchasing (5 Domains),
readmissions, and hospital acquired conditions.
Hospitals that fall below the national average for readmissions are subject to penalties
Hospitals that perform in bottom quartile nationally for hospital acquired conditions are
subject to penalties.
✔✔performance improvement plan - ✔✔Plan that establishes a systematic approach to
achieving quality measures in performance, process,analysis, or service
✔✔physician advisor - ✔✔An MD who performs secondary UM reviews and address
care with care providers and hospital leadership
✔✔Potentially avoidable days - ✔✔Avoidable Days capture potentially preventable
occurrences or events during hospital stay that can cause longer LOS or delay in
discharge
✔✔Power of Attorney (POA) - ✔✔Written auth to represent or act on a person's behalf.
Durable POA means document stays in effect if you become incapacitated. Ordinary or
nondurable POA end if a pt loses capacity. Healthcare POA for medical treatment. In
effect when person is not able to make decisions.
✔✔Pre admission screening and resident review (PASRR) - ✔✔Completed when
person is being considered for SNF or are already residents with change in condition.
✔✔Project Boost Risk Assessment - ✔✔Risk assessment developed by Society of
Hospital Medicine
✔✔Quality Improvement Organization (QIO) - ✔✔A group of experts that improve the
care delivered to people with Medicare