What two types of med gas are required in a typical med\/surg patient room?
vacuum and oxygen according to Guidelines for Design and Construction of Health Care Facilities.<\/p>\n\n\n\n
When should medical equipment modality selections ideally be made during the planning, design, and construction process?
Before the end of SDs<\/p>\n\n\n\n
When should medical equipment manufacturer selections ideally be made for each modality during the planning, design, and construction process?
Before the end of DDs<\/p>\n\n\n\n
What is a medical equipment modality?
Refers to different types of imaging equipment<\/p>\n\n\n\n
What are some examples of medical imaging modalities?
Conventional radiography
Fluoroscopy
Angiography
Mammography
Computed Tomography
Ultrasound and Ultrasound\/Doppler
Magnetic resonance Imaging
Nuclear Medicine<\/p>\n\n\n\n
NFPA 101-2000 details that “primary level of exit discharge of a building shall be the lowest story whose floor is level with or above finished grade on the exterior wall line for XX% or more of its perimeter.”
50%<\/p>\n\n\n\n
Does an MRI machine use radiation to produce its images?
No, it uses magnetic and radio frequencies<\/p>\n\n\n\n
Does an ultrasound use radiation to produce its images?
No, it uses sound waves<\/p>\n\n\n\n
What does a CT scan machine use to produce its images?
Ionizing radiation<\/p>\n\n\n\n
When should ICRA planning be complete when a new construction project is being built next to an existing building if the two will eventually connect?
Before construction starts<\/p>\n\n\n\n
Before an employee enters a permit-required confined space, the internal atmosphere shall be tested with a calibrated direct-reading instrument for oxygen content and which of the following?
potential toxic air contaminants, and flammable gases and vapors<\/p>\n\n\n\n
What are the 3 main components of the exterior wall system that keeps moisture out of the building?
weather barrier, air gap, exterior finish<\/p>\n\n\n\n
What is the best contract type for an owner if a project is only 50% designed?
cost plus GMP<\/p>\n\n\n\n
Is a facility in bad shape if it has a high FCI number?
Yes<\/p>\n\n\n\n
Is self latching hardware required at doors within openings that are part of the smoke barrier?
No<\/p>\n\n\n\n
How often should fire extinguishers be inspected at an HCF?
Monthly<\/p>\n\n\n\n
How often should alternate exits caused by an ILSM plan be inspected during construction?
Daily<\/p>\n\n\n\n
What wall type should separate renovation space from occupied space in a non-sprinklered?
1-hour<\/p>\n\n\n\n
What is a sentinel event?
Any event that causes unanticipated harm to a patient not related to the natural course of the patient’s illness (according to TJC)<\/p>\n\n\n\n
Acute is to ambulatory as\u2026
inpatient is to outpatient<\/p>\n\n\n\n
What is the most important ICRA requirement during a roof replacement?
Keeping the building dry to prevent mold growth<\/p>\n\n\n\n
How many smoke compartments must a floor have if it is somewhere that patients sleep or patients are treated?
2 according to NFPA 101-2000<\/p>\n\n\n\n
Does a general hospital or an ACC have a higher patient acuity? Why?
General hospital because it has an ER and an ICU. Ambulatory hospitals are outpatient hospitals.<\/p>\n\n\n\n
When should an ILSM plan be implemented?
Anytime construction occurs, but also anytime a life safety issue is identified and cannon be immediately mitigated.<\/p>\n\n\n\n
What is the most important patient safety feature in an inpatient behavioral health unit?
Suicide prevention<\/p>\n\n\n\n
Is lead shielding required when constructing an MRI room?
No, no radiation is involved in the imaging process<\/p>\n\n\n\n
What is the general procedure for when a hospitals fire alarm system is down during construction for an extended amount of time?
A hot work permit should be obtained, a fire watch implemented, and the system restored after closing out the hot work permit<\/p>\n\n\n\n
How long does fire watch need to be implemented during hot work?
Fire watch must be implemented until the hot work permit is closed out<\/p>\n\n\n\n
What specifies the duration of a fire watch during hot work?
The hot work permit<\/p>\n\n\n\n
What type of radiation does a positron emission tomography (PET) Scan use for imaging?
intravenous radioactive materials<\/p>\n\n\n\n
What does an electroencephalography (EEG) machine monitor?
Brainwaves<\/p>\n\n\n\n
What is polysomnography (PSG) used for?
PSG monitors physiological data during sleep studies.<\/p>\n\n\n\n
What is the Green Guide for Healthcare used for?
The Green Guide for Health Care is an agency that awards certification for buildings constructed to meet their standards.<\/p>\n\n\n\n
Is temporary signage a required component in maintaining patient safety during construction?
No<\/p>\n\n\n\n
What are some examples of patient safety requirements during construction?
back-up power, method of infection control, and fire\/life safety<\/p>\n\n\n\n
What typical cryogenic material is used to cool an MRI device?
Liquid helium<\/p>\n\n\n\n
What is the danger to the patient if cryogenic material leaks?
it can displace air (starting at floor level because it is heavier than air) and cause asphyxiation<\/p>\n\n\n\n
What is it called when cryogenic material is suddenly released?
Quenching<\/p>\n\n\n\n
What is a risk associated with quenching a cryogen?
the liquid cryogen may rapidly turn to gas and release large amounts of energy resulting in an explosion.<\/p>\n\n\n\n
Which of the following considerations is MOST important when selecting a construction delivery method for a project
Goals<\/p>\n\n\n\n
What is the order of load shedding that should occur if a power outage occurs?
Equipment then critical then life safety<\/p>\n\n\n\n
What is the purpose of having segregated branches of electrical systems?
load shedding that should occur if a power outage occurs<\/p>\n\n\n\n
Place the following building envelope materials from the LEAST to MOST
expensive per square foot.<\/p>\n\n\n\n
Is tilt wall construction more expensive than masonry type construction?
No<\/p>\n\n\n\n
What are the 2 dangers of storing new IT equipment on a construction site?
Theft and dust<\/p>\n\n\n\n
How many people die a year from hospital
acquired infections (HAI’s)
99,000<\/p>\n\n\n\n
What percent of those that die from HAI’s can
be attributed to construction
5% to 7%<\/p>\n\n\n\n
What are 4 main components of an ante room?
Hepa with magnehelic gauge, Sticky and walk off mats, Dedicated power, Signs with precaution levels<\/p>\n\n\n\n
What class of construction requires an anteroom?
Class IV and whenever the ICRA plan specifies<\/p>\n\n\n\n
What are some examples of construction activities that require a fire watch?
Cutting, torching, welding, Soldering, All open flame work, Fire alarm is inoperable for more than 4hrs in a 24 hour period, Using a chop saw<\/p>\n\n\n\n
During an ILSM the Hospital Safety department
is required to conduct additional fire drills how
often?
Once per shift per quarter<\/p>\n\n\n\n
How often are exits checked during an ILSM condition?
Daily<\/p>\n\n\n\n
What should partitions be made out of in an ILSM condition?
non-combustible materials<\/p>\n\n\n\n
What does the acronym ILSM stand for?
Interim life safety measurement<\/p>\n\n\n\n
The ILSM will be established, implemented, documented and monitored during construction by:
The Director of Facilities & The Construction Manager<\/p>\n\n\n\n
What are some examples of construction related educational concepts that a hospital might promote?
a) Building deficiencies
b) Construction hazards
c) Temporary measures are implemented
e) Maintaining fire safety<\/p>\n\n\n\n
What are the two purposes of a fire watch?
-Supplement the existing fire detection
and response system
-To confirm all hot work has “cooled”
down and the safety of patients, staff and
visitors is not jeopardized<\/p>\n\n\n\n
Corridor doors in a one hour smoke barrier must meet the following minimum requirements?
20 minute label, self-closing with non-latching hardware<\/p>\n\n\n\n
According to the Life Safety Code, which of the following is correct in regard to corridor walls in a sprinklered occupancy?
The walls must limit transfer of smoke<\/p>\n\n\n\n
In an Existing Facility, that is sprinklered, corridor doors must be able to resist X pounds of pressure from the latch side of the door?
