Presentation Transcript

1. Domain VI-Legal and Regulatory Standards (6%)

   RHIA Prep Workshop 2014
2. Domain Content 1.Administer organizational compliance with healthcare information laws, regulations and standards (for example, audit, report and/or inform; legal health record) 2.Prepare for accreditation and licensing processes (for example, Joint Commission, Medicare, state regulators)
3. Hot Topics Data quality management Medicare Conditions of Participation Health programs RHIO Living Wills Advanced Directives Power of Attorney Consent to treat Patient Rights and Responsibilities
4. Hot Topics IT standards- X12N, HL7, LOINC, National Health Information Network National Committee on Vital and Health Statistics EHR Collaborative Data collection: OASIS HEDIS MDS UHDDS Record retention- purpose, NOT state specific rules HIPAA
5. Practice question #1 What is it called when accrediting bodies such as the Joint Commission or AOA can survey facilities for compliance with the Medicare Conditions of Participation for Hospitals instead of the government? Deemed Status Judicial decision Subpoena Credentialing
6. Legal Aspects Sources of Law: Constitutional Common law Statutory law Administrative law State vs. Federal regulations and statutes- know how they work, who has more power
7. Regulatory/licensing agencies State power Develop standards hospitals must meet Issue licenses to hospitals who meet standards Monitor continuing compliance Penalize violations of standards. Licensure Accrediting The Joint Commission American Osteopathic Association Statutory and regulatory law HIPAA- Privacy and security
8. The Joint Commission Develops standards that help healthcare organizations measure and evaluate the care they provide. Performance Measurement System Indicators monitoring system (IMS) Core performance measures Data-driven accreditation ORYX (not an acronym) Performance initiative, national measures Patient Safety Considered voluntary and not legally mandated.
9. Practice Question #2 Accreditation standards and the Medicare Conditions of Participation require that the patient’s _______ be documented by the attending physician in the patient’s health record no more than 30 days after discharge. Principal diagnosis Principal procedure Comorbidities Complications
10. HEDIS Health Plan Employer Data and Information Set Effectiveness of care Access and availability of care Satisfaction with care Health plan stability Utilization of services Cost of care Healthcare choices Health plan descriptive information Collects data on managed care plans.
11. HIPAA Privacy rule: How and for what purposes PHI can be used Security rule: Administrative, physical, and technical safeguards Patient authorization- confidentiality Patient access to records Accounting of disclosures HITECH
12. Practice Question #3 Mary Smith, RHIA, has been charged with the responsibility of designing a data collection form to be used on admission of a patient to the acute care hospital in which she works. The first resource that she should use is ____. UHDDS UACDS MDS ORYX
13. Any Questions????