Sayles Chapter 16

123456789101112131415161718192021222324252627
Across
  1. 4. the practice of using multiple codes when one contains all elements
  2. 6. medical condition that coexists with the primary affects the patient's length of stay
  3. 9. addresses privacy and security of health information as well as fraud and abuse
  4. 10. RAC governmental program to identify improper Medicare payments
  5. 11. retrospective reconstruction of events in question, why, and what changes were made
  6. 12. quantifiable measures used over time to measure against best practices
  7. 13. (MU) incentive program issued by CMS part of the HITECH and ARRA of 2009
  8. 14. intentional deception or misrepresentation that an individual knows to be false
  9. 17. Redetermination-Reconsideration-Administrative-Appeals review-Final review
  10. 19. Claims Act penalties for those who knowingly submit fraudulent claims to the US governt
  11. 20. (POA) A condition present at the time of inpatient admission
  12. 21. physicians cannot receive benefits for referring patients to a facility
  13. 22. inappropriate utilization of services typically is not a criminal or intentional act
  14. 23. (CAC) extracting and translating free-text data EHR, assigns codes
  15. 24. practice of assigning codes that represent higher payment rates than services given
  16. 26. Prohibits physicians from referring patients to a business they have a financial interest
  17. 27. organizational culture promotes the prevention of conduct that does not conform
Down
  1. 1. (QIO)performs medical peer review of Medicare and Medicaid
  2. 2. (NLP)Converts language into data to be translated/manipulated
  3. 3. is a medical condition that arises during an inpatient hospitalization
  4. 5. comparison of outcomes of one organization with those of a similar organization
  5. 7. (MAC) private healthcare insurer with geographic jurisdiction
  6. 8. (CDI)process that will improve clinical specificity
  7. 15. excludes organizations convicted of healthcare crimes from Medicare
  8. 16. (HAC) identified by CMS as "reasonably preventable
  9. 18. federal government works to combat fraud and improve efficiency
  10. 25. actions that directly or indirectly result in unnecessary costs