Concepts/Defintions Flashcards
CDI
Clinical Documentation Integrity/Improvement
What is the purpose of CDI?
Consists of the policies, procedures, technology, people, and effort that promotes legible, clear, consistent, complete, precise, non-conflicting and reliable provider documentation essential to the final assignment of accurate and clinically congruent HIPAA-associated transaction code sets.
Medical Necessity
No payment may be made under Part A or part B for expenses incurred for services or items which are not reasonable and necessary for the dx or tx of illness or injury or to improve the functioning of a malformed body member.
Why Query?
Questions asked to physicians to obtain additional clarifying documentation, to improve the specificity and completeness of the data, which is used to assign diagnosis and procedure codes.
MS-DRG
Medicare Severity - Dx Related Group; fixed payment based on principle dx adjusted for comorbid conditions.
VBP
Value Based Purchasing - its an CMS initiative that rewards acute care hospitals and physicians with incentive payments for the quality of care they provide to Medicare beneficiaries.
VBP encourages hospitals to improve overall what?
Quality and safety of acute inpatient care for Medicare bene.
What are the measurements VBP uses to gauge a score of the hospitals?
- Efficiency and cost reduction
- Safety
- Person and Community Engagement
- Clinical outcome
What is the quality metric calculation?
Risk adjusted metric = Observed Mortality Metric Rate/Expected Mortality Metric Rate
What is SOI?
It is directly correlated with a higher risk of complications (expected complication risk).
AHRQ
What is SIRS?
Systemic Inflammatory Response Syndrome
SIRS Criteria?
Temperature> 100.4 (>38.0C) or <96.8F (36C)
HR > 90 beats per minute
RR > 20 breaths per minute
WBC>12k or less than 4k or Bands >10%
Organ Dysfunction Variable?
SBP<90mmHg
MAP<65mmHg
Bilirubin >2.0mg/dL
Platelets<100k
INR>1.5 or aPTT >60s
Lactate >2mmol/L
Creatinine >2.0mg/dL
Urine Output <.5ml/kg/hr for more than 2 hours
What is Sepsis?
SIRS criteria met + any documented or suspected infection
What is severe sepsis?
sepsis criteria met + acute organ dysfunction
What is severe shock?
severe sepsis criteria met
+ 2 or more consecutive low blood pressure readings (SBP <90) within 1 hour of concluding fluid resuscitation (30ml/kg/hr) or Lactic acid >4mmol/L
ACUTE/ ACUTE ON CHRONIC Respiratory Failure Def
Acute respiratory failure is classified as hypoxemic (low arterial oxygen levels), hypercapnia (elevated levels of
carbon dioxide gas). Or a combination of the two. In most cases one or the other predominates.
Most patients with acute respiratory failure demonstrate either impaired oxygen exchange or impaired ventilation
of the lung alveoli.
Lab Values of Acute Respiratory Failure
-Arterial PCO2>50mmHg
-Arterial PO2 <60mmHg
-SpO2<91% on room air or PaO2/FiO2 ratio <300 or
Change in Arterial PO2 or PCO2>10 mmHg from baseline.
Rapid deep breathing (RR>20 per minute)
Paradoxical breathing, intercoastal retraction, cyanosis, anxiety
May use Venous Blood Gas (VBG) in lieu of ABG.
When was HIPAA started?
1996
What is HIPAA Security Rule?
It protects a subset of information covered by the privacy rule. This subset is all individually identifiable health information a covered entity creates, receives, maintains, or transmits in electronic form.
This information is called “electronic protected health information” (e-PHI)
The security rule does not apply to PHI transmitted orally or in writting.
HIPAA Privacy Rule
This rule is to ensure that individuals’ health information is properly protected while allowing the flow of information needed to provide and promote high-quality care and to protect the public’s health and well-being.
