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Health Policy III

AACN Board Review

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