5 pounds<\/p>\n\n\n\n
Tubing for positive pressure medical gas systems delivered from the manufacturer shall have these 3 requirements:
Plugged or capped, Hard-drawn seamless, Identified as “oxy” or “med”<\/p>\n\n\n\n
In positive pressure systems, area alarm sensors for vital life support and critical care areas shall be located on which 3 sides side of the
zone valve box assemblies?
patient room, outlet\/inlet, and downstream<\/p>\n\n\n\n
Where shall pressure indicators be provided for medical gas systems? (3 part answer)
On the main supply line, At the area alarm, Outlet\/inlet side of zone valve<\/p>\n\n\n\n
A level 1 dedicated WAGD source shall consist of ______or more producers, each shall be sufficient to serve the peak calculated
demand.
two<\/p>\n\n\n\n
Level 1 medical-surgical vacuum sources shall consist of an automatic means to prevent __<\/em><\/strong><\/em><\/strong> through any off-cycle vacuum pump. Where medical air piping systems at different operation pressures are required, the piping shall separate after the __<\/strong><\/em><\/strong>. What is the required time that life safety equipment must be restored to power? When using a metal clad cable for branch wiring in a Healthcare facility what type of cable is to be used? What are the 4 basic test requirements associated with patient care area receptacles and what NFPA Code addresses the issue? How many receptacles are required at a patient bed location (headwall) in a General Care area? Critical Care area? According to NFPA 99-1999, to which branch of the essential electrical system are the medical gas alarm panels connected: Does a laundry room belong on the Critical Branch of the Essential Electrical System in a Patient Care area ? The Joint Commission dates as far back as 1910 with Dr. Ernest Codman with The premise on which TJC inspects is called The three basic elements that make up the environment of Care are When TJC is on site for an inspection they expect to see documentation for these 4 things: What is 3 things are key to minimizing risk to the patient population When you in your accreditation cycle you can be inspected with in _<\/em><\/strong> of your last inspection. For the DOH book, certified subcontractor completion letters should have all of the following 4 attributes If you fail the inspection how long must you typically wait before DOH will come back out? What must you include in the follow up email after the inspection? What NFPA code is required to be shown on the Fire Suppression Compliance Letter? What is NFPA 13? What is NFPA 25? What 3 requirements must be met for Imaging equipment rooms to be permitted to open into a hybrid operating room? When replacing a CT system within an existing suite, which 2 parties must be coordinated with before tie-in of utilities and use of newly completed machine? What are the 3 main procedures of planning the utility interruption itself MGPHO definition What 3 organizations address the qualification of med gas piping inspectors Does the NITC address the qualification of med gas piping inspectors? What kind of plan do you always need? Which ASSE Standard outlines medical gas installer requirements Most Fires from Hot Work occur: Who is responsible for confirming area conditions prior to issue of Hot Work Permit: NPV= ROI= Which project delivery method combines architectural and engineering services with construction performance under one contract (with the CM)? 9) ___<\/em><\/strong><\/em><\/strong> is a tool used to reduce large scale projects into small, easy to manage parts. Name 3 things that are examples of a non-construction activity that should be included in the front end of a hospital renovation project? What does CHC stand for? What are the 4 types of Exam Questions? Name 5 Trends in Health Care Name the 5 types of Health Care Facilities Explain the Departmental Relationships Explain the Departmental Relationships OR Classification Cath Lab” Definition: MOB Definition: PACU Definition: CATH LAB Definition: OB Definition: LDR Definition: LDRP Definition: C-SECTION Definition: ICU Definition: NICU Definition: PICU Definition: SICU Definition: CICU Definition: CCU Definition: BMT Definition: SDs Definition: DDs Definition: CDs Definition: POE Definition: IBC Definition: UBC Definition: NFPA Definition: AHJ Definition: TJC Definition: HFAP Definition: DNV Definition: OSHA Definition: EPA Definition: HIPAA Definition: ADA Definition: CDC Definition: USP Definition: NRC Definition: LEED Definition: UL What does it Govern: NFPA 99 What does it Govern: ANSI\/ASSE Standard 6010″ What does it Govern: ANSI\/ASSE 6030 What does it Govern: NFPA99-2012 Chapter 6 What does it Govern: NFPA 101 Definition: FGI List 3 Items shutting down the Medical Air System affects Max amount of compressed gas allowed in a storage rm How frequently do you have to test Fire Alarm Systems Definition: EOP Definition: HVA What type of space needs lead lining How to calculate ACH: how to find CFM To determine CFM required: AIIR MERV EXPLAIN OR CLASSES: CLASS A EXPLAIN OR CLASSES: CLASS B EXPLAIN OR CLASSES: CLASS C When is 2 stage filtering required? What does it Govern: ASHRAE 188 What determines Capital Expense Vs. Operational Expense Explain MRI Zones What is Emergency Planning and Mitigation based on? List 5 places for heightened safety and security needs \/ issues in the hospital When to implement ILSM? 4 things required when FA out of service more than 4 hours in 24 or when Sprinkler out of service more than 10 hrs in 24 hr period Explain: Vertical exits Explain: Horizontal Exit Passageways Explain: Horizontal Exit What does it Govern: NFPA 241 Exit enclosures cannot be used for (4 things) What utilities can run through an exit enclosure (both vertical and horizontal) What rating is required for separation of occupancies? Typical Rating to protect from Hazards Maximum compartment size of smoke compartments Basic premise used to develop the Life Safety Code Health Care Chapters Maximum travel distance of smoke compartments How many types of construction are on the Risk Classification Matrix? How many Risk Groups are in the Risk Classification Matrix? Definition: ICRMR Where does it come from: PCRA requirement Define PCRA Where does it come from: ICRA during early planning phase Definition: Code Red Definition: Code Pink Definition: Code Blue Definition: HCF Definition: EMR Definition: EHR Definition: PACS To recharge Plumbing Systems (4 options) Definition: RO Definition: DI List 3 types of water treatment system used in a Dialysis system What does it Govern: FGI 2018\/ASHRAE 170 Pressure Relationship: Aii Pressure Relationship: construction sites at Risk Class 3 or 4 What are risk factors for Legionella Door requirements of egress corridors What is a hyperbaric facility FCI calculation 2 main parts we use in FGI Pressure Relationship: Surgery Class B and C \/ Cysto<\/p>\n\n\n\n Pressure Relationship: Critical and intensive care<\/p>\n\n\n\n Pressure Relationship: Aii<\/p>\n\n\n\n Pressure Relationship: PE<\/p>\n\n\n\n What is an Aii room? What is a PE room? Pressure Relationship: Patient Room Filtration Required: Surgery Class B & C\/Cysto