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Chapter 1: Health Care Delivery Systems Feipei Lai National Taiwan University Health Care Delivery Systems History of Medicine and Health care Delivery Continuum of Care Health Care Facility Ownership Health Care Facility Organizational Structure Licensure, Regulation, and Accreditation

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health care delivery systems
Health Care Delivery Systems
  • History of Medicine and Health care Delivery
  • Continuum of Care
  • Health Care Facility Ownership
  • Health Care Facility Organizational Structure
  • Licensure, Regulation, and Accreditation
introduction
Introduction
  • Health care delivery has been greatly impacted by escalating costs, resulting in medical necessity requirements, review of appropriateness of admissions, and requirement for administration of quality and effective treatments.
on line medical dictionary
On-Line Medical Dictionary
  • http://cancerweb.ncl.ac.uk/omd/
slide5
MRXO
  • 在臨床醫學中,進行手術時同時使用磁振造影並整合各種影像技術是目前最熱門的醫療概念。新式的「未來手術室」中,安裝有全球首套MRXO解決方案,即完全整合磁振造影(MR)、X光及電腦斷層掃描(CT)系統,大幅減少病患危險並簡化醫師的手續,可望提高手術成功率。
  • 這項由日本東海大學、飛利浦醫療系統事業部合力推動的「未來手術室」,已經由日本東海大學的松前教授、津具醫師、山本醫師共同在手術室同時使用MR(磁振造影)和X光影像技術,來進行神經外科手術。
slide6
MRXO
  • 在「未來手術室」中執行手術,可依執刀醫師與病患狀況,在數分鐘內將病患從手術台搬移到磁振造影、電腦斷層掃描或X光診斷系統,增加手術精密度與成功率。在磁振造影和電腦斷層掃描區域有拉門。
history of medicine health care delivery
History of Medicine & Health Care Delivery
  • History of medicine
  • Evolution of health care delivery in the United States
history of medicine
History of medicine
  • Ancient Chinese developed traditional medical practices based on the belief that two life forces, yin and yang, flow through the human body.
  • Disease results when the two forces are out of balance, and the Chinese use acupuncture (inserting needles into parts of the body) to control the flow of yin and yang.
history of medicine10
History of medicine
  • In 1981, Acquired Immune Deficiency Syndrome (AIDS) and the Human Immunodeficiency Virus III (HIV) were identified.
  • In 1990, the Human Genome Project was established. In 2000, human genome sequencing was published.
history of medicine11
History of medicine
  • In 1994, scientists discovered the genes responsible for many cases of hereditary colon cancer, inherited breast cancer, and the most common type of kidney cancer.
slide12
HW
  • History of Medicine in Taiwan
evolution of health care delivery in the united states
Evolution of health care delivery in the United States
  • 1946 The Communicable Disease Center (CDC) was established and is the forerunner of the Centers for Disease Control and Prevention.
  • 1971 The National Cancer Act was signed into law, which amended the Public Health Service act to more effectively carry out the national effort against cancer.
evolution of health care delivery in the united states14
Evolution of health care delivery in the United States
  • 1991 The Workgroup on Electronic Data Interchange (WEDI) was created to reduce health care administrative costs through implementation of the electronic data interchange (EDI), which uses national standards to transmit data for reimbursement purposes.
evolution of health care delivery in the united states15
Evolution of health care delivery in the United States
  • 1996 The Health Insurance Portability and Accountability Act (HIPAA) was passed.
