*Documentation*
True or False
Cannabis Dependence risk adjusts.
What is TRUE?
Cannabis Dependence is a newly added diagnosis to the risk adjustment model. If it is not a prescribed medication, the DSM-V criteria does not apply and the diagnosis can be made clinically.
This is the time frame for action on the Osteoporosis Management in Women with a Fracture measure.
What is 6 months from date of fracture?
This should be ordered when you have a patient with COPD -and/or- BMI of 40 or greater.
What is a Senior Wellness ECHO?
The Prenatal Care Measure is for pregnant women who need a Prenatal Visit withing this time frame.
What is the first trimester or within 42 days or enrollment?
Name two of the new categories that have been added to the HCC model.
What are Personality Disorders, Drug/Alcohol Use Disorders, Dementia with/without Behavior Disturbance, CKD 3, Pressure Ulcer Stage 2
This documentation should be included in when using the diagnosis of Alcohol Dependence.
What is recommendation to drug or alcohol treatment program?
True or False: A diabetic with a HbA1c of 8.9% meets the Part C Stars Measure for A1c Control.
What is TRUE?
In the Part C model, the HbA1c must be below 9%
This test is available at the SWC for women aged 60-85 with a fracture.
What is a portable DEXA?
For the Cervical Cancer Screening measure, women in this age range are in the measure.
What is 24-64 every measurement year or two years prior?
Documentation of Morbid Obesity on a patient with a BMI of 38.5 requires this.
What is documentation and linkage of the co-morbid condition?
DOUBLE JEOPARDY
Documentation of this diagnosis meets criteria for the Diabetes Care-Nephropathy measure, ADDITIONALLY, this lab can also be done to meet the measure.
What is CKD?
What is Urine for Microalbumin?
True or False:
The patient's Pain Score should be noted at each visit.
What is TRUE?
Your patient does not have any previous Vascular Disease or evidence of Aortic Atherosclerosis on CXR. This is what you should do.
What is order/complete a QuantaFlo/FloChec?
DOUBLE JEOPARDY!
Name four Core HEDIS Measures for the Medi-Cal line of business.
What are:
Antibiotics in Bronchitis, LT Rx (ACE/ARBS, Diuretics), Breast Cancer Screening, Cervical Cancer Screening, Childhood Immunizations, Diabetes Care, Imaging for Low Back Pain, Prenatal and Postpartum Care, Well Child Visits?
What is required documentation to support an HCC diagnosis?
What are Status and Plan?
Under the DSM-V Criteria, this number of maladaptive patterns must be present and documented to report the diagnosis of Drug Dependence.
DOUBLE JEOPARDY! Name that many of them.
What is 2?
This is the age range for the Colorectal Cancer Screening Star measure.
What is 50-75?
You have a Pre-Diabetic patient that tests negative on Monofilament Exam. This is what you should do.
What is order/complete an NCV?
True or False: BMI is a measure for every single line of business at HDMG.
What is TRUE?
This particular diagnosis needs to be specified when documenting Diabetes with Other Specified Manifestations.
What is the Specified Manifestation?
Name three acute diagnosis that providers should avoid documenting in the outpatient setting.
What are CVA/Stroke/Infarct, Cerebral Occulsion/Stenosis, Acute Respiratory Failure, Coronary Occlusion/MI, Unstable Angina, Sepsis, Established Compression Fx without any worsening?
Name three HOS Measures
What are:
Addressing Risk of Urinary Incontinence, Monitoring Physical Activity, Improving Physical Activity, Improving Mental/Emotional Health, Reducing Fall Risk, Getting a Flu Shot?
Name the three Gift Card Incentives Sr. HMO members are eligible for from HDMG in 2019.
What are gift cards for:
Senior Wellness Visit, Colorectal Cancer Screening, and Breast Cancer Screening?
Health Net Medi-Cal members are eligible for incentives for care gaps, on of which is worth $50 in Gift cards.
Name the three elements of Diabetic Screening that need to be completed for the $50 Diabetic Incentive.
What are:
HbA1c, Nephropathy Screening and a Diabetic Retinal Exam?
DOUBLE JEOPARDY!
Multiple Choice:
This CKD 3 was brought back into the HCC model for 2018 dates of service and has this RAF weighting.
0.169, 0.69, 0.069
What is 0.069?