Room, Radiology, Inpatient Delivery and recovery Filtration Required: Inpatient care, treatment and diagnosis, Clean supply and clean processing, Aii Filtration Required: PE Room Filtration Required: Skilled nursing facilities Filtration Required: Admin, bulk storage, soiled holding, laundry, food prep, other outpatient spaces Filtration Required: Laboratories and Class A surgery What electrical branch should serve: auto doors used for building egress, elevator cab lighting \/ control \/ communication \/ signaling, generator lighting, battery charger for emergency power battery lighting? What electrical branch should serve: task illumination \/ fixes equipment \/ for patient care of critical care areas, psych bed areas, medication prep areas, pharmacy dispensing areas What electrical branch should serve: egress lighting, exit signs, fire alarms, med gas and med vac alarms, hospital communications systems What electrical branch should serve: isolated power systems in special environments, nurses’ stations, nurse call systems, blood \/ bone \/ and tissue banks, telephone equipment rooms and closets What electrical branch should serve: Non-delayed automatic connection – generator accessories essential for generator operation (must auto transfer) What electrical branch should serve: Delayed – auto connection – vacuum, compressed air, medical and controls air, smoke control stair pressurization, heating, select elevators What electrical branch should serve: HVAC surgery, (OB, ICU, CCU, Nursery, Emergency Procedure areas) and critical areas (AII, PE,\u2026), controls for emergency system equipment Explain Med Gas System Levels What are the 5 types of valves in a Med Gas System? What material is to be used on med gas Levels 1&2 and how to join? What material is to be used on med gas Level 3 and how to join? How do you purge a med gas system? What tests are required for med gas systems? What tests are required for med gas system certification? What general type of scope does the FGI cover? What are the 3 parts of the FGI 2018? What general type of scope does the NFPA 101-2012 cover? List 6 chapters of NFPA 101-2000 and what they cover. What general type of scope does NFPA 99-1999 cover? List 5 chapters NFPA 99-1999 covers What general type of scope does the CDC cover? What general type of scope does USP cover? Explain the ISO number What general type of scope does the NRC cover? What general type of scope does LEED cover? What are the LEED Categories What general type of scope does UL cover? Explain the impact of design on life-costs in the PDC Process List the 5 items of the Project Process (planning based) List the 6 items of the Project Process (construction based) What does it Govern: NFPA 10 What does it Govern: NFPA 13 What does it Govern: NFPA 25 What does it Govern: NFPA 70 What does it Govern: NFPA 70E What does it Govern: NFPA 72 What does it Govern: NFPA 80 What does it Govern: NFPA 90A What does it Govern: NFPA 96 What does it Govern: NFPA 99 What does it Govern: NFPA 99B What does it Govern: NFPA 101 What does it Govern: NFPA 105 What does it Govern: NFPA 110 What does it Govern: NFPA 111 What does it Govern: NFPA 241 What does it Govern: NFPA 1600 What does it Govern: NFPA 54 What does it Govern: NFPA 220 What is the maximum travel distance to a fire extinguisher What are the fire extinguisher mounting height requirements? A reason for having all normal non-emergency branch circuits fed from a single distribution panel at a particular patient bed location is to minimize Which 2 medical gas systems are REQUIRED to be in a typical med\/surg patient room? The owner of an outpatient diagnostic center is planning an expansion and considers adding several new imaging modalities. The owner asks for the construction manager’s input on when the medical imaging equipment selections should be made. When is the BEST time for those selections to be made A new hospital is being developed on a steep sloping site. Several levels will have doors exiting to grade from different levels of the building. According to NFPA 101, how do we determine the “primary level of exit discharge?” When discussing MRI, electromyography (EMG), computerized tomography (CT), and ultrasound examination, which of these uses lead as its primary shielding material? Of the following, which BEST describes an ILSM measures set? In the event of a failure of the medical air compressors, what would be directly affected? Under which of the following delivery methods does a design team NOT have a contract with an owner? Before an employee enters a permit-required confined space, the internal atmosphere shall be tested for oxygen content and what else? A hospital plans to build a 125,000 sq ft ambulatory care center on a green field site. The project schedule requires occupancy within 12 months and a target budget is fixed. The design will be approximately 50% complete at the scheduled time of construction start. To achieve the given schedule and target budget, which of the following is the LEAST practical delivery model for this project? An outpatient unit with a separate CMS provider number is being constructed as an addition to a hospital. How should the addition be separated from the hospital? What is the most effective way of testing the integrity of temporary construction barriers according to the CDC? A fire alarm system is being taken out of service for three months and a temporary fire alarm system will be put into place. According to the interim life safety measures, is testing required of this system? What component of interim life safety measures is\/are required to be inspected daily? Thinking from the standpoint of a contractor, when doing a construction project in a NICU, work will include minor demo, electrical work, and reconstruction of the nursing stations. When selecting demolition equipment, permission must be attained from ______<\/em><\/strong><\/em><\/strong> and the work should be performed as _____<\/em><\/strong><\/em><\/strong> as possible The CDC recommends that microbiologic sampling of air, water, and inanimate surfaces occur only in which of the following situations? A contractor is working in an area that uses the Guidelines for the Design and Construction of Health Care Facilities as code. The contractor should use the version: During what phase of construction is the cost of changing desing features the lowest? According to the Guidelines for the Design and Construction of Hospitals and Outpatient Facilities (2014) the owner shall be provided with which of the following upon occupancy of the building or portion thereof? A hospital is preparing to replace an existing roof. Leadership has voiced concerns on how to proceed based on past failed installations. Samples from the existing roof show moisture in the installation and possible decking deterioration. What is best practice? A construction manager is constructing a comprehensive cancer center. Which of the following is MOST likely to have an effect on the construction sequencing? Which of the following is the newest methodology for project construction? Which of the following is the MOST effective