random 2 Flashcards
When is a balloon pump contraindicated
aortic valve insufficiency
What is integrative medicine
Brings conventional and complementary approaches together in a coordinated way
3 goals of technology in nursing
capture tasks performed, enhance scope of practice and EBP, make practice knowledge driven
4 nursing informatics roles
practice, education, government, industry
what is nursing informatics
manage and communicate data, information, and wisdom
Benchmarking
compares/measures services against other healthcare national organizations
four core principles of benchmarking
maintain quality, improve customer satisfaction, improve safety, continuous improvement
What is peer review? and why do you want to do it?
Formalized review required for magnet recognition
5 components of establishing rapport/professional therapeutic relationships
nonjudgement approach, mutual trust, professional boundaries, confidentiality, cultural competency
2 components of cultural competency
respect, spiritual needs
Advanced directive
patient’s intent regarding medical treatment
healthcare directive may include what?
living will or durable power of attorney
What is a living will, what can it include
written compilation of statements that specifies which life prolonging measures
what is a durable power of attorney; another name? when is it honored?
“proxy/agent/attorney-in-fact” usually significant other or someone else in charge of articulating advanced directive; must be in writing before it is honored
Title 1 of HIPAA
health insurance coverage when they change or lose jobs
title 2 of HIPAA; known as?
“administrative simplification provisions”; establishes national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
who enforces HIPAA
Office of civil rights
HIPAA security rule
national standards for security of electronic protected health information
Patient safety rule
confidentiality provisions which protect identifiable info being used to analyze patient safety events and improve patient safety
What are healthcare clearing houses
process nonstandard health information data received from another entity into a standard (like standard electronic formats)
What are covered entities that are required to follow HIPAA regulations
health plans, government programs that pay for healthcare (medicare, medicaid), most health care providers, health clearing houses
PSQIA
Confidential voluntary reporting system regarding patient safety issues
strongest method to evaluate teaching
return demonstration
le fort fracture of skull; 3
1: floating palate; 2: floating maxilla; 3: floating face
2 goals of healthy people 2030
increase quality and years of healthy life; eliminating health disparities
Common reporting statutes
criminal acts/injury; STDs (G/C/S); HIV; TB; animal bites; suspected child/elder abuse
key elements of palliative care
early identification, impeccable assessment, treatment of pain and other problems (psychosocial/spiritual)
Who sets standard for reimbursement and cutting costs
medicare
third party payers
medicare, medicaid, commercial indemnity insurers, commercial management organizations (hmos), business/schools wanting health services for employees/students
How much does medicare reimburse
80%
5 levels of physical exam documentation to determine levels of E/M services
problem focused, expanded problem focused, detailed, comprehensive
Medicare A - what services
INPATIENT; every gets at 65 years - hospitalization/inpatient, SNF, home health and/or hospice associated with inpatient event
Medicare B - what services and cost
OUTPATIENT; physician services, outpatient, labs/diagnostics, medical equipment, some home health; premium that is paid monthly
How much of physician reimbursement does the NP get for services provided in collaboration with physician
85%
How much does Medicare reimburse for physician services, how much does patient pay
80%; patient pays for 20%
Medicare C
A+B=C; can receive all healthcare services through provider organizations under part C (like hmos, PPOs)
Medicare D
limited prescription DRUG coverage; requires monthly premium and copay with each prescription
Medicare requirements for NPs (3)
state license, certification by national certifying body, MS degree
How much of the physician fee does an NP get reimbursed for procedures?
80% of the 85% physician fee schedule rate
incident to billing rate requirements
Services billed under physician provider number gets 100%; physician initiates plan, NP can continue, physician must be available in the suite; not allowed inpatient
Do NPs need physician order to bill for NP home visits under medicare A?
No, NPs can bill under their own NP provider number
When do NPs need a physician order to bill under NP provider number for home visits?
if NP is providing nursing services only
Medicaid benefits state to state
vary, and made after other insurance/third party payments have been made
QA/QI/Continuous process improvement (CPI)
Management process of monitoring, evaluating, continuous review, and improving the quality in providing health care
