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Health Policy III
AACN Board Review
| Question | Answer |
|---|---|
| What are in goals of Healthy People 2020 | 1. Increase the quality and years of healthy life 2. Eliminate health disparities among Americans |
| True or False: NPs required to report criminal acts and injury from a dangerous weapon? | True |
| In most states the NP must report the following Dx | Gonorrhea HIV Chlamydia TB Syphilis |
| Where does the NP report animal bites | animal control |
| You suspect child abuse are you required to report it? | Yes via police or social services |
| The NP suspects that elder abuse is occurring. Should he or she report it? | yes via police or social services |
| Are NPs required to report domestic violence | In most states NO |
| Role of Home Health | Check on patient a few times a week |
| Hospice Care | Death/dying Dx. COMFORT MEASURES ONLY |
| Skilled nursing facility | essentially a nursing home. a means of cost containment |
| Private duty nursing | 24hr nursing care extremely expensive |
| Who sets the standard for reimbursement and cutting cost? | Medicare |
| Problem Focused exa involves? | limited exam of the affected body area or organ system |
| Expanded problem focused exam involves | limited exam of the affected body area or organ system nd any other symptomatic or related body area/s or organ systems/s |
| Detailed exam is | extended exam of the affected body area/s, organ system/s, and any other r symptomatic or related body area/s orgran system/s |
| Comprehensive exam | general multisystem examination or complete examination of a single organ system and other symptomatic or related body area/s or organ system/s |
| When do you qualify to receive Medicare A benefits? | most qualify at age 65 |
| What does medicare A cover? | inpatient/hospitalizations, SNF services, Home health services, and/or hospice accosted with the inpatient event |
| What is Medicare B | supplemental medical insurance to Medicare A it requires patient to pay premium |
| What does Medicare B cover | physician services, outpatient hospital services, laboratory and Dx procedures, medical equipment and some home health services |
| How much of the patients bill does Medicare B pay | 80 percent then the patient is responsible for the other 20 |
| How does a patient receive Medicare C? | A + B = C |
| What does medicare D cover | limited prescription drug coverage. there is a copay |
| What forms of medicare require the patient to pay a premium | B and D |
| What qualifies an NP to be a medicare provider? | hold a state license Certified as an NP by a recognized national verifying body Minimum of MSN |
| what is the percentage of the physician service the practice can receive when an NP bills under medicare | 85 percent of the physician rate when billed under the NPs provider number |
| How much does medicare reimburse for a procedure that the NP bills for? | 80% of the 85% of the physician fee schedule rate |
| What is incident to billing? | services billed under he physician's provider number to get the full physician fee (100%) |
| Is incident billing allowed in the hospital setting | No; the NP must bill under his or her own provider number in this setting |
| Where must the physician be when incident to billing occurs? | They physician must be present in the office or suite when the service is provided |
| who performs the initial services under incident to billing? | the physician performs the initial services and subsequent services that reflect his or her active participation in the MGMT of the course of Tx |
| What is Medicaid? | State administered program for low-income families and individuals. federally supporeted |
| When are Medicaid payment made? | after other insurance or third party payments have been made |
| True or false: Medicaid benefits are the same in all states? | False; they vary |
| What is the role of case management? | Mobilize, monitor, and control resources that are used during the course of the patients care while balancing cost and quality |
| What is quality asurance? | process for evaluating the care of patients using established standards of care to ensure quality |
| What is root cause analysis | Process that is part of the effort to build a culture of safety and move beyond the culture of blame |
| what question does Root cause analysis continually ask? | Why at each level of cause and event |
| Who is involved in root cause analysis | inter-disciplinary experts from the frontline services and those who are most familiar with the situation |
| Why type of process is root cause analysis | one that is impartial as possible |
| Sentinel event | unexpected occurrences involving death or serious physical/psychological injury or risk thereof |
| What does a sentinel event signal? | the immediate need for investigation and response |
| Are the terms medical error and sentinel even synonymous | NO not all sentinel events occur from error and not all errors result in sentinel events |
| What type of analysis occurs after a sentinel event? | Root cause analysis |
Created by:
EL92578
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