method for reducing infant abductions from a hospital? Sustainability is important for healthcare institutions for which of the following 2 reasons? What should the contractor do after closing the Hot Work Permit? The primary patient safety hazard for computerized tomography (CT Scan) imaging is Which of the following are recognized certification agencies for sustainable design and construction? A hospital is under construction and currently occupied. Which of the following are required to maintain patient safety? What is the maximum number of beds a critical access hospital may have? Which of the following considerations is MOST important when selecting a construction delivery method for a project? Which if the following statements is correct regarding (inpatient) healthcare occupancies and ambulatory healthcare occupancies? Affordable Care Act FGI: Guidelines (2014 Edition 2) Used to be published by the Federal Government HILL-BURTON ACT of 1946<\/p>\n\n\n\n “The Hospital Survey and Construction Act” 2012 NFPA Life Safety Codes<\/p>\n\n\n\n July 5, 2016 the CMS ruled that everyone has to use it. Options for Accreditation (to get Medicare\/Medicaid Reimbursements)<\/p>\n\n\n\n The JC of HFAP (Joint Commission of Healthcare Facilities Accreditation Program) BRAC military healthcare construction CDC: Center For Disease Control<\/p>\n\n\n\n Publishes: Guidelines for Environmental Infection Control in Healthcare Facilities. Building Codes: BOCA and IBC and ICC International codes ICC (International Code Council) is a group resulting from BOCA working to establish global compliance NFPA 101: the Life Safety Code<\/p>\n\n\n\n This is widely adopted in the US. NFPA 25 NFPA 70 NFPA 70 E NFPA 72 NFPA 13 NFPA 70 E NFPA 72 NFPA 99 NFPA 101 NFPA 110 ASHRAE ASHRAE\/ASHE Standard Ventilation of Healthcare Facilities ASHRAE 188P USP USP 797<\/p>\n\n\n\n Refers to chapter 797 called “Pharmaceutical Compounding- Sterile Preparations” in the USP NATIONAL FORMULARY. NFPA 10 NFPA 1600 Types of Capital Assets:<\/p>\n\n\n\n NFPA 10<\/p>\n\n\n\n Federal Sentencing Guidelines – Culpability Score Aggravating Factors<\/p>\n\n\n\n Federal Sentencing Guidelines – Culpability Score Mitigating Factors<\/p>\n\n\n\n Federal Sentencing Guidelines – Seven Elements of an Effective Compliance Program<\/p>\n\n\n\n The only thing worse than not having a policy is\u2026 Medicare reimbursement – hospital inpatient codes Medicare reimbursement – physician codes Questions to guide the scope of an internal investigation.<\/p>\n\n\n\n It is in the best interest of the organization to have the board _<\/em><\/strong>. Six tips for saving on future costs of compliance.<\/p>\n\n\n\n Baseline Audit Process<\/p>\n\n\n\n Compliance Program – Measures of Effectiveness<\/p>\n\n\n\n Modifier gives new meaning to the code<\/p>\n\n\n\n International Classification of Diseases (ICD) Current Procedural Terminology (CPT) Organized Health Care Arrangements (OHCA) Diagnosis Related Group (DRG) Healthcare Common Procedure Coding System (HCPCS) CMS contracts with American Medical Association to use CPT coding for the Medicare program using this expanded version<\/p>\n\n\n\n Upcoding Unbundling Outlier Billing and Coding Concerns (*)<\/p>\n\n\n\n “Incident To” services physician must be present to bill (*)<\/p>\n\n\n\n Two-Midnight Rule 72 Hour Rule\/3 Day Window Project (*) False Cost Reports (*) Credit Balances – Failure to Refund () provider has 60 days to refund credit balances (<\/em>)<\/p>\n\n\n\n PPS Transfer Project Advance Beneficiary Notice (ABN) must be provided and signed by patient before services are provided (or provider cannot bill patient if Medicare denies)<\/p>\n\n\n\n Medicare Secondary Payer Questionnaire Hospital Outpatient Cardiac Rehabilitation DRG Utilization (*) The three components of Evaluation and Management (E&M) services (*)<\/p>\n\n\n\n Evaluation & Management Codes<\/p>\n\n\n\n Types of History or Examination<\/p>\n\n\n\n Complexities of Medical Decision Making<\/p>\n\n\n\n Initial patient visit (*) Established patient visit (*) Inpatient Documentation Requirements<\/p>\n\n\n\n Factors to Consider When Making the Decision to Admit as Inpatient<\/p>\n\n\n\n Medicare Part A Medicare Part B Medicare Part C (Medicare Advantage) Medicare Part D Medicare Administrative Contractor (MAC) Focused Medical Review (FMR)<\/p>\n\n\n\n Medicaid 1500 Form used to bill Part B claims<\/p>\n\n\n\n CMS 1450 or UB-04 used to bill Part A claims<\/p>\n\n\n\n Fiscal Intermediary (FI) a Carrier Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (COP) CMS Allowable Third Party Carrier Disproportionate Share Hospital (DSH) CMS provides increased reimbursement for these hospitals to cover cost of uninsured patients<\/p>\n\n\n\n Common Working File (CWF) Return to Provider (RTP) Report Health Professional Shortage Area Participating Provider\/Supplier Certificate of Medical Necessity (*) Assignment Reassignment Coordination of Benefits Local Coverage Determination (LCD) National Coverage Determination (NCD) Medicare Code Editor Grouper Pricer Remittance Advice Why develop a Compliance Program?<\/p>\n\n\n\n How is the Compliance Program Addressing Significant Risks?<\/p>\n\n\n\n Why Does the Healthcare Industry Need Compliance Programs?<\/p>\n\n\n\n Accountable Care Act Compliance Program Requirements (*) Federal Sentencing Guidelines – General Information<\/p>\n\n\n\n Sarbanes\/Oxely Act (SOX)<\/p>\n\n\n\n Federal Sentencing Guidelines – 2004 Amendment Compliance Program Recommendations<\/p>\n\n\n\n Governing Authority (relationship to compliance program)<\/p>\n\n\n\n Developing a Compliance Plan (resources)<\/p>\n\n\n\n Risk Assessment (definition)<\/p>\n\n\n\n Why conduct a risk assessment?<\/p>\n\n\n\n Risk Assessment process What is risk?<\/p>\n\n\n\n Risk Management (definition) A risk assessment review will\u2026<\/p>\n\n\n\n Things that affect risk<\/p>\n\n\n\n Risk Identification<\/p>\n\n\n\n Management Responsibility Related to Risk<\/p>\n\n\n\n It is incumbent upon a health system’s __<\/strong> to provide ethical leadership to the organization and assure that adequate systems are in place to facilitate ethical and legal conduct. adequate systems = internal controls (*)<\/p>\n\n\n\n Code of Conduct (elements)<\/p>\n\n\n\n Code of Conduct (definition) Standards and Procedures<\/p>\n\n\n\n Training and Communication<\/p>\n\n\n\n Monitoring and Auditing Plan<\/p>\n\n\n\n OIG Questions on Audit Plan – Assessing Effectiveness of Compliance Program<\/p>\n\n\n\n Auditing (*)<\/p>\n\n\n\n Monitoring (*)<\/p>\n\n\n\n When to Audit (*)<\/p>\n\n\n\n When to Monitor (*)<\/p>\n\n\n\n What is Needed for An Effective Compliance Auditing and Monitoring Plan?