Unit 2 Flashcards
Define compliance
To meet standards
What is the importance of accurate documentation?
Incorrect coding could occur
Why is noncompliance an important concern for health service coordinators?
It directly affects the patient
What are bundle payments?
When everything is included in the bill i.e. doctor, labs,x-rays etc.
What is the purpose of clinical reviews?
A review to examine for potential errors or gaps in medical care with the goal of preventing them from happening again
What is HEDIS?
Healthcare Effectiveness and Data Information Set
- measurements to enable consumers with information to make comparison of health plan performance
Explain Third Party Insurance Reimbursement
Compensation for services provided by a third party
What is co-insurance?
Percentage of a medical charge you pay, with the rest paid by your health insurance plan
What is co-payment?
Payment made by a beneficiary in addition to that made by an insurer
What is deductible?
The amount you pay before your insurance plan starts to pay.
What is capitation?
Set amount paid for each enrolled person
What is your understanding of InterQual?
It is an evidence-based clinical decision support solution
What is the focus on the Patient-Centered Medical Home model of care?
The patient
What are the basic components of the QI process?
- establish a culture of quality
- prioritize areas for improvement
- collect data
- communicate
- ongoing evaluation
- spread the success
Why is accreditation important?
Shows that an institution meets or exceeds standards
