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Case Management week 2021

Horizontales
A health condition (disease) that lasts three months or longer (2 words)
The mental ability and capacity to make decisions, accomplish actions, and perform tasks that another person of similar background and training, or any human being, would be reasonably expected to perform adequately.
A notice of discharge from the acute care setting that hospitals are required to deliver to all Medicare beneficiaries (original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospitalized, informing them of their hospital discharge appeal rights. (abbreviation)
A person appointed by the court to be a substitute decision- maker for persons receiving services deemed to be incompetent of making informed decisions for themselves. (2 words)
Instructions given by individuals specifying what actions should be taken for their health in the event they are no longer able to make decisions due to illness or incapacity; a person is appointed to make such decisions on their behalf. (2 words)
A system of inpatient and outpatient care, which is supportive and palliative family-centered care, designed to assist the individual with terminal illness to be comfortable and maintain a satisfactory lifestyle through the end of life.
The act of recommending, pleading the cause of another; to speak or write in favor of.
No authorization or certification is given for healthcare services because of the inability to provide justification of medical necessity or appropriateness of treatment or length of stay.
A condition under which clients who appear in the emergency department (ED) but need a little more time after their ED stay to sort out whether they truly need admission to an acute care/hospital setting as inpatients. Care for these clients usually lasts less than 24 hours although sometimes may extend to a few days.
Equipment needed by patients for self-care. Usually it must withstand repeated use, is used for a medical purpose, and is appropriate for use in the home setting (abbreviation)
The person responsible for caring for a client in the home setting. Can be a family member, friend, volunteer, or an assigned healthcare professional.
A specialized care facility designed to treat acutely ill patients who benefit from a prolonged ALOS for a minimum of 25 days. (abbreviation)
Verticales
A letter provided to patients informing them of insurance noncoverage in case they refuse hospital discharge or insist on continued hospitalization despite the review by the peer review organization (PRO) that indicates their readiness for discharge. (abbreviation)
The process of collecting in-depth information about a person’s situation and functioning to identify individual needs in order to develop a comprehensive case management plan that will address those needs.
The deliberate organization of patient care activities between two or more participants (including the patient) involved in patient's care to facilitate the appropriate delivery of health care services. (2 words)
A type of review used to determine that the hospital admission is appropriate, clinically necessary, justified, and reimbursable (2 words)
Designation given to eligible rural hospitals by CMS which is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. Ex: Urbana Hospital (2 words)
A collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet the client’s health and human services needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes (2 words)
Quality Improvement Organization (QIO) used in Ohio to process patient discharge appeals
The number of days that a health plan member/client stays in an inpatient facility, home health, or hospice. (abbreviation)
A specific amount of money the insured person must pay before the insurer's payments for covered healthcare services begin under a medical insurance plan.
A patient day in the hospital during which hospital services were not rendered or could have been safely and appropriately performed in an alternate or lower level of care. (2 words)
A term for the coverage gap in Medicare Part D, that causes individuals to pay 100 percent of drug costs until the annual deductible amount is reached.
The thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups
A national law that ensures clients’ medical information is kept confidential (abbreviation)