Medicare and Medicaid
Describe medicare
Medicare is the government-sponsored healthcare program for qualified seniors and the disabled
Which of the following organization offers a deemed status from CMS?
HFAP - Healthcare Facilities Accreditation Program
Commission on Accreditation of Rehabilitation Facilities (CARF)
An accrediting organization for rehabilitation facilities.
Det Norske Veritas Healthcare, Inc. (DNV)
An annual on-site survey.
Accreditation Association for Ambulatory Health Care (AAAHC)
An organization committed to developing Standards that advance and promote patient safety, quality healthcare, and value in ambulatory healthcare settings.
National Committee for Quality Assurance (NCQA)
An organization that provides an assessment of the quality of managed care plans. Developed the Health Plan Employer Data and Information Set (HEDIS) that is a tool for measuring quality of care.
Describe medicaid
Medicaid is a joint state and federal healthcare program for qualified individuals who lack resources to pay for healthcare.
If the facility will seek Medicare/Medicaid funding, WHAT would be required.
certification
The Centers of Medicare and Medicaid (CMS) states that if a facility is accredited the:
The Joint Commission, the Healthcare Facilities Accreditation Program (American Osteopathic Association) or Det Norske Veritas Healthcare, Inc. they are deemed to be in compliance with the Conditions of Participation and do not have to undergo a separate certification process.
What department is the The OIG department under?
The OIG department is under the U.S. Department of Commerce.
Office of Inspector General (OIG)
The Office of Inspector General monitors and tracks the use of taxpayer dollars through audits, inspections, evaluations and investigations.
In order for a facility to receive federal healthcare funding what must they meet?
Conditions of Participation (CoP)
What is the survey frequency of the The Joint Commission?
On-site surveys of hospitals every three (3) years. An annual self-assessment with Periodic Performance Review is prepared by the hospital.
What is the survey frequency of the Healthcare Facilities Accreditation Program (HFAP)
On-site surveys of hospitals once every three (3) years.
What organizations have to meet the Conditions of Participation (CoP) besides Medicare and Medicaid?
Ambulatory Surgical Centers Critical Access Hospitals Home Health Agencies, Hospice Hospitals Clinics.
A rehabilitation hospital would seek accreditation from which of the following organizations?
CARF - Commission on Accreditation of Rehabilitation Facilities
What is CMS?
CMS is an agency of the Department of Health and Human Services that administers the Medicare and Medicaid programs.
If a facility only accepts private funding, WHAT IS NOT REQUIRED? WHAT? is voluntary?
Certification Accreditation
What is the role of OIG?
OIG investigating hospitals for payments for canceled surgical procedures.
What is the initiative plan and how often does OIG publish it?
OIG publishes a yearly Work Plan that outlines the initiatives for the upcoming year.
Centers for Medicare and Medicaid Services (CMS)
The Centers for Medicare and Medicaid Services (CMS) is an agency of the Department of Health and Human Services.
Department of Health and Human Services (DHHS)
The Department of Health and Human Services (DHHS) is the federal agency tasked with governing and regulating healthcare in the United States.
Why are the regulations in place?
The regulations (standards) are the foundation for improving quality and protecting health and safety for patients. The regulations protect the health and safety of beneficiaries.
The facility would have to be WHAT by the state before it operates.
licensed
A new healthcare facility is planning to operate next year. Before the facility can open, which of the following must be achieved?
licensure
The hospital must have a procedure for ensuring the confidentiality of patient records. Information from or copies of records may be released only to authorized individuals.
§482.24(b)(3)