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 14
Page 27
... X - rays , computerized tomography scans , mammograms , and ambulance services . The goals for postpayment utilization review are ( 1 ) to monitor the Medicare claims experience of all physicians , other providers , and sup- pliers and ...
... X - rays , computerized tomography scans , mammograms , and ambulance services . The goals for postpayment utilization review are ( 1 ) to monitor the Medicare claims experience of all physicians , other providers , and sup- pliers and ...
Page 28
... X - rays , physical therapy , consul- tations , and other carrier - proposed categories ) . Physicians and suppliers who fall into this initial 3 - percent investigation list are subjected to additional review to determine if other ...
... X - rays , physical therapy , consul- tations , and other carrier - proposed categories ) . Physicians and suppliers who fall into this initial 3 - percent investigation list are subjected to additional review to determine if other ...
Page 126
... X - ray in a quarter . The diagnostic - driven screens would allow an initial electrocardiogram or chest X - ray only when a certain diagnosis or medical problem were present . Examples of typical optional screens based on frequency ...
... X - ray in a quarter . The diagnostic - driven screens would allow an initial electrocardiogram or chest X - ray only when a certain diagnosis or medical problem were present . Examples of typical optional screens based on frequency ...
Page 127
... X - rays in 12 months only for a covered diagnosis on the attached list ( maintained by carrier ) . 3. Suspend claim for procedures 82951 and 82952 , unless diagnosis is diabetes , possible diabetes , or hypoglycemia . 4. Allow claim ...
... X - rays in 12 months only for a covered diagnosis on the attached list ( maintained by carrier ) . 3. Suspend claim for procedures 82951 and 82952 , unless diagnosis is diabetes , possible diabetes , or hypoglycemia . 4. Allow claim ...
Page 130
... X 38. Lifetime reserve days used X 39. Professional component charges X 40. Primary payer code 41. Primary payer amount 42. Noncovered ancillary charges X 43. Inpatient deductible X 44. Coinsurance days and amount a . Days b . Rate per ...
... X 38. Lifetime reserve days used X 39. Professional component charges X 40. Primary payer code 41. Primary payer amount 42. Noncovered ancillary charges X 43. Inpatient deductible X 44. Coinsurance days and amount a . Days b . Rate per ...
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 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 indicator initial 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 monitoring NCHSR&HCTA neopl nosocomial infections optional screens outliers outpatient Peer Review Organizations percent physical therapy physician plans posthospital premature discharges PRO's procedures profiles PROMPTS-2 PROS prospective payment quality assessment Quality Assurance Strategy quality of care quality problems quality review quality screens quality-related readmissions recommend report to HCFA Resources for Assessing responsibility review activities simple mastectomy skilled nursing facility specific standards studies subacute care SuperPRO tion utilization X X X
Fréquemment cités
Page 97 - Amendments of 1967) respecting — (1) the accessibility, acceptability, planning, organization, distribution, technology, utilization, quality, and financing of health services and systems; (2) the supply and distribution, education and training, quality, utilization, organization, and costs of health manpower...
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 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).
Page 48 - Temperature on day before or day of discharge greater than 101 degrees oral (rectal 102 degrees). c. Pulse less than 50 (or 45 if the patient is on a beta blocker), or greater than 120 within 24 hours of discharge.