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Chapter 15 & 16 Review

Across
Medical condition that arises during an inpatient hospitalization
Paying for healthcare with own funds
The intentional deception that an individual knows to be false
Set of internal policies and procedures that healthcare entity puts into place to comply with applicable state and federal laws
Function that allows retrospective reconstruction of events
Medical condition that coexists with primary cause for hospitalization and affects the patient's treatment and LOS
Helps with the medical costs for Americans with low incomes and limited resources
Down
The insurance company that pays the claim for a patient
Using multiple codes to bill for various steps instead of using a single code that includes everything.
The amount the policy holder must incur
Systematic comparison of the products, services, and outcomes of one organization with those of a similar organization
A healthcare delivery system or network organized to manage cost, utilization, and quality
Whistleblower provision of False Claim Act
Practices that, either directly or indirectly, result in unnecessary costs to the Medicare program
A cost sharing measure to pay a fixed dollar amount