HITT-1345 Assignment 2

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Alvin Community College *

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1345

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Health Science

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May 6, 2024

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docx

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Ryan Hetkes Assignment 2 HITT-1345 Answer the following questions based on the readings. Please list the page number from which you obtained the information. 1. What has been the trend in the utilization of hospital-based services? What factors help to account for this trend? According to the video we watched within the assignment’s, hospital biased services are expected to make a small decrease over the next few years while outpatient services slowly increase. This comes from many factors such as an increase in technology that helps people need to visit hospital less frequently, an increase in workforce in the outpatient services side of healthcare which would open up options for potential patients, as well as the economy getting worse which is turning people away from spending money on expensive inpatient hospital visits if they can avoid them. 2. What organization accredits the majority of hospitals in the United States? Which accrediting organization most recently received “deeming authority” from CMS for its hospital accreditation program? The Joint Commission is the overall most respected accreditation a healthcare setting could receive. The most recent accreditation program to receive deeming authority was the NIAHO. (chapter 2, Page # not shown, part 2-2c) 3. What key components must both inpatient and outpatient records contain in the documentation of surgery? The reports must include a history and physical examination report, an operation report, anesthesia records, postoperative recovery notes, and pathology reports when appropriate. Chapter 2, section 2-3) 4. What are the key issues with regard to documentation of services rendered by teaching physicians? The resident physician is usually paid a salary but when teaching physicians administer a service they aren’t paid on a fee by service basis and instead must try to bill medicare directly. This could be tricky because medicare requires all of the exact paperwork and said paperwork needs to be flawless before they consider reimbursing the teaching physicians who were present during the operation or administering of services. Chapter 2, Part 2-3b 5. What is the hospital chargemaster or charge description master? This is an electronic database that catalogs all billable services for the hospital. (Chapter 2, Part 2-4a) 6. What are DRGs? What are APCs? What is their impact on hospital reimbursement? DRG stands for Diagnosis Related Group, while APC stands for Ambulatory Payment Classifications. APC’s create groups of outpatient procedures and services with similar characteristics and costs, which would
Ryan Hetkes Assignment 2 HITT-1345 help for sorting and comparison purposes. DRG’s are another form of grouping for medical purposes that is used within reimbursements. Though DRG’s are used once per patient visit, patients may have multiple APS’s assigned to them per visit. (Chapter 2, Part 2-4b) 7. What coding systems are used in hospital-based care? ICD-10-CM and ICD-10-PCS are the books used for coding, but the systems used for hospital-based coding are the HCPCS and for code editing the MCE, OCE, and CCI systems are used. (Chapter 2, Part 2-5A) 8. What is EMTALA? This is part of the social security act that requires medicare participating hospitals to provide emergency care to any patient regardless of their ability to pay for said services. 9. What is ARRA? ARRA is the American Recovery and Reinvestment Act (2009), that provided incentives to healthcare providers for using EHR’s in they deemed in “Meaningful ways” (Chapter 2, Part 2-5c) 10. What factors should be considered to avoid legal risk in hospital-based care? Having the highest quality paperwork possible for all services provided and patients seen is the best way to avoid potential future legal issues. Policies should also be in place and highly enforced to ensure no one is going outside of policy which would be a risk for future lawsuits. Having a HIPPA [privacy officer also helps ensure digital records are secure within your healthcare facility. (Chapter 2, Part 2-7) 11. List and describe three types of freestanding ambulatory care settings. Dentists office, at home with the assistance of midwives, counselors offices. (Chapter 3, Part 3-1) 12. Define the following terms used in ambulatory care: encounter, reason for visit, superbill. Reasonn for visit: the patients reasoning for requesting care Encounter: Face to face contact between provider and patient Superbill: form used for billing purposes that include what was done, costs, and codes Chapter 3, Part 3-5) 13. Name the two main organizations that accredit ambulatory care. The Joint Commission, and the Accreditation Association for Ambulatory Health Care Inc. (Chapter 3, Part 3-2c) 14. List the major types of documentation that are basic to all ambulatory care encounters and settings.
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