The Future of Medicare--N.J.: Hearing Before the Subcommittee on Human Services of the Select Committee on Aging, House of Representatives, Ninety-eighth Congress, First Session, March 28, 1983, Princeton, N.J.U.S. Government Printing Office, 1983 - 219 pages |
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Page 89
... assignment and claims , and generate and interpret reports . Three , implementation . Based upon New Jersey's experience the phasing in of the hospitals over a 3 - year period was very impor- tant . It is not until a system is actually ...
... assignment and claims , and generate and interpret reports . Three , implementation . Based upon New Jersey's experience the phasing in of the hospitals over a 3 - year period was very impor- tant . It is not until a system is actually ...
Page 98
... assignment and affect hospital reimbursement . The term " DRG Creep " was coined to describe deliberate and systematic ordering of secondary diagnoses or procedures to obtain the highest reimbursement . In some instances , rearrange ...
... assignment and affect hospital reimbursement . The term " DRG Creep " was coined to describe deliberate and systematic ordering of secondary diagnoses or procedures to obtain the highest reimbursement . In some instances , rearrange ...
Page 99
... assignment , it also mandated that documentation for everything be present in the medical record . DRG Creep is not a problem with the 467 DRGs . The computer program selects the secondary diagnosis codes or procedure codes needed for ...
... assignment , it also mandated that documentation for everything be present in the medical record . DRG Creep is not a problem with the 467 DRGs . The computer program selects the secondary diagnosis codes or procedure codes needed for ...
Page 100
... assignment and dollars charged . They must have edit and submission checks to obtain accurate data on a timely basis . Data requirements and timeliness for data submission should be worked out ahead of time and then enforced ...
... assignment and dollars charged . They must have edit and submission checks to obtain accurate data on a timely basis . Data requirements and timeliness for data submission should be worked out ahead of time and then enforced ...
Page 102
... assignment and claim check . PSROS must understand their role in assuring quality data and quality care under DRGs . Planning agencies must be able to use DRGs as tools to make their planning decisions . If the entire hospital is not ...
... assignment and claim check . PSROS must understand their role in assuring quality data and quality care under DRGs . Planning agencies must be able to use DRGs as tools to make their planning decisions . If the entire hospital is not ...
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Common terms and phrases
AARP accept assignment acute Administration Association average benefits bills budget chronic clients coinsurance CONGRESS THE LIBRARY copayments cost containment County coverage DAVIS deductible demonstration Department of Health disabled discharge doctors DRG hospitals DRG system durable medical equipment elderly evaluation expenditures Federal fees fiscal HCFA Health and Human health care costs Health Care Financing health insurance health services home health agencies hospital costs Hospital Insurance Human Services implementation incentives income increase inflation Jersey KEISERMAN legislation LIBRARY OF CONGRESS Livengood long-term major medi Medicaid Medicare and Medicaid Medicare beneficiaries Medicare patients Medicare program ment million Monmouth County National nursing home out-of-pocket out-of-pocket costs payers percent physicians premium preventive problems proposal prospective payment system prospective reimbursement reduce reform revenues RINALDO savings senior citizens skilled nursing SMITH Social Security Somers spell of illness
Popular passages
Page 202 - The most critical issues, however, relate to the Medicare program. Both the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund show alarming financial results...
Page 26 - ... (1) part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse...
Page 27 - ... (A) in the case of home health services (i) such services are or were required because the individual is or was confined to his home (except when receiving items and services referred to in section 1861 (m)( 7) ) and needed skilled nursing care on an intermittent basis, or physical or speech therapy...
Page 171 - ... on a daily basis skilled nursing care (provided directly by or requiring the supervision of skilled nursing personnel) or other skilled rehabilitation services, which as a practical matter can only be provided in a skilled nursing facility on an inpatient basis...
Page 80 - ... already so apparent that it seems inevitable that it will have to be revised, qualified, or regulated by law before the program is very old. If repayment of costs, whatever they turn out to be, is virtually guaranteed— and Medicare, under present regulations, is openended in that respect— where are the financial incentives for cost control, difficult enough in any case, to come from?
Page 27 - IV-A of the Act for failure to provide early and periodic screening, diagnosis, and treatment of children. (4) Provide for the inclusion of home health services which, as a minimum, shall include nursing services, home health aide services, and medical supplies, equipment and appliances, as specified in paragraph (b) (7) of this section. Under this requirement, home health services must be provided to all categorically needy individuals 21 years of age or over; to all categorically needy individuals...
Page 27 - Physical therapy, occupational therapy, or speech pathology and audiology services, provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services. (See § 441.15 of this subchapter.) (c) A recipient's place of residence, for home health services, does not include a hospital, skilled nursing faciliHealth Car...
Page 80 - In no other realm of economic life today are payments guaranteed for costs that are neither controlled by competition nor regulated by public authority, and in which no incentive for economy can be discerned.
Page 84 - The splitting of the atom has changed everything, save our mode of thinking and thus we drift toward unparalleled catastrophe.
Page 27 - Federal funding became available for the costs of case management, homemaker, home health aide, personal care, adult day health, habilitation, respite care, and other services requested by the State and approved by the Secretary (46 FR 48532). Combining this "services...