Policy and Procedure
When should we contact a patient / ATP after we have received a voicemail in which a concern or need was noted?
Within 24 Hours.
How long before or after an appointment should we wait to call a patient for their care call?
48 Hours.
In order to be enrolled in the CCM program, a patient is required to have successfully completed an appointment within how long?
1 Year.
When sending an Email containing PHI, how would you ensure the information is secured?
Name 1 Compliance Infraction
Acceptable answers:
Time Inflation, HIPAA, FCC, False or Inaccurate Documentation, Failure to Act
According to Policy and Procedure, between what hours should your meal break be taken if you are working 5 or more hours?
The unpaid Meal Break should be taken between hour 3 and hour 5 of the shift.
How soon should a care plan be submitted for approval after a patient has been enrolled?
Within 60-days after the 1st successful care call with the patient.
What does CCM Stand for?
Chronic Care Management or Chronic Condition Management.
Who must we state FCC to, informing them that the call is being recorded?
Everyone we speak with.
Examples: ATP, DME Supplier, Patient, Pharmacy, and Providers Offices
Between what times are we allowed to contact patients?
8:00 AM - 6:30 PM local patient time.
What is the minimum notice time to send an OOO before a shift you are not able to complete?
15 Minutes prior.
If you are adding an outside provider to the Care Team, what method would you use to locate and add the provider in TimeDoc?
Provider NPI Search
Name 1 reason why we would exclude a patient from CCM.
Acceptable answers include:
Deceased, Moved to Skilled Nursing (Permanently), on Hospice, No longer a Patient with the Practice, on Dialysis.
What are some examples of hostile patient behavior in which you would notify your Team Lead?
1. Verbal Hostility.
2. Threats of physical harm or violence.
3. Inappropriate comments related to race or color; religion; national origin; gender, gender identity, gender expression or sexual orientation; age; and/or disability status.
4. Unwelcomed sexual advances and/or attempts to discuss sexuality, sexual preferences or body parts in a non-medical context.
Under what tab in the Hub can you locate the QA Evaluation Criteria for Care Managers?
Quality Tab.
Per Policy, if connectivity issues persist after troubleshooting has been completed, after how many minutes should you clock out?
15 minutes. Your Team Lead should be notified as well.
List 1 reason a Fall Risk Assessment should be completed
1.Patient reports a recent fall without injury (within the past 30 days)
2.Patient reports a recent fall with injury (past 90 days)
3.Patient with a history of multiple falls in a 6 month period
4.Patient is over the age of 65 with no reported falls - complete once a year
What is the definition of soft skills?
Skills that allow someone to interact and communicate effectively with other people
If a patient's spouse answers the phone and states "This is Mrs. Smith. I can complete Williams care call today." How do we ensure we are HIPAA Compliant?
1. Review the chart for permission to speak with the Wife.
2. Confirm the Wife's Full Name.
3. Have the Wife complete HIPAA for the patient.
2 Part Question:
1. How would you navigate to find the QA enactment date for new additions or updates to P&P's or Workflows?
2. What is the document called?
1. People > Policies and Procedures
2. QA Change Log
2 Part Question:
A. How long after an EMR message is sent, is the CM who sent the message to follow up?
B.Does a follow-up need set for EVERY message?
A. 24-Hours unless the practice preferences state otherwise.
B. Yes.
What are the 3 criteria that must be met in order to take advantage of a care planning opportunity of an Established Patient?
1. The Care Plan must be CREATED.
2. The patient must have had a SUCCESSFUL call the prior month.
3. The patient must have had at least 1 call attempt in the current month.
2-Part Question:
A. What does being "Dual-Eligible" mean?
For patients who are NOT dual-eligible, What is the cost-sharing amount the patient is responsible for?
A. The patient has both Medicare and Medicaid. ( The program will be at no cost to the patient).
B.20%. Usually, the cost is around $8 but can be more.
List 2 acceptable alternatives to DOB that can be used to verify HIPAA
1. Phone Number
2. Address
2 Part Question:
A. If you wish to contest a QA Evaluation, how long do you have to make your wish of an appeal known?
B. Who is your first line of contact to start the process?
A. 5 business days.
B. Your Team Lead.