If applicable, is there a question in the audit that states adding a goal for preventing falls is necessary?
yes
This workflow talks about notifying enrollment of a member’s death
Deceased Member Workflow
What is a fall with injury called?
Medical emergency
This event is to show people you have spoken to someone other than the member with member's permission
HIPAA
This spreadsheet shows which case manager is working with which facility
NH Assignment Grid
What section in the care plan is the auditor looking for the caregiver names, number of hours, and services provided?
Informal and Formal Support
what template goes with the interRAI?
NCQA
Where are we documenting a CI?
Critical Incident and Follow-up event
this event is for when you speak with member’s care team regarding care plan goals
IDCT
A new BH program that provides telephonic outreaches to our members at the nursing facility
Brave
Which section in the NCQA template is this paragraph referring to?
Social Functioning
Per the Assessing and Evaluating LTSS Program desktop, how often do members in the nursing facility need to have a face to face visit?
180 calendar days/6 months
If member is UTL with an open CI, how many outreaches do we need to complete?
5 outreaches
This event is done initially, annually, and as needed for community transition
NF diversion
$25 eligible for members to spend at CVS
OTC benefit program
What is question number51? It is the last applicable question on the audit.
Vulnerable member
these two assessments are valid for mental health and substance abuse. One should be completed with InterRAI
UNCOPE and CRAFFT
These reports are are from what agency: report of investigation and report of substantiation
APS
This event is where you indicate which method of outreach and at what time member likes best
Member Preferences
This resource shows a member's SDOH, health care equity, and you can even mail an insurance card
Snapshot/CEC
What are three factors that the audit looks for in question number 5 (initial evaluation)?
Health status, self-reported health status, CSA, see medication integrated file, diagnosis of interest, special interest group, interRAI completed within 30 days of enrollment, NCQA template with bullet points
this desktop talks about what to do if a member needs to be re-stratified, their eligibility has ended, or member has re-enrolled
Closing and Re-opening Episode
What does FWA stand for?
fraud, waste, and abuse
This event describes a member's admission and when they discharged from a hospitalization
Care transition event
What does IHMG stand for?
IHMG/in home medical group