Chapter One Flashcards
(42 cards)
American Medical Association (AMA)
formed in 1847 by Nathan Smith Davis to ensure quality medical education.
“to elevate the standard of medical education in the US.”
AMA’s purpose is to develop standards for medical education, to improve public health, to establish a set of medical ethics, and to advance the study of science
American Hospital Association (AHA)
founded near the end of the 19th century.
committed to improving medical care by advocating for the healthcare community, educating health care leaders, and tracking trending healthcare-related issues, specifically for hospitals and all other types of healthcare facilities.
Licensure
regulations regarding the minimum requirements to practice medicine or provide medical services: they vary from state to state
American College of Surgeons (ACS)
founded in 1913 in Chicago
purpose it was to improve the quality of patient care by setting high standards for surgical education and practice- it went on to establish a system of hospital standardization as well.
they believed written records were essential for quality patient care and that data collected from the records would lead to the information necessary to set and measure standards of care.
Accreditation
Voluntary assessment by an accrediting agency that proves a healthcare facility exceeds the minimum requirements set by licensing agencies
The Joint Commission (TCJ)
Formerly known as the Joint Commission on Accreditation of Hospitals, a voluntary accrediting agency holding deemed status by Medicare.
Healthcare Facilities Accreditation Program (HFAP)
A voluntary accreditation program used by the American Osteopathic Association, which, like the Joint Commission, holds deemed status for Medicare.
Hill-Burton Act
legislation that supplied funding for the modernization of existing hospitals and building of new ones, in exchange for which hospitals provided care at a reduced rate or for free to patients who did not have the ability to pay
Medicare
Title XVII of the Social Security Act of 1935: Medicare provides financial assistance for healthcare coverage to persons 65 years of age and over, to persons who are disabled and to those with end-stage renal disease.
Medicaid
Title XIX of the Social security Act of 1935: Medicaid provides financial assistance for healthcare coverage to poor and indigent populations
Conditions of Participation (CoP
Regulations that health-care facilities and providers must meet in order to receive reimbursement from Medicare and Medicaid
Fee for Service
Billing for healthcare services after the services have been provided (retrospectively) according to the facility’s or office’s actual fees for each service
Quality Improvement Organizations (QIOs)
Entities with which CMS contracts to review medical care, base on health record documentation and to assist Medicare and Medicaid beneficiaries with complaints about quality of care issues and to implement improvements in the quality of care available throughout healthcare facilities.
Centers for Medicare and Medicaid Services (CMS)
Formerly known as the Health Care Financing Administration (HCFA),CMS manages Medicare and Medicaid claims and regulates Medicare and Medicaid programs.
Tax Equity and Fiscal Responsibility Act of 1982
Legislation that resulted in a shift from fee-for-service reimbursement to a prospective payment system
Prospective Payment System (PPS)
A fixed reimbursement system based on the diagnosis related group (DRG) assigned to each inpatient stay”used by Medicare and Medicaid reimbursement and some third-party payers
Diagnosis related group (DRG)
A system that classifies patients into groups based on a patient’s principal and secondary diagnoses, procedures performed and other factors and determines the amount reimbursed to the hospital by Medicare, Medicaid and other third-party payers
Omnibus Budget Reconciliation Act of 1986
The act that focused on substandard care and resulted in the requirement that PROs report substandard care to licensing agencies
Informed Consent
Patient consent required for invasive surgical procedures and any treatment or procedure that carries a risk to the patient, informed consent provides explanation of the procedure/treatment to be performed and the reason for it, in other words, the risk and benefits of the procedure/treatment, alternatives, to the procedure/treatment and their risks and benefits, and the name(s) of the healthcare providers(s) performing the procedure/treatment.
Patients Rights
Patients have the right to know who their healthcare team consists of, the right to privacy and confidentiality, the right to be informed about their diagnosis and treatment, the right to refuse treatment, the right to actively participate in their care plan, and the right to be cared for in a safe environment, free from abuse. Patients also have the right to read or have a copy (paper or electronic)of their health record, the right to know who has accessed their health record, and the right to request and amendment to their health record
Health Insurance Portability and Accountability Act (HIPPA)
a law consisting of five rules-privacy, security, data sets and electronic transaction standards, administrative simplification and enforcement and compliance: it impacted healthcare in general and the health information profession in particular more than any place of legislation since Medicare and Medicaid
Primary care physician (PCP)
A family practitioner, and internist, or a pediatrician who manages a patient’s basic healthcare needs and coordinates care with specialist under a managed care insurance plan
Managed care insurance plans
insurance plans that promote quality, cost-effective healthcare through the monitoring of patients, preventive care and performance measures.
Medicare Prescription Drug Improvement and Modernization Act of 2003
this act provides Medicare beneficiaries with financial assistance in paying for prescription medications