  • It mandates administrative simplification regulations that govern privacy, security, and electronic transaction standards for health care information.
evolution of health care delivery in the united states16
Evolution of health care delivery in the United States
  • 1996 The Healthcare Integrity and Protection Data Bank (HIPDB) was created which combats fraud and abuse in health insurance and health care delivery by alerting users to conduct a comprehensive review of a practitioner’s, provider’s, or supplier’s past actions.
healthcare integrity and protection data bank
Healthcare Integrity and Protection Data Bank
  • Access to information in the HIPDB is available to entities that meet the eligibility requirements defined in Section 1128E of the Social Security Act and the HIPDB regulations. In order to access information, eligible entities must first register with the Data Bank.
  • HIPDB information is not available to the general public. However, information in a form that does not identify any particular entity or practitioner is available.
healthcare integrity and protection data bank18
Healthcare Integrity and Protection Data Bank
  • http://www.npdb-hipdb.hrsa.gov/
  • Estimates of annual losses due to health care fraud range from 3 to 10percent of all health care expenditures--between $30billion and $100billion based on estimated 1997 expenditures of over $1 trillion.
continuum of care
Continuum of Care
  • A complete range of programs and services is called a continuum of care, with the type of health care indicating the health care services provided.
  • Primary care
  • Secondary care
  • Tertiary care
primary care services
Primary care services
  • Include preventive and acute care, are referred to as the point of first care, and are provided by a general practitioner or other health professional who has the first contact with a patient seeking medical treatment, including general dental, ophthalmic 眼科的, and pharmaceutical services.
primary care services21
Primary care services
  • Annual physical examinations
  • Early detection of disease
  • Family planning
  • Health education
  • Immunizations
  • Treatment of minor illnesses and injuries
  • Vision and hearing screening
secondary care services
Secondary care services
  • Provided by medical specialists or hospital staff members to a patient whose primary care was provided by a general practitioner who first diagnosed or treated the patient.
tertiary care services
Tertiary care services
  • Provided by specialized hospitals equipped with diagnostic and treatment facilities not generally available at hospitals other than primary teaching hospital or Level I, II, III or IV trauma centers.
trauma centers
Trauma centers
  • Level I: provides the highest level of comprehensive care for severely injured adult and pediatric patients with complex, multi-system trauma.
  • Level II: broad range of sub-specialists are on-call and promptly available to provide consultation or care.
trauma centers25
Trauma centers
  • Level III: physicians are advanced trauma life support (ATLS) trained and experienced in caring for traumatically injured patients; nurses and ancillary staff are in-house and immediately available to initiate resuscitative measures.
trauma centers26
Trauma centers
  • Level IV: critically injured patients who require specialty care are transferred to a higher level trauma system hospital in accordance with pre-established criteria.
