Healthcare Delivery Systems

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Healthcare Delivery Systems by Mind Map: Healthcare Delivery Systems

1. Long term Care

1.1. Data Set

1.1.1. MDS

1.1.1.1. Hearing, speech and vision

1.1.1.2. Cognitive Patterns

1.1.1.3. Mood Behavior

1.2. Coding

1.2.1. ICD-10-CM

1.3. Reimbursement

1.3.1. Medicare Payment Methodology

1.3.1.1. MS LTC DRGs

1.3.2. Medicaid Per Diem

1.4. Regulatory Body

1.4.1. Joint Commission

1.4.2. CMS

1.4.3. State Licensing Agency

1.5. Professional Roles

1.5.1. Directory of Health Information Systems

1.5.2. Health Information Manager

2. Ambulatory/Same Day Surgery

2.1. Data Set

2.1.1. UACDS

2.1.1.1. Patient Data

2.1.1.2. Provider Data

2.1.1.3. Encounter Data

2.2. HEDIS

2.2.1. Adolescent Immunizations

2.2.2. Breast Cancer Screening

2.2.3. Medical Assistance with Smoking

2.2.4. Antidepressant Medication

2.3. Coding

2.3.1. ICD

2.3.2. HCPCS

2.3.3. CPT

2.3.3.1. Breast Cancer Screening

2.4. Reimbursement

2.4.1. Paid by Medicare Based on HCPCS and CPT Codes

2.4.2. Meidcare ASC Reimbursement System

2.4.2.1. Capitation

2.5. Regulatory Body

2.5.1. State Department of Health

2.5.2. Joint Commission

2.5.3. Accreditation Association for Ambulatory Health Care INC.

2.5.4. Commission for the Accreditation of Birth Centers

2.6. Professional Roles

2.6.1. Coding

2.6.2. Electronic Information Systems

2.6.3. Regulatory Compliance

2.6.4. Administrative Functions

3. ER

3.1. Data Sets

3.1.1. Deeds

3.1.1.1. Patient Identification Data

3.1.1.2. ED Payment Data

3.1.1.3. ED Medication Data

3.1.1.4. ED Hisotry and Physical Patient Data

3.2. Coding

3.2.1. ICD-10-CM

3.2.2. CPT

3.2.3. HCPCS

3.3. Reimbursement

3.3.1. Medicare Hospital Outpatient Prospective Payment System (HOPPS or OPPS)

3.3.1.1. Known as Ambulatory Payment Classifications, (APCs)

3.3.2. APC Reimbursement

3.4. Regulatory Body

3.4.1. Federal Government

3.4.2. Joint Commission

3.4.3. Healthcare Facilities Accreditation Program (HFAP)

3.4.4. National Integrated Accreditation of Healthcare Organizations (NIAHO)

3.4.5. Professional Roles

3.4.5.1. Health Information Managers

3.4.5.2. Coding Specialists

4. Physician/ Clinic

4.1. Data Set

4.1.1. HEDIS

4.1.1.1. Adolescent Immunizations

4.1.1.2. Breast Cancer Screening

4.1.1.3. Medical Assistance with Smoking

4.1.1.4. Antidepressant Medication

4.1.2. ORYX

4.1.2.1. Pneumonia

4.1.2.2. Stroke

4.1.2.3. Prenatal Care

4.1.3. UACDS

4.1.3.1. Patient Data

4.1.3.2. Provider Data

4.1.3.3. Encounter Data

4.2. Coding

4.2.1. CPT

4.2.2. ICD-10-CM

4.3. Reimbursement

4.3.1. Medicare Part B Based on Number of Visits

4.4. Regulatory Body

4.4.1. State Licensure

4.4.2. Federal Government

4.4.3. NCVHS

4.5. Professional Roles

4.5.1. Statistics

4.5.2. Complete Records

5. Inpatient Hospital

5.1. Data Set

5.1.1. HEDIS

5.1.1.1. Adolescent Immunizations

5.1.1.2. Medical Assistance with Smoking

5.1.1.3. Antidepressant Medication

5.1.2. ORYX

5.1.2.1. Pneumonia

5.1.2.2. Stroke

5.1.2.3. Prenatal Care

5.1.3. UHHDS

5.1.3.1. Date of Birth

5.1.3.2. Sex

5.1.3.3. Prenatal Care

5.1.3.4. Race and Ethnicity

5.1.3.5. Admission Date

5.2. Coding

5.2.1. ICD-10-CM

5.2.2. ICD-10-PCS

5.3. Reimbursement

5.3.1. CDM

5.3.2. IPPS

5.3.2.1. Based on MS-DRG

5.4. Regulatory Body

5.4.1. State Licensure

5.4.2. Federal Government

5.4.3. NCVHS

5.5. Professional Roles

5.5.1. Statistics

5.5.2. Complete Records

6. Outpatient

6.1. Data Sets

6.1.1. UACDS

6.1.1.1. Patient Data

6.1.1.2. Provider Data

6.1.1.3. Encounter Data

6.2. Coding

6.2.1. ICD-10-CM

6.2.2. HCPCS

6.3. Reimbursement

6.3.1. Medicare Hospital Outpatient Prospective Payment System (HOPPS or OPPS)

6.3.1.1. Known as Ambulatory Payment Classifications (APCs)

6.3.2. APC Reimbursement

6.4. Regulatory Body

6.4.1. HFAP

6.4.2. AOA

6.4.3. NIAHO

6.4.4. Joint Commission

6.4.5. Licensed by the State

6.5. Professional Roles

6.5.1. Coding Specialists

6.5.2. Retrieving and Filing of Records

6.5.3. Release of Information

6.5.4. Data Collection

7. Prisons

7.1. Data Sets

7.1.1. Government Agencies

7.1.1.1. FBI

7.1.1.2. Center for Disease Control

7.1.2. Healthcare Facilities

7.1.2.1. Hospitals

7.1.2.2. Community Health Clinics

7.2. Coding

7.2.1. Schedule

7.2.2. Budget

7.2.3. ICD-10-

7.3. Reimbursement

7.3.1. Private Managed Care Organizations

7.3.2. Taxes

7.3.3. Inmate Self-Pay or Co-Payment

7.4. Regulatory Body

7.4.1. National Commission on Correctional Healthcare

7.4.2. American Correctional Association

7.4.3. Joint Commission

7.4.4. American Public Health Association

7.5. Professional Roles

7.5.1. Manage Inmate Health Records

7.5.2. Gathering Statistical Information

7.5.3. Developing Tools to Monitor and Measure Compliance