Laws & Regulations Flashcards
(10 cards)
I’m compliance with CIA, this review for 50 financial billing and claims per year, assess whether the claims meet program payment requirements, such as medically necessary, appropriate documentation, and coding accuracy
IRO (Independent review organization)
CIA stands for this
Corporate integrity agreement
This agreement promoted compliance with law and regulations
CIA
Compliance officer & committee, p&p’s, training & education, quality monitor, independent review organization, risk assessment& work plan, disclosure program and compliance hotline, process for identifying excluded indiv., overpayment p&p, & self reporting sanctions, are a part of this
Scope of cia
This quality monitor has been engaged to perform facility assessments via treatment team meetings and group sessions, facility your & medical records, patient care observation, and to provide UHS & oig written reports regarding CIA compliance
Ankura
QOC dashboard components (7)
Physical hold, chemical restraint, seclusion rate, turnover, leadership stability, rounding compliance, & high risk events
General documentation must reflect appropriation and professional standards (4)
1) progress & active treatment towards individualized goals & evidence of involvement 2) state criteria for holding involuntarily 3) seclusion and restraint documentation of necessity for safety 4) medical necessity for need, admission, and continued stay
Education on the federal false claims act, Stark and anti kick back supports preventing and detecting these 3 areas
Fraud, waste, and abuse
Medical necessity for admission and continuance, active and individualized care, physician participation and supervision, & proper use of restraints ,/ seclusion are apart of cia’s (blank)
Quality of care standards
Emergency evaluation and stabilization of pts regardless of ability to pay is the focus of this
Emtala