tertiary care
Tertiary care
  • Burn center treatment
  • Cardiothoracic and vascular surgery
  • Inpatient care for AIDS patients
  • Magnetic resonance imaging (MRI)
  • Neonatology level III unit services
  • Neurosurgery
  • Organ transplant
tertiary care28
Tertiary care
  • Pediatric surgery
  • Positron emissions tomography (PET)
  • Radiation oncology
  • Services provided to a person with a high-risk pregnancy
  • Services provided to a person with cancer
  • State-designated trauma centers
  • Trauma surgery
positron emissions tomography pet
Positron emissions tomography (PET)
  • builds images by detecting energy given off by decaying radioactive isotopes.
  • Isotopes are atoms of an element with the same number of protons (positively charged particles) in the nucleus, but a different number of neutrons (neutral particles).
  • Because radioactive isotopes are unstable, as they decay, they throw off positrons that collide with electrons and produce gamma rays that shoot off in nearly opposite directions.
pet http www doemedicalsciences org abt sidebars pet shtml
PET http://www.doemedicalsciences.org/abt/sidebars/pet.shtml
  • PET systems use the paths of the two detected gamma rays to determine the originating collision point, a process called electronic collimation (瞄準).
  • The scanners use a circular series of gamma ray-detectors to envelope the patient or test animal so both gammas can be detected so the instrument can use electronic collimation to predict where the energy signal originated.
  • This signal is then converted into a three-dimensional image slice.
http www healthvault com
http://www.healthvault.com/
  • The Microsoft HealthVault record you create is controlled by you.
  • You decide what goes into your HealthVault record.
  • You decide who can see and use your information on a case-by-case basis.
  • We do not use your health information for commercial purposes unless we ask and you clearly tell us we may.
slide32
台灣醫院分類
  • 診所
  • 地區醫院 (497/2005)
  • 區域醫院 (80/2005, 65/2006, 64/2007)
  • 醫學中心 (23/2005, 18/2006, 19/2007)
slide33
醫學中心
  • 在衛生局登記開放的急性一般病床與急性精神病床合計須達五百床以上
  • 至少應能提供 家庭醫學、內、外、婦產、兒、骨、神經外、泌尿、耳鼻喉、眼、皮膚、神經、精神、復健、麻醉、放射線、病理、核醫、牙 等十九科之診療服務。
slide34
醫學中心
  • 專任主治醫師人數 (包括主任在內) 每八床應有一名。
  • 專任護理人員每2床至少1名。
  • 加護病房:每床2.5名。
  • 手術室:每班每台2.5名。
  • 手術恢復室:每班每床0.5名。
  • 產房及待產室:每床2名。
  • 嬰兒室:每床0.4名。
  • 急診室:觀察室每床0.5名;
  • 診療室每12人次1名。
  • 門診:每班每診療室0.5名。
  • 血液透析室:每4人次1名。
  • 行政、教學、研究及其他護理人員 (如院內感染控制、公衛、供應中心等護理人員) 另計,應佔總人數百分之六。
  • 應有受過感染控制訓練之專任護理人員,每300床應設1名。
slide35
醫學中心
  • 藥事人員每40床至少1名。
  • 每60張門診處方至少1名。
  • 特殊藥品處方每15張至少1名。
  • 藥事人員總數至少四分之三為藥師。
  • 藥事人員至少有4名負責藥品管理諮詢及臨床等工作。
slide36
區域醫院
  • 應設置250床位以上急性病病床數
  • 每床所擁有的樓地板面積應在50平方公尺以上
  • 每9床至少應擁有一名主治醫師
  • 每2.5床至少應擁有一名護理人員等。
  • 至少應能提供 家庭醫學、內、外、婦產、兒、骨、耳鼻喉、眼、精神、復健、麻醉、放射線、病理、牙 等十四科之診療服務。
nurse
區域醫院 Nurse
  • 加護病房:每床2名。
  • 手術室:每班每台2名。
  • 手術恢復室:每班每床0.5名。
  • 產房及待產室:每床1.2名。
  • 嬰兒室:每床0.4名。
  • 急診室:觀察室每床0.5名;
  • 診療室每12人次1名。
  • 門診:每班每診療室0.5名。
  • 血液透析室:每4人次1名。
  • 行政、教學、研究及其他護理人員 (如院內感染控制、公衛、供應中心等護理人員) 另計,應佔總人數百分之四。
  • 應有受過感染控制訓練之專任護理人員,每300床應設1名。
slide38
區域醫院
  • 藥事人員每50床至少1名。
  • 每70張門診處方至少1名。
  • 特殊藥品處方每15張至少1名。
  • 藥事人員總數至少四分之三為藥師。
  • 藥事人員中,至少有2名負責藥品管理諮詢及臨床等工作。
slide39
地區醫院
  • 在衛生局登記開放的急性一般病床需20床以上,
  • 急性一般病床及急性精神病床合計249床(含)以下。
slide40
地區醫院
  • 專任員工總人數每床應有1名。
