HIM2012 COPAssignment Week8 completed
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School
St. Petersburg College *
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Course
2012
Subject
Medicine
Date
Apr 3, 2024
Type
doc
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2
Uploaded by DoctorMonkey8278
HEALTH INFORMATION MANAGMENT
Federal and State Requirements and Accreditation Guidelines Assignment: Medicare Conditions of Participation
Lab Assignment Directions: 1.
Go to Medicare’s Condition of Participation website: https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs
2.
Search for Interpretive Guidelines (
also located in the supporting files
folder).
3.
Answer the following questions:
Under 482.22 Conditions of participation: Medical Staff:
When must a medical history and physical examination be performed? Under 42 CFR 482.22 Conditions of participation for Medical Staff, a medical history and
physical examination must be performed within 30 days before or 24 hours after admission or registration. This regulation applies to patients who are admitted to the hospital, ensuring that necessary medical information is collected promptly to inform the patient's care plan.
Under 482.24 Conditions of participation: Medical record services:
What is the standard for form and retention of regarding coding?
Under 42 CFR 482.24 Conditions of participation for Medical Record Services, the standard for form and retention of records regarding coding is that the medical records must contain appropriate coding for diagnoses and procedures. These codes should accurately reflect the patient's conditions and treatments as documented in the medical record. Additionally, healthcare facilities must retain records regarding coding for at least
5 years. This retention period ensures that coding information is available for auditing, billing, and quality improvement purposes.
Under 482.24 Conditions of participation: Medical record services:
What is the standard for form and retention regarding confidentiality of patient records?
Under 42 CFR 482.24 Conditions of participation for Medical Record Services, the standard for form and retention regarding confidentiality of patient records requires healthcare facilities to maintain the confidentiality of patient records. This includes implementing policies and procedures to safeguard patient information against unauthorized access, use, or disclosure. The confidentiality of patient records must be maintained throughout the record's retention period, which typically extends for a minimum of 5 years. Healthcare facilities are also required to comply with applicable federal and state laws, such as the Health Insurance Portability and Accountability Act (HIPAA), which provide comprehensive regulations regarding the privacy and security of patient health information. Additionally, healthcare providers and staff must receive 1
training on confidentiality policies and practices to ensure compliance and protect patient
privacy.
Under 482.24 Conditions of participation: Medical record services:
What is the standard for content of record regarding the medical record?
Under 42 CFR 482.24 Conditions of participation for Medical Record Services, the standard for content of the medical record is comprehensive and includes various elements to ensure the accuracy, completeness, and accessibility of patient information.
As an HIM professional, how would you apply these policies and procedures to ensure the accuracy and integrity of health data?
As a Health Information Management (HIM) professional, ensuring the accuracy and integrity of health data involves implementing and enforcing policies and procedures that
govern the creation, maintenance, and use of patient records.
Each question is worth 2 points.
2
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