OIG
Office of Inspector General- established by the Dept. of Labor by the Inspector General Act of 1978 to identify fraud and abuse of Medicare part A
... [Show More] and part B programs
MAC
Medicare Administrative Contractor - used by the OIG to process claims for services rendered
Criteria for high quality documemtation
1. Legible
2. Reliable
3. Precise
4. Complete
5. Consistent
6. Clear
7. Timely
EBM
Evidence Based Medicine - the best scientific data a available for clinical documentation
Two part theory for high quality clinical documentation is derived from what
Legal/regulatory sources and peer reviewed research
Four standards used in EBM
1. Design
2. Terminology
3. Performance
4. Procedural
DHHS
Department of Health and Human services
ARRA
American Recovery and Reinvestment Act of 2009 provides specific guidance established as part of the meaningful use incentive program
Meaningful use requirements
Provider must maintain an up to date problem list of current and active diagnoses for 80% of patients and 80% of all patients have to have at least one coded problem as opposed to their entire problem list coded
IPPS
Hospital Inpatient Prospective Payment System. Reimbursement now being driven by codes assigned to the patient stay with the inception of IPPS in 1982
House Staff
Interns, residents and fellows - physicians in training
CMS
Centers for Medicare and Medicaid Services
NCHS
National Center for Health Statistics
CMS and NCHS created what?
Both departments within DHHS, CMS AND DCHS created the Official guidelines for Coding and Reporting
Cooperating parties that developed and approved ICD-9-CM AND ICD-10-CM
AHA -American Hospital Association
AHIMA
CMS
NCHS
ACA
Affordable Care Act
POA Indicators
Present on admission indicators. These are required by CMS beginning in 2007. Must be done on all secondary diagnoses for Medicare inpatient cases
HAC
Hospital Acquired Condition - beginning in 2008, certain HACs that are not POA may not be included in the DRG payment
Deficit Reduction Act of 2005
Requires POA inclusion in the payment guidelines for conditions that:
1. Are high cost, high volume or both
2. Result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis
3. Could reasonably have been prevented through the application of evidence based guidelines
WHO
World Health Organization [Show Less]