  • 專任主治醫師人數以及專任護理人員應符合醫療機構設置標準。
  • 藥事人員每50床至少1名。
  • 每80張門診處方至少1名。
  • 每增加100張處方應增加1名。
  • 應有藥師1人以上。
slide41
評鑑分級
  • 設施
    • 總樓地板面積
    • 病房設施
    • 安全設備及一般設備
    • 保險病床比率
slide42
評鑑分級
  • 人員
    • 員工總人數 醫師總數
    • 麻醉科醫師 放射線科醫師
    • 核醫科醫師 病理科醫師
    • 復健科醫師 精神科醫師
    • 護理 藥事
    • 醫事檢驗 醫用放射線技術
    • 復健技術 精神科
    • 社會工作 營養師
    • 病歷管理
slide43
評鑑分級
  • 醫療業務及設備
    • 醫療業務 急性病床數
    • 診療科別 急診業務
    • 手術及麻醉作業 產房
    • 嬰兒室 加護病房
    • 藥事作業 檢驗作業
    • 輸血作業 放射線診療作業
    • 病理作業 復健醫療作業
    • 精神科 核子醫學
    • 牙科 特殊醫療服務
    • 醫務社會服務工作 營養部門
    • 病歷部門 社區衛生服務
    • 員工健康檢查
slide44
評鑑分級
  • 品質保證
    • 醫療品質審查
    • 感染控制
    • 人體試驗
    • 藥事作業品質
    • 護理服務品質
    • 檢驗作業品質管制
    • 輸血作業品質管制
    • 病理作業品質管制
    • 放射線診療品質管制
    • 核子醫學品質管制
    • 病歷管理
    • 醫院管理業務
    • 醫病關係之促進
slide45
評鑑分級
  • 指定項目評估
    • 住院
    • 診斷
    • 處置
    • 用藥
    • 手術
    • 病歷寫作
slide46
評鑑分級
  • 教學訓練
    • 教學師資
    • 教學訓練與研究設備
    • 教學訓練活動
    • 與其他醫院(醫學院)交流合作情形
    • 研究情形及論文發表
    • 教學進修研究經費
slide47
新制教學醫院評鑑基準
  • 教學資源
  • 教學訓練計畫與成果
  • 研究執行與成果
  • 臨床師資培育及繼續教育
  • 學術交流與社區功能及角色
  • 管理行政
health care facility ownership
Health Care Facility Ownership
  • Government (not-for-profit) 25%
  • Proprietary (for-profit) 15%
  • Voluntary (not-for-profit) 60%
medical staff
Medical Staff
  • Intern: a physician in the first year of graduate medical education, which ordinarily immediately follows completion of the four-year medical curriculum.
  • Resident: a physician who has completed an internship and is engaged in a program of training designed to increase his or her knowledge of the clinical disciplines of medicine, surgery, or any of the other special fields that provide advanced training in preparation for the practice of a specialty.
medical staff51
Medical Staff
  • Chief resident: a physician who is in his final year of residency or in the year after the residency has been completed.
  • Visiting Staff (VS): 主治醫師
health care facility organizational structure
Health Care Facility Organizational Structure
  • Governing board
  • Administration
  • Medical staff
  • Departments, services, and committees
  • Contracted services
governing board
Governing board
  • The governing board (board of trustees, board of governors, board of directors) serves without pay, and its membership is represented by professionals from the business community.
administration
Administration
  • Serves as liaison between the medical staff and governing board and is responsible for developing a strategic plan for supporting the mission and goals of the organization.
  • CEO: chief executive office
  • CFO: chief financial officer
  • CIO: chief information officer
  • COO: chief operating officer
medical staff55
Medical staff
  • Consists of licensed physicians and other licensed providers as permitted by law (e.g., nurse practitioners and physician assistants) who are granted clinical privileges.
physician assistants
physician assistants
  • Examine, diagnose, and treat patients under the direct supervision of a physician.
medical staff membership categories
Medical staff membership categories
  • Active: delivers most hospital medical services, performs significant organizational and administrative medical staff duties
  • Associate: advancement to active category is being considered
  • Consulting
  • Courtesy: admits an occasional patient to the hospital
  • Honorary
ntuh departments
NTUH Departments

