Ubiquity
HBMC processes
Documentation
Diagnoses
Good to know!
100

This is very important for the Provider to remember to do before leaving the home visit.

What is scheduling the next appointment?

100

This is how often ICT meetings take place.

What is once weekly?

100

Due to, secondary to, caused by, with.

What are linking terms to connect two diagnoses?

100

Repeat testing is not needed for this diagnosis.

What is prediabetes?

100

A platform to find job aids and other needed resources

What is Thought Industries?

200

A provider does this if their desired diagnosis does not populate in the drop down on the A&P.

What is free text the diagnosis?

200

This is visit cadence and level of patient engagement.

What is acuity and intensity?

200

Monitor, evaluate, assess/address, treat. This is used to address an appropriate plan of care during patient visits.

What is MEAT?

200

A patient has 2-3 symptoms of the 11 DSM-5 criteria (such as cravings, taking the substance in larger amounts, using substance in physically hazardous situations).

What is SUD, mild?

200

Where one goes to access quick links such as global self service, concur, MyLearning, and other resources.

What is MyHR?

300

This tool is used in Ubiquity to determine severity of Major Depressive Disorder. 

What is the PHQ-9?

300

This face to face visit is conducted within 72 hours and consists of a thorough review of hospital records, referrals, and a high quality medication reconciliation. This is also a good time to review GOC.

What is the Post Discharge Visit (PDV)?

300

This is when a patient's risk score resets and clinicians have to readdress all current conditions.

What happens on January 1st of every year?

300

Patient meets 5 of the 9 symptoms which has to include depressed mood and/or decreased interest or pleasure during the same 2 week period and represent a change from previous functioning.

What is the DSM-5 criteria for Major Depressive Disorder?

300

A shared platform for entering your PTO, accessing your paycheck, and other human resource activities.  

What is MyHR?

400

The tab where you can chart on conditions such as: Depression Screening Tool, Substance Use Disorder, and/or the Generalized Anxiety Disorder. 

What is the BHRA?

400

What a clinician must validate to confirm a patient or caregiver's identity and it has to be at least 3.

What are patient/caregiver identifiers?

400

Age, access, and gender are used to determine this. (Hint: from the Medicare Advantage Video)

What is a patient's baseline health risk score?

400

A rarely used diagnosis that is used when a mental disorder is associated after medication/substance initiation or use.

What is Substance-medication induced mental disorder (SID)?

400

A shared platform for entering your expenses for reimbursement including CME, mileage, etc.?

What is Concur?

500

This HIE is available, after obtaining a consent from a patient, within Ubiquity. 

What is Health Gorilla?

500

A process that starts when a patient/caregiver calls with an urgent complaint. Then LM1 APC or market provider opens an encounter with next day follow up scheduled by the NCM. The longitudinal provider then does a face to face follow up visit. Lastly, the target closure is within 21 days or sooner based on patient stability. 

What is an urgent episode of care process?

500

We document the potential for withdrawal or tolerance when we are including this diagnosis.

What is physical dependence?

500

2 abnormal GFR or aCR results that are at least 3 months apart.

What is the CKD diagnosis criteria?

500

longitudinal care in the home, BH care services, 24-7 call availability, decreases patient ER/UC visits and hospitalizations, patient care preferences honored, time for quality SIC & GOC discussions. 

What are some of the benefits of HBMC?

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