Utilization management - Study guides, Class notes & Summaries

HIGH-FIDELITY SIMULATION FOR POSTPARTUM HEMORRHAGE 2 Executive Summary This proposal addresses a curriculum gap identified at Western University as the lack of utilization of high-fidelity simulation (HFS) in the prevention and management of postpartum hemorrhage module. A proposed curricular change from LFS to High-fidelity simulations (HFS) to improve the student’s confidence and clinical skills is recommended. The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) m...

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

UHC Certification 2023/2024 Exam| Actual Questions and Verified Answers| A Grade Q: A government program, offered only through a private insurance company or other private company approved by Medicare, that provides prescription drug coverage describes which of the following: Answer: Medicare Parts A and B Q: Which of the following statements is true about eligibility requirements for Medicare Prescription Drug Plans? Answer: A consumer must be entitled to Medicare Part A ...

SAFe POPM Exam Questions and Answers (Graded A)SAFe POPM Exam Questions and Answers (Graded A)v What is one benefit of constant customer feedback? A) Fast learning cycles B) It reduces the need for face-to-face collaboration C) Teams can better align working days with a customer's schedule D) It reduces the amount of changes to the Features - ANSWER-A) Fast learning cycles Which statement describes the Scaled Agile Framework? A) It scales Scrum to multiple Agile Teams B) It provides g...

TEST BANK for Marketing Health Services 4th Edition. by Thomas Richard. ISBN 1596. TABLE OF CONTENTS: Chapter 1. The Origin and Evolution of Marketing in Healthcare Chapter 2. Basic Mar keting Concepts Chapter 3. Marketing and the Healthcare Organization Chapter 4. The Nature of Healthcare Markets Chapter 5. Healthcare Consumers and Consumer Behavior Chapter 6. Healthcare Products Chapter 7. Factors in Health Services Utilization Chapter 8. The Changing Environment for Healthcare Marketing Chapt...

UTILIZATION MANAGEMENT NURSE EXAM 20232024 1.Utilization - CORRECT ANSWERS-How efficient a facility is in providing necessary care in the most cost-effective manner Goal of Utilization Review - CORRECT ANSWERS-1. To prevent overutilization or underutilization of resources 2. To control inappropriate use of health resources Overutilization - CORRECT ANSWERS-1. Using to many unnecessary resources 2. Not needed for that diagnosis or treatment Example; using the ER for runny nose Un...

Test Bank for Operations and Supply Chain Management 2e 2nd Edition by David A. Collier, James R. Evans. ISBN-13: 1695 Full Chapters test bank included PART 1: BASIC CONCEPTS OF OM AND VALUE CHAINS. 1. Operations Management and Value Chains. 2. Measuring Performance in Operations and Value Chains. 3. Operations Strategy. 4. Technology and Operations Management. PART 2: DESIGNING OPERATIONS AND SUPPLY CHAINS 5. Goods and Service Design. 6. Supply Chain Design. 7. Process Selectio...

Test bank for Leading and Managing in Nursing, YoderWise, 8th Edition exam questions with 100% correct answers As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select? a. Collaborate with the human resource/personnel department to develop on-site daycare services. b. Provide a hierarchical organizational structure. c. Implement a model of shared governance. d. Promote the development of a flexible benefits package. - ANSWER...

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage HMO Conventional PPO and POS H...

Abandon Before Answer (ABA) - The percentage of total calls received where callers hang up or leave the queue before reaching a support team member Access Management - Manage access requests in a manner that meets the business needs. Access management procedures are based on the security and availability policies. Aggressiveness - Demonstrates a disregard for the rights of others. Assertiveness - Demonstrates knowledge of your right and the rights of others. Automated Call Distributor (ACD...