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CRCS EXTRA 6

AAHAM CRCS STACK 1

QuestionAnswer
Who reviews written quality of svc complaints for Medicare and what does the review address? QIO (Quality Improvement Organization, which is under CMS). Review addresses: whether svcs provided met professionally recognized standards of HC, if appropriate svcs were provided in appropriate setting. Results are submitted to the CMS.
What is the goal of the QIO? QIO= Quality Improvement Organization Program: Under CMS, monitors and improves utilization and quality of care for MC beneficiaries. There is a national network of QIO's for each state, territory and DC.
What does AHA stand for and what is it responsible for? American Hospital Association Patient Bill of Rights, which later was replaced by a plain language brochure called the Patient Care Partnership.
What does the Patient Care Partnership state? Expectations that patients and their families can have for treatment during their care.
What does OIG stand for and what does it do? Office of Inspector General protects the integrity of the HHS programs and the health and welfare of the beneficiaries of these programs. Play a major role in investigating Fraud and Abuse.
What does AAHAM stand for? American Association of Healthcare Administrative Management.
What does CMS stand for and what do they do? Centers for Medicare and Medicaid Services Rules & Regs that govern MC & MA. Oversight of MC program (Title XVIII) and federal portion of MA Program (Title XIX) as well as state CHIP, the health ins marketplace and related quality assurance activities.
What are the 2 main governing bodies that affect healthcare change and what department oversees them? CMS (Centers for Medicare and Medicaid Services) OIG (Office of Inspector General) Overseen by: HHS (US Dept of Health and Human Services)
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