Medicare: Improving Quality of Care Assessment and Assurance : Report to the Chairman, Subcommittee on Health, Committee on Ways and Means, House of RepresentativesThe Office, 1988 - 176 pages |
À l'intérieur du livre
Résultats 1-5 sur 17
Page 12
... collection was completed in fall 1987 . We interviewed HCFA program officials and staff and obtained support- ing materials ( copies of project plans , data system documentation , and so forth ) . We examined information systems closely ...
... collection was completed in fall 1987 . We interviewed HCFA program officials and staff and obtained support- ing materials ( copies of project plans , data system documentation , and so forth ) . We examined information systems closely ...
Page 15
... collection and monitoring responsibilities of Medicare claims pro- cessors and PROS ; ( 2 ) creating a program to evaluate options for incorpo- rating valid and reliable medical record review methodologies into peer reviews ; and ( 3 ) ...
... collection and monitoring responsibilities of Medicare claims pro- cessors and PROS ; ( 2 ) creating a program to evaluate options for incorpo- rating valid and reliable medical record review methodologies into peer reviews ; and ( 3 ) ...
Page 42
... collection Number of cases denied payment for utilization and quality reasons Number of cases failing quality , utilization screens , or physician reviews PRO Quality Review Organizations ( HMO and CMP ) Ambulatory Surgical Centersa ...
... collection Number of cases denied payment for utilization and quality reasons Number of cases failing quality , utilization screens , or physician reviews PRO Quality Review Organizations ( HMO and CMP ) Ambulatory Surgical Centersa ...
Page 65
... collection to information from claims and queries , except for medical reviews of skilled nursing facilities , hospices , and home health agency claims , which may require review of medical records . The initial data source for PRO ...
... collection to information from claims and queries , except for medical reviews of skilled nursing facilities , hospices , and home health agency claims , which may require review of medical records . The initial data source for PRO ...
Page 67
... collection of diagnostic data on part B bills and strengthening the availability of information to monitor both processes and outcomes of care . There is more information available on process than outcome indicators of quality ...
... collection of diagnostic data on part B bills and strengthening the availability of information to monitor both processes and outcomes of care . There is more information available on process than outcome indicators of quality ...
Autres éditions - Tout afficher
Medicare : Physician-sponsored Organizations Receive Priority for Peer ... United States. General Accounting Office Affichage du livre entier - 1988 |
Medicare: Potential Effects of Shifting the Home Health Benefit from Part A ... United States. General Accounting Office Affichage du livre entier - 1988 |
Expressions et termes fréquents
accuracy admission appropriate Assessing Quality bills Carrier and Intermediary charges claims data clinical coordination costs coverage criteria currently data system determine Developing a Medicare diagnostic codes electrocardiograms evaluation example Existing Data Resources funding guidelines HCFA's health care health services research HMOS and CMPS ICD-9-CM codes identify inpatient inpatient hospital intensified review Intermediary and Carrier Intermediary Medical Review issues Medicaid medical necessity medical records Medicare beneficiaries Medicare program Medicare Quality Assurance methods mortality NCHSR&HCTA neopl Ongoing optional screens outliers outpatient Peer Review Organizations percent physical therapy physician posthospital premature discharges PRO's procedures profiles PROMPTS-2 PROS prospective payment Prospective Payment System quality assessment Quality Assurance Strategy quality of care quality problems quality review quality screens quality-related readmissions recommend report to HCFA Resources for Assessing review activities simple mastectomy skilled nursing facility specific standards studies subacute care SuperPRO tion types utilization X X X
Fréquemment cités
Page 19 - Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided...
Page 19 - Nothing in this title shall be construed as authorizing the Secretary or any other officer or employee of the United States to interfere in any way with the practice of medicine or with relationships between practitioners of medicine and their patients, or to exercise any supervision or control over the administration or operation of any hospital. (2) The term "period of disability...
Page 53 - DEPARTMENT OF HEALTH AND HUMAN SERVICES BEFORE THE SUBCOMMITTEE ON HUMAN RESOURCES AND INTERGOVERNMENTAL RELATIONS COMMITTEE ON GOVERNMENT OPERATIONS US HOUSE OF REPRESENTATIVES DECEMBER 10, 1987 RELEASE ONLY UPON DELIVERY Food and Drug Administration Rockville MO 20857 Introduction Mr.
Page 19 - ... aggregate amount expended in fiscal year 1988 for direct and administrative costs (adjusted for inflation and for any direct or administrative costs incurred as a result of review functions added with respect to a subsequent fiscal year) of such reviews), (ii) in the case of hospitals...
Page 90 - Demographic characteristics and health care use and expenditures by the aged in the United States: 1977-1984.
Page 49 - Unscheduled return to surgery within same admission for same condition as previous surgery or to correct operative problem (exclude "staged" procedures) Source: Health Care Financing Administration, 1987.
Page 28 - Other types of abuse include, but are not limited to "excessive charges for services or supplies," "claims for services not medically necessary, or if medically necessary, not to the extent rendered...
Page 43 - Medicare payment; and (4) the necessity and appropriateness of care for which payment is sought on an "outlier...
Page 18 - Secretary, with the concurrence of the members of the appropriate program review team appointed pursuant to section 1862(d) (4) who are physicians or other professional personnel in the health care field, to be substantially in excess of the needs of individuals or to be harmful to individuals or to be of a grossly inferior quality.
Page 49 - Hospital acquired decubitus ulcer 19 f. Care resulting in serious or life-threatening complications, not related to admitting signs and symptoms, including but not limited to the neurological, endocrine, cardiovascular, renal or respiratory body systems (eg. resulting in dialysis. unplanned transfer to special care unit, lengthened hospital stay).