<\/p>\n\n\n\n Creating\/Updating Annual Compliance Audit and Monitoring Plan<\/p>\n\n\n\n Conducting a Compliance Audit – OIG Probe Audit Approach<\/p>\n\n\n\n Conducting a Compliance Audit – Statistical Approach (*)<\/p>\n\n\n\n Corporate Integrity Agreements – Discovery Samples (auditing)<\/p>\n\n\n\n Consider Attorney Advice\/Privilege – Retrospective Approach to Obtaining Audit Sample (*)<\/p>\n\n\n\n Consider Attorney Advice\/Privilege – Concurrent Approach to Obtaining Audit Sample<\/p>\n\n\n\n Monitor and Audit Process (*)<\/p>\n\n\n\n Internal Audit & Compliance Reporting – Hotline\/Helpline<\/p>\n\n\n\n Reporting – Investigations<\/p>\n\n\n\n Exit Interviews Incentives<\/p>\n\n\n\n Enforcement<\/p>\n\n\n\n Response<\/p>\n\n\n\n Prior to Beginning Investigation Preventative Measures<\/p>\n\n\n\n Common Remediation Areas<\/p>\n\n\n\n Evaluating Effectiveness<\/p>\n\n\n\n Enforcement Environment Enforcement Activity Enforcement Weapons Compliance should serve as catalyst to\u2026<\/p>\n\n\n\n Compliance cannot implement control processes because\u2026 A compliance program is never _, it should always be <\/em><\/strong>. Establish a , be assured that <\/strong><\/em><\/strong>, then focus on <\/em>. Policies and Procedures<\/p>\n\n\n\n can have a policy without procedure but not procedure without policy<\/p>\n\n\n\n Policy (definition)<\/p>\n\n\n\n Procedure<\/p>\n\n\n\n Components of Policy<\/p>\n\n\n\n Compliance Work Plan<\/p>\n\n\n\n What is Infrastructure? Compliance Program’s Infrastructure (members)<\/p>\n\n\n\n What Impacts Infrastructure? (*)<\/p>\n\n\n\n for most – compliance is voluntary Physicians At Teaching Hospitals (PATH)<\/p>\n\n\n\n The Compliance Function The Legal Function The Internal Audit Function The HR Function Quality Improvement Compliance Oversight Committee<\/p>\n\n\n\n Compliance Officer<\/p>\n\n\n\n Physicians (relationship to compliance)<\/p>\n\n\n\n Compliance Staff<\/p>\n\n\n\n Buy-In (*)<\/p>\n\n\n\n Key Buy-In Techniques<\/p>\n\n\n\n Building Trust<\/p>\n\n\n\n Strategic Planning<\/p>\n\n\n\n Commission of Sponsoring Organizations (COSO) Internal Control (definition) (*) Primary Objective of Internal Controls<\/p>\n\n\n\n COSO Components of Internal Control<\/p>\n\n\n\n Types of Internal Controls<\/p>\n\n\n\n Benefits of Controlled Self-Assessment<\/p>\n\n\n\n Who Manages Risk?<\/p>\n\n\n\n Preparation of Audit Plan<\/p>\n\n\n\n Risk Mitigation Plan (development)<\/p>\n\n\n\n Adult Education Principles<\/p>\n\n\n\n Curriculum Design for Adult Learners<\/p>\n\n\n\n Classroom Design for Adult Learners<\/p>\n\n\n\n Four Critical Elements of Learning<\/p>\n\n\n\n Desirable Teaching Characteristics<\/p>\n\n\n\n Understanding the Organization’s Culture to Provide Education<\/p>\n\n\n\n Compliance Marketing and Themes<\/p>\n\n\n\n Education – Audiences and Scheduling<\/p>\n\n\n\n Training Scope\/Matrix Challenges When Training Physicians<\/p>\n\n\n\n General Training Components (*) Focused Training Components (*) OIG Recommended Training Topics<\/p>\n\n\n\n Training Approaches<\/p>\n\n\n\n Lectures (*)<\/p>\n\n\n\n Computer Based Training Cons<\/p>\n\n\n\n
Backflow<\/p>\n\n\n\n
Filters<\/p>\n\n\n\n
10 seconds<\/p>\n\n\n\n
HCF MC cable<\/p>\n\n\n\n
Physical integrity, continuity of grounding, correct polarity and retention force “NFPA 99”<\/p>\n\n\n\n
8 & 14<\/p>\n\n\n\n
Life Safety<\/p>\n\n\n\n
No<\/p>\n\n\n\n
End Result System of Hospital Standardization<\/p>\n\n\n\n
The Environment of Care<\/p>\n\n\n\n
Building, Equipment & Staff Support Services<\/p>\n\n\n\n
-Signs and training for altered egress
-Fire & Smoke Barrier Management System
-Additional Fire Fighting Equipment in
Impaired Areas
-Continuous Debris Removal<\/p>\n\n\n\n
Planning, implementing & evaluating changes<\/p>\n\n\n\n
1.5 to 3 years<\/p>\n\n\n\n
a) Typed on subs company letterhead
c) Notarized, signed and dated
d) File number
e) Index number<\/p>\n\n\n\n
4 weeks<\/p>\n\n\n\n
Corrective action with backup and photos<\/p>\n\n\n\n
b) NFPA 13 and NFPA 25<\/p>\n\n\n\n
Standard for the Installation of Sprinkler Systems<\/p>\n\n\n\n
Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems<\/p>\n\n\n\n
a) It is physically separated from it with walls
and a door
b) Large enough to contain transformers and
power distribution equipment
c) Large enough to contain computers,
associated electronics, electrical gear, and
their associated clear floor areas<\/p>\n\n\n\n
Coordinate with owner and appropriate facility personnel<\/p>\n\n\n\n
a) owner notification \/ UIR form
b) ILS plan
e) EOP<\/p>\n\n\n\n
Med gas professional healthcare organization<\/p>\n\n\n\n
a) NFPA
b) ASSE
c) MGPHO<\/p>\n\n\n\n
No<\/p>\n\n\n\n
A back up plan<\/p>\n\n\n\n
6010<\/p>\n\n\n\n
Within 5 minutes of the work<\/p>\n\n\n\n
PAI<\/p>\n\n\n\n
CF0 + CF1\/(1+DR) + CF2\/(1+DR)^2 +\u2026+ CFn\/(1+DR)^n where DR is discount rate<\/p>\n\n\n\n
(Net Profit \/ Cost of Investment) x 100<\/p>\n\n\n\n
Design-build<\/p>\n\n\n\n
PDC process<\/p>\n\n\n\n
ATP received, decant, EH&S Dept sign off<\/p>\n\n\n\n
Certified Health Care Constructor<\/p>\n\n\n\n
Health Care Industry Fundamentals, PDC Process, Health Care Facility Safety, Financial Stewardship<\/p>\n\n\n\n
Changing Regulations;
Services offered;
Construction;
Length of stay;
Finance;
Patient flow and efficiency;<\/p>\n\n\n\n
Hospital;
Outpatient facilities;
Medical office building;
Elder care;
Skilled nursing facilities<\/p>\n\n\n\n
Emergency Department=
ED = Gateway to the hospital<\/p>\n\n\n\n
Surgery (surgery suite, operating rooms) (3)=
Pre-op, PACU (post anesthesia care unit \/ some call it recovery), Post-op (might combine recovery and discharge in ambulatory surgery)”<\/p>\n\n\n\n
OR = Class A, B & C<\/p>\n\n\n\n
Cath Lab = Cardiac Catheterization Lab
Often treated as surgery<\/p>\n\n\n\n
Medical Office Building<\/p>\n\n\n\n
Post Anesthesia Care Unit<\/p>\n\n\n\n
Cardiac Catheterization Lab<\/p>\n\n\n\n
Obstetrics<\/p>\n\n\n\n
Labor Delivery Recovery<\/p>\n\n\n\n
Labor Delivery Recovery Post Partum<\/p>\n\n\n\n
Caesarian Section<\/p>\n\n\n\n
Intensive Care Unit<\/p>\n\n\n\n
Neonatal Intensive Care Unit<\/p>\n\n\n\n
Pediatric Intensive Care Unit<\/p>\n\n\n\n
Surgical Intensive Care Unit<\/p>\n\n\n\n
Cardiac Intensive Care Unit<\/p>\n\n\n\n
Coronary Care Unit<\/p>\n\n\n\n
Bone Marrow Transplant<\/p>\n\n\n\n
Schematic Design<\/p>\n\n\n\n
Design Development<\/p>\n\n\n\n
Construction Drawings<\/p>\n\n\n\n
Post Occupancy Evaluiation<\/p>\n\n\n\n
International Building Code<\/p>\n\n\n\n
Unified Building Code<\/p>\n\n\n\n
National Fire Protection Association<\/p>\n\n\n\n
Authority Having Jurisdiction<\/p>\n\n\n\n
The Joint Commission<\/p>\n\n\n\n
Healthcare Facilities Accreditation Program<\/p>\n\n\n\n
Det Norske Veritas<\/p>\n\n\n\n
Occupational Safety and Health Administration<\/p>\n\n\n\n
Environmental Protection Agency<\/p>\n\n\n\n
Health Insurance Portability and Accountability Act<\/p>\n\n\n\n
Americans with Disabilities Act<\/p>\n\n\n\n
Centers for Disease Control and Prevention<\/p>\n\n\n\n
United States Pharmacopeia<\/p>\n\n\n\n
Nuclear Regulatory Commission<\/p>\n\n\n\n
Leadership in Energy and Environmental Design<\/p>\n\n\n\n
Underwriter Laboratories<\/p>\n\n\n\n
It’s the “healthcare code” and it covers several things including medical gas. We are using 2012 now<\/p>\n\n\n\n
Med Gas Installer Qualifications<\/p>\n\n\n\n
Med Gas System Verifier Qualifications<\/p>\n\n\n\n
Essential Electrical Systems<\/p>\n\n\n\n
Life Safety Code<\/p>\n\n\n\n
Facilities Guidelines Institute<\/p>\n\n\n\n
NICU, Ability to calibrate respiratory therapy equipment, critical care and coronary care<\/p>\n\n\n\n
