D052 Navigating Care Across the Continuum Questions and Answers 2023 with complete solution
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D052 Navigating Care Across the Continuum
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D052 Navigating Care Across The Continuum
D052 Navigating Care Across the Continuum Questions and Answers 2023 with complete solution
When considering the regulatory requirements for healthcare, which agencies primarily oversee the use of medication?
FDA and DEA
The FDA (Federal Drug Administration) and DEA (Drug Enforcement Agency) f...
d052 navigating care across the continuum questions and answers 2023 with complete solution when considering the regulatory requirements for healthcare
which agencies primarily oversee the use of me
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D052 Navigating Care Across the Continuum Questions
and Answers 2023 with complete solution
When considering the regulatory requirements for healthcare, which agencies primarily
oversee the use of medication?
FDA and DEA
The FDA (Federal Drug Administration) and DEA (Drug Enforcement Agency) focus on
medication compliance and medication utilization.
How would you follow up on a denied claim?
Make sure resubmissions are marked as "corrected claim" and include the reference
number from the denied claim.
What information should you supply when you are calling to discuss a claim?
Client's date of birth, the organization's tax ID or NPI, info from the claim about date of
service and coding, how much is being billed.
What are the possible outcomes of the phone call that Barbara Griswold describes?
A corrected claim will need to be submitted, you may need to speak with a supervisor,
or you may need to file an appeal.
Which statement about the role of the healthcare services coordinator (HSC) is true?
The goal of the HCS is to improve the quality of client care and reimbursement practices
through accurate documentation and to assist the client to improve the quality of life
across the continuum of care.
The goal of care coordination is to improve the quality of care delivery and resource
management, ensure correct documentation is available for coding, and assist the client
throughout the continuum of care.
What do the terms HIPAA and PHI stand for?
Health Insurance Portability; Accountability Act and Personal Health Information
HIPPA and PHI are two areas where everyone is responsible for protecting the
information for the client.
When considering the regulatory requirements for healthcare, which agencies help
protect against fraud?
The Department of Health and Human Services (DHHS) and the Office of the Inspector
General (OIG)
Which of the following is a valid comparison of Medicare versus Medicaid?
Medicare is a federal health care coverage program mainly for people over 65 and
some people younger than that who have disabilities, whereas Medicaid is a federal and
state health care coverage program for low-income adults, pregnant women, and
children.
Medicare is a federal health care coverage program mainly for people over 65 and
some people younger than that who have disabilities, whereas Medicaid is a federal and
state health care coverage program for low-income adults, pregnant women, and
children.
How do the reporting requirements for a sentinel event differ from those for a less
serious health outcome?
Sentinal events are reportable to the government.
What insurance was available prior to the 1900's?
,None
There was no insurance available prior to 1900 for most citizens.
Payment by an insured member, a share of the payment made against a claim
Co-insurance
Fixed amount of money paid by the insured each time a service is rendered
Co-payment
Fixed amount of money a member must pay each year before benefits are paid by
insurance company
Deductible
Set amount paid to providers on the basis of per member, per month, regardless of
amount of services used
Capitation
Who is the gatekeeper for a patient's healthcare needs?
General Practice Provider
The general practice provider can be an MD, FNP, PA or other medical oversight
specialist working with a provider.
Why is it important to know insurance regulations and requirements?
The importance of knowing insurance regulations and requirements is to deliver
effective and efficient care in a timely fashion while removing the burden of dealing with
the insurance company from the patient.
Which software company is considered the gold standard for providing care
coordination?
InterQual
What is the purpose of the Hospital Compare website?
To provide information to consumers about their local hospitals for comparison
The goal is to ensure that the customer has the ability to make an informed decision on
the facility in which they want to be cared for.
A team of coordinators is creating a clinical review process for patient paperwork to
maximize compliance with insurance regulations toward the goal of reducing claim
denials. Which two elements must be included within the review process?
Cost containment and utilization management
Clinical review processes must include both cost containment and utilization
management to be effective.
Which action will assist the coordinator in identifying areas where errors in patients'
insurance paperwork are causing claim denials?
Analyzing EHR data
Tracking and analyzing patient records will provide for the identification of problem
areas where processes can be adjusted.
Which coordinator's task is aligned with reducing patient insurance costs?