秘書室 總務室 企劃管理室

病歷資訊管理室

醫療事務室 社會工作室 公共事務室

工務室 資訊室 圖書室 安全衛生室

警衛隊 會計室 人事室 教學部

醫學工程部

ntuh departments61
NTUH Departments

內科部 外科部 骨科部 婦產部 小兒部

神經部 精神部 耳鼻喉部 眼科部 泌尿部

皮膚部 牙科部 復健部 家庭醫學部

麻醉部 影像醫學部 核子醫學部

檢驗醫學部 病理部 藥劑部 護理部

營養部 綜合診療部 醫學研究部

基因醫學部 門診部 急診醫學部 腫瘤醫學部

創傷醫學部 老年醫學部 環境及職業醫學部

ntuh departments62
NTUH Departments

品質管理中心

資財管理中心

健康管理中心

肝炎研究中心

形體美容醫學研究中心

國家級卓越臨床驗與研究中心

slide63
抗老及健康諮詢中心
  • 心臟衰竭中心
  • 乳房醫學中心
  • 感染控制中心
  • 運動醫學中心
  • 過敏免疫中心
  • 臨床心理中心
  • 健康教育中心
  • 睡眠中心
  • 國際醫療中心
ntuh departments64
NTUH Departments
  • 公館院區: 綜合內科部, 綜合外科部
the johns hopkins hospital
The Johns Hopkins Hospital
  • Allergy and Clinical Immunology
  • Anesthesiology/Critical Care Medicine
  • Cardiology
  • Dermatology (Skin)
  • Emergency Medicine
  • Endocrinology 內分泌學
  • Gastroenterology 胃腸病學
  • Gynecology & Obstetrics 婦產
  • Hematology 血液學
  • Infectious Diseases
  • Internal Medicine
  • Nephrology 腎病學
  • Neurology & Neurosurgery
the johns hopkins hospital66
The Johns Hopkins Hospital
  • Oncology (Cancer)
  • Ophthamology (Eyes)
  • Orthopedic Surgery 整形外科
  • Otolaryngology (ENT)
  • Pediatrics 兒科
  • Physical Medicine/Rehabilitation
  • Psychiatry/Behavioral Sciences
  • Pulmonary/Critical Care Medicine 肺
  • Radiology
  • Surgery
  • Urology 泌尿科
internal medicine
Internal Medicine
  • Adolescent medicine
  • Cardiovascular medicine 心血管
  • Critical care medicine
  • Electrophysiology 電生理學
  • Endocrinology 內分泌學
  • Gastroenterology 胃腸病學
  • Geriatrics 老年醫學
  • Hematology 血液學
  • Immunology
  • Infectious disease
  • Nephrology 腎病學
  • Oncology
  • Pulmonary medicine 肺
  • Rheumatology 風濕病學
  • Sports medicine
hospital departments
Hospital Departments
  • Admitting (Patient Registration)
  • Biomedical Engineering
  • Business Office
  • Case Management (Discharge Planning)
  • Central Sterilizing Service
  • Chaplain
  • Clinical Laboratory
  • Community Relations (Public Relations)
hospital departments69
Hospital Departments
  • Compliance
  • Computing
  • Durable Medical Equipment
  • Electroneurodiagnostic Testing
  • Emergency Room
  • Employee Assistance Program (EAP)
  • Employee Health Services
  • Environmental Services
  • Health Information Management Services
hospital departments70
Hospital Departments
  • Hospice Care
  • Human Resources
  • Medical Education
  • Medical Library
  • Medical Staff
  • Nursing
  • Nutrition and Food Service
  • Occupational Therapy
hospital departments71
Hospital Departments
  • Operating Room Suite
  • Patient Advocacy
  • Patient Education
  • Performance Improvement
  • Pharmacy
  • Physical Therapy
  • Plant Operations and Maintenance
  • Preadmission Testing (PAT)
hospital departments72
Hospital Departments
  • Purchasing
  • Radiation Oncology
  • Radiology
  • Recreation Therapy
  • Rehabilitative Services
  • Respiratory Therapy
  • Respite Care
  • Risk Management
  • Safety Management
hospital departments73
Hospital Departments
  • Social Services
  • Speech and Language Pathology
  • Telemedicine
  • Utilization Management
  • Volunteer
hospital committees
Hospital Committees
  • Disaster Control
  • Drug Utilization Review
  • Education
  • Finance
  • Forms
  • Health Information
  • Infection Control
  • Quality Management
  • Risk Management
  • Tissue Review
  • Transfusion
  • Utilization Management
health information department
Health Information Department
  • Department administration
  • Cancer registry
  • Coding and abstracting
  • Image processing
  • Incomplete record processing
  • Medical transcription
  • Record circulation
  • Release of information processing
coding
Coding
  • Involves assigning numeric and alphanumeric codes to diagnoses, procedures, and services; this function is usually performed by credentialed individuals.
  • Coders assign ICD-9-CM codes to inpatient cases and CPT, Health Care Procedure Coding System (HCPCS) Level II (National), and ICD-9-CM codes to outpatient, emergency department, and physician office cases.
cancer registry
Cancer registry
  • Performed by individuals who are credentialed as certified tumor registrars and include using computerized registry software to conduct lifetime follow-up on each cancer patient, electronically transmit data to state and national agencies for use at local, regional, state, and national levels, and generate reports and information for requesting entities.
