100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
CMOM Module 5 Questions with Answers $12.59   Add to cart

Exam (elaborations)

CMOM Module 5 Questions with Answers

 5 views  0 purchase
  • Course
  • CMOM
  • Institution
  • CMOM

CMOM Module 5 Questions with Answers MCO Coordinator functions - Answer-1) Patient training and education 2)HMO intermediary 3)Hospitalization approvals and discharge planning 4) coordinating referrals 5)patient satisfaction surveys 6)coordinating with physician in utilization review committe...

[Show more]

Preview 2 out of 6  pages

  • August 2, 2024
  • 6
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • CMOM
  • CMOM
avatar-seller
Scholarsstudyguide
CMOM Module 5 Questions
with Answers
MCO Coordinator functions - Answer-1) Patient training and education
2)HMO intermediary
3)Hospitalization approvals and discharge planning
4) coordinating referrals
5)patient satisfaction surveys
6)coordinating with physician in utilization review committee
7)coordinating quality assurance data needed by MCO or other regulatory agency

Utilization review committee - Answer-should be used to review all cases which may
need to be referred to a specialist, where surgery is anticipated or where testing has
failed to find the cause of the problem

Utilization Coordinator functions - Answer-1)Referral systems control
2)hospitalization controls
3)emergency care controls
4)hospital and referral physician contracts and relations
5)monitoring ongoing care
6)monitoring care for non-covered or non-authorized services
7)Utilization control committees in medical groups, IPAs or hospitals
8)patient education and counseling
9)patient actions required by HMO in utilization control

Patient education - Answer-involves a variety of programs aimed at preventative care,
maintaining health through better nutrition, exercises and other techniques with can help
to promote better health.

Chronic Illness programs - Answer-education for those with chronic illnesses (such as
diabetes and hypertension) that includes teaching the patient how to eat right, use
medication properly and know when to visit the physician for a check up

Prenatal Classes - Answer-another type of educational program during pregnancy that
is intended to prevent acute problems and aid in self-monitoring

Factors behind development of the Affordable Care Act - Answer-1)Rising healthcare
costs per capita
2)an increasing number of individuals living with chronic conditions

, 3)a proportions of the population that remains uninsured due to cost, pre-existing
conditions and other factors

Accountable Care Organization - Answer-a healthcare organization that agrees to be
accountable for the quality, cost and overall care of traditional fee for service medicare
beneficiaries assigned to it. AKA 'medical neighborhood'

Types of ACO (Accountable Care Organization) - Answer-Medicare Shared Savings
Program
Advanced Payment ACO Model
Pioneer ACO Model

Patient Centered Medical Homes (PCMH) - Answer-involve coordination between
providers, particularly at the primary care level, and a variety of healthcare entities in
order to create a more integrated system of care for the patient

A PCMH (patient centered medical home) contains the following characteristics -
Answer-Personal physician
physician directed medical practice
whole person orientation
care is coordinated and/or integrated
emphasis on quality and safety

Credentialing - Answer-verifies that a physician meets standards through the review of
license, experience, certification, education, training, malpractice and adverse clinical
occurrences, clinical judgement and character via investigation and observation

Privileging - Answer-Defines a physician's scope of practice and the clinical services he
or she may provide

Council for Affordable Quality HealthCare (CAQH) - Answer-not-for-profit collaborative
alliance of health plans and networks which offers a standardized credentialing process

PECOS (Provider Enrollment, Chain and Ownership System) - Answer-Medicare's
Internet Based provider enrollment

NCQ (National Committee for Quality Assurance) - Answer-used to limit its accreditation
to HMOs, but has recently expanded to accredit CVOs, Behavioral Managed Health
Care organizations and Physician Organizations

JCAHO (Joint Commission on Accreditation of Healthcare Organizations - Answer-
started out as a hospital accreditation org, accredits all types of MCOs through its health
care network accreditation program. They Also have a specific set of standards for
PPOs and Managed Behavioral Health Care Orgs

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller Scholarsstudyguide. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for $12.59. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

80202 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy study notes for 14 years now

Start selling
$12.59
  • (0)
  Add to cart