Arranging patient preventive care services
Preventive care services have proven to reduce the need for medical services and
reduce patient insurance costs.
What are the six domains of care across which HEDIS collects more than 90
measures?
Effectiveness of Care
Access/Availability of Care
,Experience of Care
Utilization and Risk-Adjusted Utilization
Health Plan Descriptive Information
Measures Collected Using Electronic Clinical Data Systems
How many goals are included in the Affordable Healthcare Act?
3
The three goals are affordability, availability and cost containment.
What are the six quality improvement concepts discussed within the webpage?
Establish a culture of quality
Determine and prioritize areas for improvement
Collect and analyze data
Communicate your results
Commit to ongoing evaluation
Spread your success
Healthcare needs innovative ways to improve care delivery and reduce costs. Identify
what the PDSA cycle means in relation to these healthcare objectives.
A Process improvement cycle
Plan Do Study Act is a performance improvement cycle used in healthcare to improve
quality and cost analysis.
What are the three areas of value provided by Compass Training?
Care Coordination
Utilization Management
Patient Transitions
What is the National Transitions of Care Standards Framework?
Standards to help organizations assess, quantify, and identify gaps in current care
transition work plan
This applies to all healthcare setting to foster effective, quality, and efficient practices in
transitional services.
What action would have broken the chain of infection?
Proper hand hygiene
Why is it important to follow organizational policies?
Policy is a written guideline that the organization and staff follow to guide practices and
to meet regulatory requirements.
Policies are based on the EBP guidelines established by the regulating agencies.
Why is certification important?
For identification of the knowledge and experience in a chosen field
Certifications require a specific amount of experience and a knowledge and application
examination.
What is the whistleblower hotline number?
1-800-HHS-TIPS (1-800-447-8477)
What would you do if you suspected fraud is occurring?
call the whistle blower hotline
This is an anonymous method for reporting that helps prevents retaliation.
Which of the following is a feature of the Affordable Care Act (ACA)?
, An end to lifetime dollar limits on what insurance companies will cover
Insurance companies can't set a dollar limit on what they spend on essential health
benefits for your care during the entire time you're enrolled in a plan.
The National Committee for Quality Assurance (NCQA) seeks to improve the quality of
healthcare by establishing and tracking more than 90 measures of care related to
providers and practitioners, which the NCQA publishes as Healthcare Effectiveness
Data and Information Set (HEDIS) and licenses for use. Who among the following is
eligible to use HEDIS results under a custom, no-cost license?
Public Sector Stakeholders
NCQA supports federal, state and public-sector entities' use of HEDIS measure
specifications in their programs under a custom, no-cost license.
Which of the following is a requirement for filing a HIPAA health information privacy or
security complaint?
The complaint must be filed within 180 days of knowledge of act.
This is true, although the Office for Civil Rights (OCR) may extend the 180-day period if
the filer can show "good cause."
What differences has technology made by moving from paper documentation to
electronic health records?
The transition from paper to computerized documentation has improved the availability
of information to care team members. This facilitates rapid decision-making. Safety
features, not available in paper documentation, have improved care delivery. Medication
safety protocols included within the EHR have saved lives. This feature of the EHR
interfaces allergies, drug interactions, and contraindications with alert notifications when
the system identifies a potential problem. Since EHRs allow simultaneous access by
multiple team members, delays in patient care have been reduced.
What is the benefit of using computers in healthcare?
To improve the efficiency of the system.
The best answer is to improve the efficiency of the system, which will hopefully improve
the quality outcomes and cost of healthcare for the client.
Why is it that there is a need to orientate the healthcare team to computers?
Computers were not used in clinical settings except for the use of order entry and
lab/transcription reports.
Use of computerized systems was limited to order entry and review of reports from
other areas; the clinical team did not generally use the computer since paper charts
were the most common means of data exchange.
How does one individual ensure the integrity of the data they enter?
Ensuring that the documentation is correct and recording the information in a timely
fashion.
It is important the information be correct as well as being entered in a timely fashion so
that clinical decision can be the best decisions because all the information is available
for informed decision-making to occur.
Why is it important to have a good understanding of technology when working in
healthcare?
It assists in improving healthcare delivery and efficiency of resources.
Technology has improved the speed of communication in clinical decision support and
has improved patient safety.
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