current procedural terminology cpt
Current Procedural Terminology (CPT)
  • Published annually by the American Medical Association and codes are 5-digit numbers assigned to ambulatory procedures and services.
  • E.g. 90663 Influenza virus vaccine, pandemic formulation
icd 9 cm
ICD-9-CM
  • The International Classification of Diseases, Ninth revision, Clinical Modification is used in the United States to collect information about diseases and injuries and to classify diagnoses and procedures.
  • National Center for Health Statistics (NCHS).
http icd9cm chrisendres com
http://icd9cm.chrisendres.com/
  • 1. INFECTIOUS AND PARASITIC DISEASES (001-139)
    • TUBERCULOSIS (010-018)
      • Includes:
        • infection by Mycobacterium tuberculosis (human) (bovine)
      • Excludes:
        • congenital tuberculosis (771.2)
        • late effects of tuberculosis (137.0-137.4)
      • The following fifth-digit subclassification is for use with categories 010-018:
        • 0 unspecified
        • 1 bacteriological or histological examination not done
        • 2 bacteriological or histological examination unknown (at present)
        • 3 tubercle bacilli found (in sputum) by microscopy
        • 4 tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture
        • 5 tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically
        • 6 tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods [inoculation of animals]
http icd9cm chrisendres com82
http://icd9cm.chrisendres.com/
  • 010 Primary tuberculous infection
    • Requires fifth digit. See beginning of section 010-018 for codes and definitions.
  • 011 Pulmonary tuberculosis
    • Requires fifth digit. See beginning of section 010-018 for codes and definitions.
    • Use additional code to identify any associated silicosis (502)
  • 012 Other respiratory tuberculosis
    • Requires fifth digit. See beginning of section 010-018 for codes and definitions.
    • Excludes:
      • respiratory tuberculosis, unspecified (011.9)
  • 013 Tuberculosis of meninges and central nervous system
    • Requires fifth digit. See beginning of section 010-018 for codes and definitions.
http icd9cm chrisendres com83
http://icd9cm.chrisendres.com/
  • 014 Tuberculosis of intestines, peritoneum, and mesenteric glands
    • Requires fifth digit. See beginning of section 010-018 for codes and definitions.
  • 015 Tuberculosis of bones and joints
    • Requires fifth digit. See beginning of section 010-018 for codes and definitions.
    • Use additional code to identify manifestation, as:
      • tuberculous:
        • arthropathy (711.4)
        • necrosis of bone (730.8)
        • osteitis (730.8)
        • osteomyelitis (730.8)
        • synovitis (727.01)
        • tenosynovitis (727.01)
http icd9cm chrisendres com84
http://icd9cm.chrisendres.com/
  • 016 Tuberculosis of genitourinary system
    • Requires fifth digit. See beginning of section 010-018 for codes and definitions.
  • 017 Tuberculosis of other organs
    • Requires fifth digit. See beginning of section 010-018 for codes and definitions.
  • 018 Miliary tuberculosis
    • Includes:
      • tuberculosis:
        • Disseminated
        • Generalized
        • miliary, whether of a single specified site, multiple sites, or unspecified site
        • polyserositis
hcpcs
HCPCS
  • The Health Care Procedure Coding System is comprised of Level I (CPT) and Level II (National) codes.
  • Level II HCPCS codes are developed by the Centers for Medicare & Medicaid Services (CMS) and used to classify report procedures and services.
cpt current procedural terminology
CPT (Current Procedural Terminology)
  • a numeric coding system maintained by the American Medical Association (AMA).
  • The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals.
slide87
Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.
level ii hcpcs
Level II HCPCS
  • Codes are reported to third-party payers (e.g., insurance companies) for reimbursement purposes.
slide89
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office
slide90
Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.
  • The Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes;
  • Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing.
http www cms hhs gov medicare hcpcs
http://www.cms.hhs.gov/medicare/hcpcs/

