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Flashcards in Government Deck (27)
1

Diagnosis related groups

system to classify hospital cases in one of 467 groups based on the services/products they offer

Allows Medicare to determine how much each service/product will be reimbursed based on grouping

2

Critical pathway contains

a blueprint for planning and managing care delivered by all disciplines

IE: structure after cardiac surgery such as vital signs, labs,, and diagnostic tests

3

Medicare Part A covers

Inpatient services
Skilled Nursing facilities
Hospice
LTAC
Inpatient rehab
Home health care
obesity-bariatric surgery

4

Medicare Part B covers

NP can reimburse under this as long as it is "physician like" cares and not "nursing like" cares

outpatient hospital care
physician visits
home care
lab services
radiology services

5

Managed Care Networks

contractually agree to provide services for certain patient groups

6

"Incident to" billing

NP was a ble to perform services ordinarily performed by physician

Cannot be used with new patients
Must be in a defined office/suite
Cannot be used in inpatient setting

7

NPs can be reimbursed nationally by

CHAMPUS

8

Preferred Provider Organizations (PPO)

type of managed care system

partnership between group of preferred physicians and insurance companies to provide specific medical and hospital care at prearranged costs

9

National Practitioner Data Bank

Compiles information on medical-legal actions taken against healthcare professionals

Includes malpractice settlements and adverse actions that influence clinical privileges/licensure

Hospitals are required to quirky the NPDB

10

Confidentiality and privacy

privacy breach is using patients name or identifiers without permission

Confidentiality is priority over privacy
Confidentiality protects sharing of information

11

ACNP practice models

Service based
Practice based
Population based

12

Service based practice model

clinical management by group

IE: medical/surgical team; surgical oncology/neurology

13

Practice based practice model

clinical management by setting/unit

14

Population based practice model

management of specific disease

IE: diabetes

15

Goals of Healthy People 2020

1. long lives of preventable diseases
2. Achieve healthy equity, eliminate disparity
3. Create social/physical environment to promote health
4. promote quality of life, healthy development

16

Medicaid

federally supported/funded
State based and administered
Medicaid pays last

17

Patient Self Determination Act of 1990

right to execute advanced directive
Must provide patient rights at admission
Ask if patient has advanced directives
Prohibits institution to require advanced directive

18

Prescription authority and death certificate is regulated by

state

19

ANA essential roles of ACNPs

RECCC

researcher
educator
clinician
collaborator
consultant

20

Advanced directives are

are guidelines and not typically legally binding

Must seek attorney

21

Patient components of Informed consent

Capacity to make decision
Comprehension of information
Can ask questions

22

Occurrence based insurance

covers injuries that occur during period policy was active regardless if it was renewed

best coverage, most expensive

23

Claims-made insurance

covers the clinician only if the injury occurs within the policy period and if claim is filled during policy period

Typically want tail cover for this

24

Tail coverage insurance

policy that covers period of expiration claims made to end of statute of limitations (2 years)

Expensive but safe after leaving job

25

Malpractice must include

duty to patient (your patient)
violated standard of care
Caused damages

26

Medicare Part C

offered by private companies

provide PPO or HMO serives

27

Medicare Part D

Drug prescription coverage

Must have part A and B to have part D

Premium is charged