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Chapter 3: Freestanding Ambulatory CareKnowledge-based questionsList and describes three types of freestanding ambulatory care setting. (p. 71)Public healthCommunity Health CentersFederally qualified Health Centers (FQHCs)Rural Health Clinics (RHCs)Urgent Care CentersAmbulatory Surgery Centers (ASCs)Industrial/Occupational HealthUniersity Health CentersBirth Centers, Family Planning CentersDefine the following terms used in ambulatory care: encounter, nurse practitioner, reason for visit, superbill.Encounter: Pt face-to-face w/providerNurse Practitioner: RN with extra training (MS/PhD) w/limited licence practiceReason for Visit: Pt provides reason for careSuperbill: Shows service provided to Pt; Charges, Dx, and Procedure codesName the two main organizations accredited ambulatory care. (p. 74)The Joint Commission and Accreditation Association for Ambulatory Health Care Inc.List the major types of documentation that are basic to all ambulatory care encounters and settings.Registration (demographic info) and H&P(Progress Notes, Encounter Form, Superbill)What types of patient identifiers are used in ambulatory care? Name / Number / Family numbering systemWhat types of data are included in the uniform adulatory care data set, and how does this affect the content of the ambulatory record? (p 101)UACDS: Pt data, Provider data, Encounter dataWhat is the ASC reimbursement system, and how is it used in Medicare reimbursement? (p. 92)Critical thinking questionsCompare and contrast the fee-for-service and PFS/RBRVS reimbursement systems.How does documentation in an industrial health Center, differ from that of physicians practice and why?How is quality assessment in ambulatory care similar to and different from quality assessment in the acute inpatient setting?Chapter 7: Mental Health: Long-Term and Acute ServicesKnowledge-based questionsExplain the difference between serious emotional disturbance and serious mental illness. Serious Emotional Disturbance: Condition in children, birth to 18, who in the last year have been diagnosed w/mental, behavioral, or emotional disorder that resulted in functional impairment which substantially interferes with or limits the child’s role or functioning in family, school, or community activities. (p. 216)Serious Mental Illness: a person who has been diagnosed w/mental, behavioral, or emotional disorder that resulted in functional impairment which substantially interferes with or limits one or more major life activities. (p. 220)Named the three most prevalent types of serious mental illness. Schizophrenia, clinical depression, bipolar disorder (p. 217)What are two categories of dual diagnoses?Mental illness and chemical addictionDevelopmentally disabled and seriously mentally illMentally ill with dementia (p. 218)Give the term by which persons with mental illness were living in the community prefer to be called.Consumers, Mental health consumers, users of mental health services (p. 217)Define "outpatient commitment. "The courts can place persons in outpt programs where they are monitored for medication and must maintain scheduled psyciatric appointments. Released from inpt care. (p. 214)Name the main components of the mental health consumer case record.Assessment, Treatment Plan, Progress Notes, Discharge Summary and Aftercare Plans (p. 228)What is the basis for payment in the inpatient psychiatric facility prospective payment system (IPF PPS)?Per diem payments are based on the pt’s age, variable per diem adjustments (lowered on days 1-22, then stabilized)Medical severity DRGCertain comorbidities (those of different families of disease) (p. 239) KNOW THESEWhat is the relationship between the treatment plan and progress notes, and why is it important?Treatment Plan tries to get the consumer invested in meeting the goals, so counselor works with the consumer to make up the plan (p. 229-33)Progress Notes document achievement or nonachievement in the consumer’s attempts at reaching the goals as stated in the treatment plan.How did the "duty to warn" originate, and how does it affect confidentiality of mental health information? (p. 250-51)1976 Ruling Tarasoff v. Regents of U. of California. Psychiatrist failed to notify authorities when pt threatened harm to someone specific and followed thru on the threat.What are the URS tables?Uniform Reporting System: System thru which State Mental Health Authority (SMHA) reports aggregate data to SAMHSA (Substance Abuse-Mental Health Services Administration Provide examples of the national outcome measures (NOMs) for which client-level data are reported.Data Infrastructure Grants (DIGs) support Commun. Mental Health Centers (CMHCs) in reporting measures to build database which adds value in decision support at state and national levels. (p. 248)National Outcome Measures: (p. 247)Employment/School AttendanceStability in HousingCriminal Justice InolvementReadmission to State HospitalCritical thinking questionsDiscuss how the mental health consumer empowerment movement may have affected development of mental health data collection systems.Discuss some of the areas in mental health services into which health information managers may expand their roles.Chapter 10: Long-Term CareKnowledge-based questionsWhat two primary agencies regulate long-term care facilities? State Public Health, CMSWhat are the primary reimbursement categories for care of residents in long-term care facilities?M’caid per diem, Resource Utilization Group (RUG) Part AWho determines how long-term care facilities are reimbursed under the Medicaid program?The state determines how long-term reimbursement will happen.What are the three categories for which ratings are provided in the five-star rating system for nursing homes?Health Inspections, Staffing, Quality Measures What are some of the specific long-stay quality measures used in the system?ADL -- Mobility, Pressure ulcers, -- Restraints, UTI, -- pain, catheterizationWhat is the single most important content characteristic of a care plan in a long-term care facility is subject to federal regulations?Individualization of care is the single most important content characteristicList common electronic software applications in long-term care.RAVENFederally mandated:Resident Assessment Instrument (RAI) ProcessMinimum Data Set (MDS)Care Area Assessment (CAA) process (old RAPs)Utilization Guidelines (in RAI manual)Comprehensive Resident AssessmentOBRA AssessmentsCATs = Care Area Trigger: Identify residents who have or are at risk for developing specific developmental problems and need further assessment.Critical thinking questionsHow is ICD coding of relevance to the long-term care setting? Compare its impact in long-term care to acute care.Why is there a greater focus on concurrent documentation monitoring the long-term care setting is compared to evaluating documentation in the closed medical record?Consider additional research is necessary to discover the principal uses of the MDS in the long-term care industry (a)?by the individual provider, (b) by the state agency, and (c) by CMS.Chapter 13: HospiceKnowledge-based questionsTrue or False: Hospice takes care of only cancer patients.FalseProvide examples of how hospice tries to eat terminal symptoms for patients. (p. 465)Analgesics, position changes, back rubs, massage, O2, tranquilizers, antidepressants, music, conversation, companionshipList the members of the interdisciplinary team in hospice. (p. 465)Dr (employed by Hospice)-- Volunteer CoordinatorNurse-- PharmacistSocial Worker-- Bereavement CounselorPastor/Counselor-- Hospice Aide-- VolunteerWhat is the role of the primary caregiver?Most of the Pt’s care: Tx, meds, baths, watch for changes, notify hospice of changes.Describe how a Medicare patient elects to receive hospice care. (p. 468)“Electing the Hospice Benefit”Describe the role that volunteers play in hospice care.Volunteers offer companionship, comfort, transportation, light housekeeping, sometimes direct Pt care.Discuss bereavement services provided by hospice.The Pt’s family works w/counselors preparing for and up to 1 year after the Pt’s death. (p. 473)Describe the four levels of hospice care for Medicare Conditions of Participation. (p. 474)Routine Home CareGeneral Inpt CareContinuous CareInpt Respite CareDescribe aspects of the hospice utilization review program. (p. 482,3)Critical thinking questionsProvide examples of some of the data it can be collected by hospices.Describe the functions of the quality assessment/performance improvement program. ................
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