300 cuft<\/p>\n\n\n\n
Monthly (unless self-diagnostic in which case it follows the quarterly, semi, and annual schedule).<\/p>\n\n\n\n
Emergency Operations Plan<\/p>\n\n\n\n
Hazard Vulnerability Analysis<\/p>\n\n\n\n
Spaces that use ionizing radiation (X-Ray, CT)<\/p>\n\n\n\n
CFM = room volume in cuft\/60<\/p>\n\n\n\n
(Room cubic feet x number of ACH per ASHRAE 170)\/60<\/p>\n\n\n\n
airborne infection isolation room<\/p>\n\n\n\n
Minimum Efficiency Reporting Value<\/p>\n\n\n\n
Class A – local anesthesia \/ procedures, 15 ACH. 2 outdoor ACH.<\/p>\n\n\n\n
Class B – general anesthesia, CYSTO, 20 ACH. 4 outdoor ACH.<\/p>\n\n\n\n
Class C – Highest, Neuro\/heart\/other open body surgery, 20 ACH. 4 outdoor ACH<\/p>\n\n\n\n
In all clinical areas. Admin Office areas don’t require this.<\/p>\n\n\n\n
Legionella in Hot Water Standard<\/p>\n\n\n\n
Cost, life expectancy, and whether it is repair or replacement<\/p>\n\n\n\n
1- when you first enter to check in
2- patient screening area and prep
3- already screened patients and personnel
4- screened MRI patients under direct supervision of trained MRI personnel only (inside room with magnet)”<\/p>\n\n\n\n
HVA (Hazard Vulnerability Analysis)<\/p>\n\n\n\n
Pharmacy
Behavioral \/ psychiatric care areas
Emergency department
Infant \/ pediatric security
Patient dementia related security needs”<\/p>\n\n\n\n
When construction alters any required life safety code elements<\/p>\n\n\n\n
Fire watch
Notify the fire department
Document (esp if ILSM is necessary)
Possible other measures”<\/p>\n\n\n\n
-Exit stairways with walls constructed as a fire barrier and direct exit to exterior without having to renter compartments
-(fire resistance rating) 1hr where exit connects 3stories or less, 2hr for 4 and up (and all new healthcare)
-cannot be supported by structure<\/p>\n\n\n\n
-Similar to vertical exits – must equal rating of stairwell it serves
-Doors must be rated same as exit enclosure, be self closing and latching<\/p>\n\n\n\n
-2hr Fire rated barrier min
-All spaces must have at least one exit that isn’t a horizontal exit<\/p>\n\n\n\n
Fire Protection During Construction<\/p>\n\n\n\n
utility chase
storage
an office
construction staging area<\/p>\n\n\n\n
only utilities serving the egress path\u2026
exit doors, lighting, ductwork \/ equipment for independent pressurization, sprinklers, heating and cooling the enclosure<\/p>\n\n\n\n
2hr FRR (Fire Resistance Rating)<\/p>\n\n\n\n
1hr FRR. (Does not include severe hazard.)<\/p>\n\n\n\n
22,500 sf. Every story used by inpatients for sleeping or treatment into 2 or more compartments every story with occupant load >50 regardless of use”<\/p>\n\n\n\n
Defend in place (evacuation is the last option)
Unit Concept (series of compartments)
Total Concept (from NFPA 101; minimize possibility of evacuation due to fire) design and construction of compartments; detection, alarm and extinguishment; planning, training and drilling”<\/p>\n\n\n\n
200′<\/p>\n\n\n\n
4
A, B, C, D (A is just inspection through D being full demo \/ build)<\/p>\n\n\n\n
4
Low, Medium, High, Highest (low = office, Highest = open body surgery)<\/p>\n\n\n\n
Infection Control Risk Mitigation Requirements<\/p>\n\n\n\n
TJC (The Joint Commission)<\/p>\n\n\n\n
Pre-Construction Risk Assessment<\/p>\n\n\n\n
FGI Guidelines<\/p>\n\n\n\n
Fire Response<\/p>\n\n\n\n
Pediatric \/ Neonatal Emergency<\/p>\n\n\n\n
Cardiac Arrest \/ Medical Emergency<\/p>\n\n\n\n
Health Care Facility<\/p>\n\n\n\n
Electronic medical record<\/p>\n\n\n\n
electronic health record<\/p>\n\n\n\n
picture archive and control system<\/p>\n\n\n\n
-flush lines
-retest water quality
-potential hyper-chlorination
-potential super heating to 180 deg F”<\/p>\n\n\n\n
Reverse osmosis<\/p>\n\n\n\n
De-Ionization<\/p>\n\n\n\n
-Carbon Filters (used to remove gases and chlorine)
-RO (Reverse Osmosis)
-DI (De-Ionization)”<\/p>\n\n\n\n
HVAC Systems Ventilation, Filtration, and pressure relationships<\/p>\n\n\n\n
-.01w.c. for airborne infection isolation rooms”<\/p>\n\n\n\n
-.03w.c.; should flow less clean to clean or be evacuated from the facility with clean make-up air supplied<\/p>\n\n\n\n
-amoeba in water (aid growth)
-dead legs in system piping
-aerosolization of water
-stagnant water
-thrives in 77-108 deg f”<\/p>\n\n\n\n
-Solid core
-self latching
-self closing
-doors must be double egress in egress path (I.e. no cane pin or slide bolts)<\/p>\n\n\n\n
Place used to force oxygen into wounds such as significant burns, etc.. High pressure and high oxygen.<\/p>\n\n\n\n
Facility Condition Index = Deferred Maintenance\/replacement cost<\/p>\n\n\n\n
Facilities Guidelines Institute – Part 2 Hospitals; Part 3 ASHRAE 170<\/p>\n\n\n\n\n
\n
\n
\n
Airborne Infection Isolation<\/p>\n\n\n\n
Protective environment<\/p>\n\n\n\n
N\/A pressure; 2 outdoor ach; 6 ach<\/p>\n\n\n\n
Filter Bank 1 MERV7; Filter Bank 2 MERV14<\/p>\n\n\n\n
Filter Bank 1 MERV7; Filter Bank 2 MERV14<\/p>\n\n\n\n
Filter Bank 1 MERV7; Filter Bank 2 MERV17 (HEPA)<\/p>\n\n\n\n
Filter Bank 1 MERV13; Filter Bank 2 N\/A<\/p>\n\n\n\n
Filter Bank 1 MERV7; Filter Bank 2 N\/A<\/p>\n\n\n\n
Filter Bank 1 MERV13; Filter Bank 2 N\/A<\/p>\n\n\n\n
Life safety branch<\/p>\n\n\n\n
Critical Branch<\/p>\n\n\n\n
Life safety branch<\/p>\n\n\n\n
Critical Branch<\/p>\n\n\n\n
Equipment Branch<\/p>\n\n\n\n
Equipment Branch<\/p>\n\n\n\n
Equipment Branch<\/p>\n\n\n\n
Level 1 – imminent danger of morbidity or mortality
Level 2 – manageable risk of morbidity or mortality Level 3 – Not place patients at risk of morbidity or mortality”<\/p>\n\n\n\n
Source, main, service, riser, zone (and future)<\/p>\n\n\n\n
Hard-drawn seamless copper to ASTM B819; brazed<\/p>\n\n\n\n
Hard-drawn seamless copper to ASTM B819; soldering may be used, brazing acceptable<\/p>\n\n\n\n
continuous, oil-free, dry nitrogen purge is required during all work on med gas systems<\/p>\n\n\n\n
-Initial blow down (oil free, medical grade Nitrogen)
-initial pressure test (150% working pressure)
-cross connection test
-piping purge test
-standing pressure test (24hrs @ 120% working pressure)<\/p>\n\n\n\n
-Cross connection (individual pressurization, pressure differential)
-Piping particulate test
-Medical air purity test
-Alarm tests<\/p>\n\n\n\n
Generally covers design of healthcare type facilities<\/p>\n\n\n\n
1- General, 2-Hospitals, 3-ASHRAE 170<\/p>\n\n\n\n
Fire protection code, focused on the preservation of life. (CMS, TJD, HFAP & DNV all reference the 2012 edition)<\/p>\n\n\n\n
CH7 – means of egress, CH 8 – Features of fire protection, CH 18 – New Health Care, CH 19 – Existing Health Care, CH 20 – New ACH, CH 21 – Existing AHC<\/p>\n\n\n\n
Focused on special systems in healthcare (we mainly reference essential electrical systems)<\/p>\n\n\n\n
CH 3 – Electrical Systems, CH 4 – Med Gas Systems, CH 7 – Materials, CH 8 – Electrical equipment, CH 20 – Hyperbaric Facilities<\/p>\n\n\n\n
Guidelines for Environmental Infection Control in Health Care Facilities (Part1 = background research, Part2 = Recommendations)<\/p>\n\n\n\n
ISO Clean Room Standards to compounding areas (pharmacy type environments for mixing drugs, etc.)<\/p>\n\n\n\n
The lower the ISO number, the cleaner the space.
