A
Case management evolved as a discipline because:
a. wealthy urban citizens were dissatisfied with the level of health care.
b. populations grew beyond the capability of the existing healthcare system.
c. healthcare costs were low.
d. there were new developments in medicine.
b. populations grew beyond the capability of the existing healthcare system.
Which health insurance plan is considered a hybrid of an HMO and a PPO?
a. FFS
b. Tricare
c. HAS
d. POS
d. POS
Which stage of the discharge process should be performed on every patient?
a. Screening
b. Planning
c. Assessment
d. Implementation
a. Screening
Which method ensures that the patient comprehends what has been communicated?
a. Encoding
b. Cognitive behavioral therapy
c. Teach back
d. Having the patient nod in assent
c. Teach back
The primary purpose of acute care is to:
a. gradually improve community health.
b. maintain profit margins in hospitals.
c. improve health in a time-sensitive fashion.
d. prevent hospital readmissions.
c. improve health in a time-sensitive fashion.
Medicare Part C is:
a. designed to cover the medication gap.
b. jointly funded between state and federal governments.
c. known as Medicare Advantage.
d. also known as original Medicare.
c. known as Medicare Advantage.
Which procedure is performed with patients to determine the level of interventions?
a. Root cause analysis
b. Risk assessment
c. Preauthorization
d. Insurance screening
b. Risk assessment
A medication commission occurs when:
a. there is a reaction to prescribed medication.
b. a medication is mistakenly reordered on patient admission.
c. two medications cause an adverse reaction.
d. a medication is not included in the admission orders.
b. a medication is mistakenly reordered on patient admission.
Which one of these healthcare entities is not within the domain of acute care?
a. Urgent care center
b. Critical care unit
c. Emergency transportation
d. Nursing home
d. Nursing home
Medically Needy is a program:
a. designed to cover disadvantaged veterans.
b. for individuals whose income is too high to qualify for Medicaid.
c. that requires patients to submit an insurance claim.
d. that requires patients to stay within a network.
b. for individuals whose income is too high to qualify for Medicaid.
Which of the following statements about root cause analysis is true?
a. Produces recommendations to reduce adverse event recurrences
b. Assesses degree of care transition interventions
c. Performed as routine screen for every patient
d. Performed exclusively on patients with insurance
a. Produces recommendations to reduce adverse event recurrences
True or False
Medication reconciliation should be performed at care transition points.
True
Coverage for SNF services by Medicare is determined by:
a. a benefit period per illness spell.
b. certification of necessity for custodial care.
c. number of outpatient days.
d. need for long-term care.
a. a benefit period per illness spell.
The CHIP program (SELECT ALL THAT APPLY):
I. excludes prescription coverage.
II. covers children up to age 19.
III. is designed for children from families who do not qualify for Medicaid due to income limit.
IV. is jointly funded between state and federal governments.
V. is never administered as part of a Medicaid program.
VI. does not require immunizations and checkups as benefits.
II, III, IV
Risk factors for readmission include all but which of the following?
a. Low self-efficacy
b. Medicare adult aged 18–64 years
c. Complex conditions
d. Numerous medications
b. Medicare adult aged 18–64 years
A conscientious disease manager performs these duties (SELECT ALL THAT APPLY):
I. coordinates patient care.
II. promotes expensive care.
III. navigates the patient through the clinical pathway.
IV. promotes behavior change.
V. focuses on patients with good health insurance.
I, III, IV
Hospice care is appropriate:
a. at any stage of the disease.
b. if curative treatment strategies are being utilized.
c. if the prognosis is 6 months or less.
d. if the patient’s health insurance coverage has lapsed.
c. if the prognosis is 6 months or less.
When qualifying an inpatient for Medicare coverage for home oxygen, the test should be performed:
a. in a chronic stable state.
b. before a breathing treatment.
c. 3 days prior to discharge.
d. before a meal.
a. in a chronic stable state.
A care transition coordinator (CTC) or navigator can make a favorable impression on the patient by:
a. avoiding eye contact and focusing on the material being presented.
b. appearing stressed and rushed.
c. sitting down while speaking with the patient.
d. using technical and medical jargon.
c. sitting down while speaking with the patient.
Medicare coverage criteria for oxygen therapy include (SELECT ALL THAT APPLY):
I. testing must be done while the patient is in a chronic stable state.
II. ABG or SpO2 must be done while the patient is wearing a high-flow device.
III. services to be provided by a Medicare DME vendor.
IV. ABG or SpO2 must be performed 5 days prior to discharge.
V. testing can be done at rest.
I, III, V