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Reimbursement and Auditing in Healthcare

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Reimbursement and Auditing in Healthcare

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Questions and Answers

How do insurance companies use documentation by the health care team?

To set standards for nursing practice

To determine payment or reimbursement for health care services (correct)

To determine the quality of care provided only

To determine the severity of illnesses only

What is one of the purposes of hospitals establishing quality improvement programs?

To conduct reviews of patient care and inform nurses of standards of nursing practice (correct)

To enforce accreditation requirements

To evaluate patient satisfaction only

To determine patient care costs

For what purpose do researchers use patient records?

To gather statistical data on health problems, interventions, outcomes, and deaths (correct)

To assess nursing staff performance

For billing and coding purposes only

To maintain hospital accreditation

What contribution does data analysis from patient records make to nursing practice according to the text?

It contributes to evidence-based nursing practice and quality health care (C) Signup and view all the answers

What is one way to learn about an individual's response to an illness, according to the text?

By reading a patient care record (B) Signup and view all the answers

What is a key aspect that accrediting agencies require in patient records?

An individualized plan of care developed with a patient's input (C) Signup and view all the answers

In the context of reimbursement, what determines the amount hospitals receive from PHILHEALTH?

Severity of illness (D) Signup and view all the answers

What role do nurses play in maintaining excellence in nursing care according to the text?

Conducting ongoing reviews of patient care (D) Signup and view all the answers

What type of statistical data do researchers gather using patient records?

Data on the incidence and prevalence of health problems and outcomes in recovery from illness (B) Signup and view all the answers

Besides conducting reviews of patient care, what is another purpose of quality improvement programs established by hospitals?

Keeping nurses informed of standards of nursing practice (C) Signup and view all the answers