ISO 5 – laminar flow workbench or isolator
ISO 7 – buffer area
ISO 8 – ante room”<\/p>\n\n\n\n
Nuclear Regulatory Commission handles all things nuclear – diagnostic, therapeutic, research<\/p>\n\n\n\n
Sustainability and energy efficiency is the main focus<\/p>\n\n\n\n
Certified (40-49 points)
Silver (50-59 points)
Gold (60-69 points)
Platinum (70 and up points)”<\/p>\n\n\n\n
They evaluate components, products and systems to meet standards. They do not approve products.<\/p>\n\n\n\n
Cost of planning=.05
Cost of design=.1
Cost of building=1
Cost of maintenance=5
Cost in use to client=50-200
Lesson Learned (POE)=.05″<\/p>\n\n\n\n
initial assessment
role of the facility
master program
master plan
functional program<\/p>\n\n\n\n
SDs (schematic design)
DDs (design development)
CDs (construction drawings)
Construction
Occupancy
POE (post occupancy evaluation)<\/p>\n\n\n\n
Portable fire extinguishers<\/p>\n\n\n\n
Installation of sprinkler systems<\/p>\n\n\n\n
Inspection, testing and maintenance of water-based fire protection systems<\/p>\n\n\n\n
National Electric Code (NEC)<\/p>\n\n\n\n
Electrical safety in the workplace<\/p>\n\n\n\n
National Fire Alarm Code<\/p>\n\n\n\n
Fire doors and other opening protectives<\/p>\n\n\n\n
installation of air conditioning and ventilation systems<\/p>\n\n\n\n
Ventilation and fire protection of commercial cooking operations<\/p>\n\n\n\n
Healthcare facilities<\/p>\n\n\n\n
Hypobaric facilities<\/p>\n\n\n\n
Life safety code<\/p>\n\n\n\n
installation of smoke door assemblies and other opening protectives<\/p>\n\n\n\n
Emergency and standby power systems<\/p>\n\n\n\n
Stored energy emergency and standy power systems<\/p>\n\n\n\n
Safeguarding construction, alteration and demolition operations<\/p>\n\n\n\n
Disaster \/ emergency management and business continuity<\/p>\n\n\n\n
National Fuel Gas Code<\/p>\n\n\n\n
Standard on Types of Building Construction<\/p>\n\n\n\n
75 feet<\/p>\n\n\n\n
No more than 5′ to the top of the extinguisher and no closer than 4″ from the floor for the bottom of the extinguisher<\/p>\n\n\n\n
possible differences between out let grounds<\/p>\n\n\n\n
Vacuum and Oxygen<\/p>\n\n\n\n
Prior to starting schematic design<\/p>\n\n\n\n
The lowest floor level with the exterior grade for 50% or more of its perimeter<\/p>\n\n\n\n
Computerized Tomography (CT)<\/p>\n\n\n\n
-Temporary exits should be designated and inspected daily, at least two fire drills should be performed per quarter per shift
-Temporary exits should be designated and clearly marked, staff should be trained, and at least two fire drills should be performed per quarter per shift
-Have the local authority having jurisdiction approve temporary exits
-provide additional firefighting equipment and train staff on usage
-Temporary exits should be designated and clearly marked, staff should be trained, and at least two fire drills should be performed per quarter per shift<\/p>\n\n\n\n
NICU, Coronary Care, Critical Care, and the ability to calibrate respiratory equipment<\/p>\n\n\n\n
-Construction manager at risk
-design\/build
-design\/bid\/build
-integrated project delivery
Design\/Build<\/p>\n\n\n\n
Potential toxic air contaminants and flammable gases\/vapors<\/p>\n\n\n\n
-lump sum
-integrated project delivery
-cost plus stipulated fee
-cost plus GMP at design completion
-lump sum
(a lump sum delivery methodology cannot practically respond to a partial design)<\/p>\n\n\n\n
By a two-hour fire barrier when both buildings have the same construction type<\/p>\n\n\n\n
airborne particle counting of occupied areas<\/p>\n\n\n\n
Yes, testing must be completed monthly<\/p>\n\n\n\n
alternate exits in the affected areas<\/p>\n\n\n\n
Facility Manager \/ Quietly<\/p>\n\n\n\n
A) Outbreak investigation, research, microbial abatement validation, and infection control procedure evaluation
B) outbreak investigation, research, verification of construction barrier effectiveness, and infection control practice evaluation
C) outbreak investigation, periodic air quality assessments, verification of construction barrier effectiveness, and microbial abatement evaluation
D) research, microbial abatement validation, periodic air quality assessments, and infection control practice evaluation
A) Outbreak investigation, research, microbial abatement validation, and infection control procedure evaluation<\/p>\n\n\n\n
A) that is most current
B) used by the design team
C) that was used for permitting
D) currently enforced by the federal AHJ
C) that was used for permitting<\/p>\n\n\n\n
A) Schematic Design
B) Design Development
C) construction Delivery
D) Construction Documents
A) Schematic Design<\/p>\n\n\n\n
A) lien release
B) set of record documents
C) clean, operational facility
D) certificate of occupancy
B) Set of record documents<\/p>\n\n\n\n
Hire a consultant to design a new roof, inspect installation, and install in phases to keep it sealed at the end of each day.<\/p>\n\n\n\n
A) first patient day
B) building commissioning
C) installation of equipment
D) imaging equipment testing
C) installation of equipment<\/p>\n\n\n\n
A) design\/build
B) design\/bid\/build
C) integrated project delivery
D) construction manager at risk
C) integrated project delivery<\/p>\n\n\n\n
A) Install a closed-circuit monitoring system
B) Conduct infant abduction drills for hospital staff
C) install an electronic infant abduction security system
D) educate mothers to release their infants only to authorized personnel
D) educate mothers to release their infants only to authorized personnel<\/p>\n\n\n\n
A) marketing and community pressure
B) lowers operational costs
C) required by the Joint Commission
D) required by the Green Guide for Health Care
A) marketing and community pressure
B) lowers operational costs<\/p>\n\n\n\n
Continue fire watch in the area of the work for one hour after permit is closed and alarm system is restored<\/p>\n\n\n\n
ionizing radiation<\/p>\n\n\n\n
A) CMS
B) Green Guide for Health Care
C) Whole Building Design Guide
D) Green Globes
B) Green Guide for Health Care
D) Green Globes<\/p>\n\n\n\n
A) ILSM, contractor parking, backup power
B) temporary signage, ILSM, contractor parking
C) backup power, infection control, fire\/life safety
D) infection control, fire\/life safety, temporary signage
C) backup power, infection control, fire\/life safety<\/p>\n\n\n\n
25<\/p>\n\n\n\n
A) goals
B) quality
C) schedule
D) first cost
A) goals<\/p>\n\n\n\n
A) NFPA 101-2012 assumes that both types of occupancy will have patient sleeping rooms for overnight occupancy
B) Both types of occupancy must meet the requirements of NFPA 101-2012 chapter 19 if they are existing occupancies
C) Since defend-in-place strategies are used in both types of occupancies, the requirements are the same
D) The requirements of NFPA 101-2012 are based on the assumption that both types of occupancy will have patients who are incapable of self-preservation
D) The requirements of NFPA 101-2012 are based on the assumption that both types of occupancy will have patients who are incapable of self-preservation<\/p>\n\n\n\n
Allowed more hospital construction bc it allowed hospitals to more confidently predict their finances. More infrastructure, tech and finance influence construction also.<\/p>\n\n\n\n
FACILITY GUIDELINES INSTITUTE: Guidelines for the design and construction of hospitals and outpatient care facilities.<\/p>\n\n\n\n\n
Was required to be followed to get a grant under the Hill-Burton Act of 1946.
Now not Fed Gov, now created by volunteers: Architects, facility managers, AHJ (Authorities Having Jurisdiction), people from ASHE, APIC (Association of Professionals in Infection Control)
40 states use this minimum standard
Determines: Room size, # of air exchanges, required medical gases, and infection control plans
4 year cycle of review.<\/p>\n<\/blockquote>\n\n\n\n\n
In 1975 it became the “Public Health Service Act”
Created first rush of hospital growth
Provided Federal grants and loans
Goal: to create 4.5 beds per 1,000 citizens
to get funds, hospitals could NOT discriminate (even though that was still legal), they had to provide some free care
Most funds went to middle class areas<\/p>\n<\/blockquote>\n\n\n\n\n
All accreditation programs use it (CMS, JC, DNV)
Published by the National Fire Protection Association
First time compliance was standardized<\/p>\n<\/blockquote>\n\n\n\n\n
CMS (Center for Medicare and Medicaid Services) which is a department of the Federal Government, which operates under the HHS (Department of Health and Human Resources)
DNV (Det Norske Veritas)<\/p>\n<\/blockquote>\n\n\n\n
The Defense Base Closure & Realignment Commission<\/p>\n\n\n\n\n
most military hospitals are repurposed<\/p>\n<\/blockquote>\n\n\n\n\n
Uses a mix of CDC documents, as well as ASHRAE (American Society for Heating, Refrigeration & Air Conditioner Engineers)
Goal: to reduce HAI’s in hospitals, CDC has a proactive risk assessment for construction<\/p>\n<\/blockquote>\n\n\n\n
Building Officials and Code Administrators<\/p>\n\n\n\n\n
IBC is International Building Codes<\/p>\n<\/blockquote>\n\n\n\n\n
It is administered, trademarked, copyrighted, and published by the National Fire Protection Association
Revised on 3 year cycle<\/p>\n<\/blockquote>\n\n\n\n
Standard for Inspection, Testing & Maintenance of Water-Based Fire Protection Systems (H20 Sprinklers)<\/p>\n\n\n\n
National Electric Code<\/p>\n\n\n\n
Standard for Electrical Safety in the Workplace<\/p>\n\n\n\n
National Fire Alarm Signaling Code<\/p>\n\n\n\n