A1001007DRESSING FOR ONE WOUND Dressing for one wound C 2002070120020701 N

A2001007DRESSING FOR TWO WOUNDS Dressing for two wounds C 02002070120020701 N

A3001007DRESSING FOR THREE WOUNDS Dressing for three wounds C 02002070120020701 N

abstracting
Abstracting
  • Performed to enter codes and other pertinent information utilizing computer software.
  • To generate statistical reports and disease/procedure indexes, which are used for administrative decision-making and quality-management purposes.
incomplete record processing
Incomplete record processing
  • Includes the assembly and analysis of discharged patient records.
  • After a patient is discharged from a nursing unit, the record is retrieved and reports are assembled according to a hospital- and medical staff-approved order of assembly.
medical transcription
Medical transcription
  • Involves the accurate and timely transcription of dictated reports.
record circulation
Record circulation
  • Includes the retrieval of patient records, for the purpose of:
    • Inpatient readmission
    • Scheduled and unscheduled outpatient clinic visits
    • Authorized quality-management studies
    • Education and research
licensure regulation and accreditation
Licensure, Regulation and Accreditation
  • Code of Federal Regulations (CFR)
  • Federal Register
    • A legal newspaper published every business day by the National Archives and Records Administration (NARA) in paper form, microfiche, and online.
  • Accreditation Standards and Surveys
regulation
Regulation
  • A regulation is an interpretation of a law that is written by the responsible regulatory agency.
  • E.g. the Conditions of Participation (CoP) are regulations written by the Centers for Medicare & Medicaid Services (CMS).
  • Congress writes and passes an act, the President signs the act into law, and CMS interprets the law creating a regulation.
accreditation
Accreditation
  • A voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law.
standards
Standards
  • Accreditation organizations develop standards, which are measurements of a health care organization’s level of performance in specific areas and are usually more rigorous than regulations.
survey
Survey
  • A survey (evaluation) process is conducted both off-site and on-site to determine whether the facility complies with standards.
accrediting organizations
Accrediting Organizations
  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • American Osteopathic Association (AOA)
  • Commission on Accreditation of Rehabilitation Facilities (CARF)
  • Community Health Accreditation Program (CHAP)
accrediting organizations103
Accrediting Organizations
  • Joint Commission on Accreditation of Health Care Organizations (JCAHO)
  • National Committee for Quality Assurance (NCQA)
  • National Commission on Correctional Health Care (NCCHC)
homework
Homework
  • Find out the corresponding accrediting agencies in Taiwan
bringing a new drug to market
Bringing a new drug to market

1 compound

approved

Review and approval by Food & Drug Administration

Phase III: Confirms effectiveness and monitors

adverse reactions from long term use in

1000 to 500 patient volunteers.

Phase II: Assesses effectiveness and

looks for side effects in 100 to 500

patient volunteers

Discovery and preclinical testing: Compounds are identified and evaluated in laboratory and animal studies for safety, biological activity, and formulation.

Phase I: Evaluate safety and dosage

in 20 to 100 healthy human volunteers.

5 compounds

enter

clinical trials

5000 compounds evaluated

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 years