HOSPITAL 101 Flashcards
The overall hospital economics involve what?
Increased requirements for justification of stay
What are the components of requirements for justification of stay?
Appropriate placement, charting, billings, and referrals
Why is it so critical to meet all the components for the justification of stay? Describe a scenario.
If you don’t document the extra care, it won’t be covered!
Although two patients may have pneumonia, one has additional co-morbidities that will need to be cared for as well.
Based off of our documentation, it will properly place the patient in the appropriate ____.
Diagnosis-Related Group (DRG)
Disproportionate Share Hospital (DSH) and Indirect Medical Education (IME) are both examples of what?
DRG’s
Who are some individuals that can help with our documentation?
Coding specialists and documentation specialist (for comorbidities and relationships)
If you order a lab test what two things MUST you do in relation to documentation?
Document WHY you need the test
MUST document that you reviewed the test!
If a patient is going to stay for more than 48 hours, what type of admission?
In-patient
: If you expect a patient to be going home in less than 48 hours, what type of admission?
Observation
If a patient is only going to be staying one night, what type of admission?
Outpatient in a bed
If a hospice patient is brought into the hospital because they can’t be cared for at home with hospice or by a hospice care facility, what diagnosis?
General inpatient
If a patient gets discharged earlier than you expected, what must you do?
You have to document that you were surprised by their progression – otherwise we don’t get paid
Who is involved in the utilization review team?
RN’s or doctors (both employed by hospital and insurance company)
What are some factors that influence costs? (5)
Infrastructure, employees, supplies, equipment, and litigation
What are some factors that influence income? (5)
Insurance payments, Medicare, Medicaid, private payments, donations