Standard for Installation of Sprinkler Systems<\/p>\n\n\n\n
Standard for Electrical Safety in the Workplace<\/p>\n\n\n\n
National Fire Alarm Signaling Code<\/p>\n\n\n\n
Healthcare Facility Code (requirements for medical gas installers)<\/p>\n\n\n\n
Life Safety Code: standard widely adopted in the US. Revised on a 3 year cycle.<\/p>\n\n\n\n
Standard for Emergency & Standby Power Systems<\/p>\n\n\n\n
American Society for Heating, Refrigeration & Air Conditioning Engineers<\/p>\n\n\n\n
This is in the 2014 FGI Guidelines<\/p>\n\n\n\n
Prevention of Legionellosis Associated with Building Water Systems (approved standard)<\/p>\n\n\n\n
United States Pharmocepeia<\/p>\n\n\n\n\n
First set of enforceable sterile compounding standards issued by the USP.<\/p>\n<\/blockquote>\n\n\n\n
Standard for Portable Fire Extinguishers<\/p>\n\n\n\n
Standard for Disaster\/Emergency Management and Business\/ Operations Continuity<\/p>\n\n\n\n\n
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\u2026having a policy and not following it.<\/p>\n\n\n\n
International Classification of Diseases (ICD)<\/p>\n\n\n\n
Current Procedural Technology (CPT)<\/p>\n\n\n\n\n
\u2026take an active rather than a passive role in compliance.<\/p>\n\n\n\n\n
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a two digit alpha\/numeric code used in conjunction with CPT or HCPCS codes that may increase or decrease reimbursement<\/p>\n\n\n\n
a statistical classification system that arranges diseases and injuries into groups according to established criteria (signs and symptoms)<\/p>\n\n\n\n
American Medical Association publishes and maintains this coding system<\/p>\n\n\n\n
HIPAA arrangement between clinically integrated setting (ex: hospitals and medical staff)<\/p>\n\n\n\n
an inpatient classification system based on: principal diagnosis, secondary diagnosis, surgical factors, age, sex, and discharge status<\/p>\n\n\n\n
for medication, maintained by CMS<\/p>\n\n\n\n
providers use a billing code that reflects a higher payment rate for a device or service provided than the actual device or service furnished to the patient<\/p>\n\n\n\n
submitting bills by piecemeal or in fragmented fashion to maximize reimbursement<\/p>\n\n\n\n
additional payment for patients with long hospital length of stay<\/p>\n\n\n\n\n
services commonly furnished in a physician’s office by a nurse practitioner in which there is direct physician personal supervision and are billed under the physician’s provider number (does not apply in hospital setting)<\/p>\n\n\n\n
CMS will consider a claim as inpatient if the patient in hospital bed over two midnights<\/p>\n\n\n\n
all diagnostic outpatient charges and other related outpatient charges within 72 hours prior to an inpatient admission are bundled into inpatient stay reimbursement<\/p>\n\n\n\n
submission of charges to Medicare which are unrelated to medical care, such as administrative overhead<\/p>\n\n\n\n
PPS transfer of patient (rather than discharge) and receiving payment<\/p>\n\n\n\n
a written form that a provider gives to a Medicare beneficiary that informs the beneficiary that Medicare may not pay for an item or service<\/p>\n\n\n\n
used to identify the correct insurance company that must pay health care bills first when Medicare pays second<\/p>\n\n\n\n
physician must be present during treatment<\/p>\n\n\n\n
DRG utilization should be reviewed when the number of uses of a particular DRG is outside of the norm or average<\/p>\n\n\n\n\n
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3 out of 3 key elements of E&M services must be met or exceeded in order to bill for this type of visit<\/p>\n\n\n\n
2 out of 3 key elements of E&M services must be met or exceeded in order to bill for this type of visit<\/p>\n\n\n\n\n
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Part of Medicare that reimburses primarily for inpatient services provided by institutions such as hospitals and skilled nursing facilities<\/p>\n\n\n\n
Part of the Medicare program that reimburses covered physician and supplier services<\/p>\n\n\n\n
Formerly known as Medicare + Choice, government managed care program, must have Part B<\/p>\n\n\n\n
part of Medicare that reimburses for outpatient prescription drugs<\/p>\n\n\n\n
Processes Part A and Part B claims<\/p>\n\n\n\n\n
state health insurance that helps many people who can’t afford medical care and pays for some or all of their medical bills<\/p>\n\n\n\n
Non-institutional providers must use this form to bill Medicare, Medicaid, CHAMPUS, and most private insurance companies<\/p>\n\n\n\n
institutional providers use this form to bill Medicare, Medicaid, CHAMPUS, and most private insurance companies<\/p>\n\n\n\n
an insurance company that contracts with CMS to process Medicare Part A claims – replaced by MACs in 2003<\/p>\n\n\n\n
an insurance company that contracts with CMS to process Medicare Part B claims – replaced by MACs in 2003<\/p>\n\n\n\n
HHS agency that establishes payment policies for providers, conducts research, and evaluates the quality of care provided to beneficiaries<\/p>\n\n\n\n
must be in compliance in order to be reimbursed by CMS<\/p>\n\n\n\n
how much CMS will reimburse for a particular service or procedure<\/p>\n\n\n\n
entity that processes the claims on behalf of CMS<\/p>\n\n\n\n
hospital that provides larger amount of care to indigent population<\/p>\n\n\n\n
information about beneficiaries<\/p>\n\n\n\n
indication of error in the claim submitted to CMS – must be corrected to receive reimbursement<\/p>\n\n\n\n
geographic areas that have been designated as primary medical care shortage areas where physician who furnish medical care are entitled to a Medicare incentive payment<\/p>\n\n\n\n
accepts CMS allowable as payment in full for services<\/p>\n\n\n\n
physician statement that services are medically necessary<\/p>\n\n\n\n
agreement to accept payment in full – 20% copay, 80% Medicare<\/p>\n\n\n\n
physician is paid a salary and entity receives payment from Medicare<\/p>\n\n\n\n
decides primary, secondary, and tertiary payor<\/p>\n\n\n\n
determination of what is a covered service within a region,
used when there is no national coverage determination<\/p>\n\n\n\n
determination of what is a covered service across the country, overrides local coverage determinations<\/p>\n\n\n\n
halts the claims process but does not correct errors in claims<\/p>\n\n\n\n
uses all information about the claim (including complications and comorbidities) to determine the primary DRG<\/p>\n\n\n\n
amount paid by CMS for each DRG<\/p>\n\n\n\n
details\/describes the payment<\/p>\n\n\n\n\n
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by end of law everyone that bills federal money must have a compliance program<\/p>\n\n\n\n\n
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identify risk -> analyze\/measure risk -> prioritize risk<\/p>\n\n\n\n\n
identification, assessment and prioritization of risks followed by coordinated and economical application of resources to minimize, monitor, and control the probability and\/or impact of unfortunate events or maximize realization of opportunities<\/p>\n\n\n\n\n
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corporate officers and managers<\/p>\n\n\n\n\n
define how to behave<\/p>\n\n\n\n\n
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Internal Audit must be independent of Compliance<\/p>\n\n\n\n\n
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helpful reporting mechanism<\/p>\n\n\n\n\n
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Determine:<\/p>\n\n\n\n\n
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Heightened scrutiny<\/p>\n\n\n\n
Recoveries are paying for the investigations<\/p>\n\n\n\n
Forensic data mining, tracking\/trending, etc.<\/p>\n\n\n\n\n
it takes away independence.<\/p>\n\n\n\n
finished; a work in progress.<\/p>\n\n\n\n
framework; elements are working; effectiveness (outcomes based)<\/p>\n\n\n\n\n
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basic framework of the organization (*)
organizational chart; strong foundation
buy in and commitment makes the program strong and effective<\/p>\n\n\n\n\n
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no one size fits all program<\/p>\n\n\n\n\n
prevention, detection, and resolution of actions<\/p>\n\n\n\n
advises the organization on legal and regulatory risks, defends the organization<\/p>\n\n\n\n
provides an objective evaluation of the existing risk and internal controls and framework<\/p>\n\n\n\n
manages recruiting, screening, and hiring, provides training and development<\/p>\n\n\n\n
promotes consistent, safe, and high quality practices<\/p>\n\n\n\n\n
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provides a sounds basis for establishing internal control systems and determining their effectiveness<\/p>\n\n\n\n
a process effected by an entity’s board of directors, management, and other personnel designed to provide reasonable assurance regarding the achievement of objectives<\/p>\n\n\n\n\n
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1 = broad principles, simple examples
2 = level 1, more detail and complex examples
3 = level 2 plus history, projected implications<\/p>\n\n\n\n\n
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everyone needs to know<\/p>\n\n\n\n\n
only certain people need to know<\/p>\n\n\n\n\n
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Pros<\/p>\n\n\n\n\n
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