Deck 1 Flashcards
The ability and ease of clients to obtain healthcare when they need it describes what?
Access to care
The term used to denote building facilities that are barrier free thus enabling all members of society safe access, including persons with physical disabilities
Accessible
Organization of healthcare providers who work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients.
Accountable Care Organization (ACO)
Voluntary evaluative process a health care organization undergoes that determines the extent its business meets nationally recognized standards and criteria as set forth by the accreditation agency
Accreditation
Legal duty, imposed by a statute or otherwise, owed by a defendant to the one injured based on sufficient legal grounds for a lawsuit.
Actionable tort
Structured way of communication and interaction where one focuses attention on the speaker and suspends one’s own frame of reference, biases, distractions and judgement to foster better understanding.
active listening
Routine activities an individual tends to do everyday for self-care. These include eating, bathing, grooming dressing, toileting, transferring (such as from bed to chair) and continence.
Activities of Daily Living (ADLs)
Difficulties a person may exhibit in executing activities, from slight to severe deviation in terms of quality or quantity in contrast with what is expected of people without the health condition.
activity limitations
Also referred to as real value. Measures the worth one derives from using or consuming a product, service, or item, and represents the utility of the same.
actual value
Statistical analysis of a population based on its utilization of healthcare services and demographic trends of the population. Results are used to estimate healthcare plan premiums or costs
actuarial study
Trained insurance professional who specializes in determining policy rates, calculating premiums and conducting statistical studies.
actuary
Complexity and severity of the client’s health/medical condition
acuity
Delivery system or setting (e.g., hospital, emergency room) that focuses on treating sudden and acute episodes of illness that cannot be managed in a less intense care setting.
acute care
The underlying premise of case managemet is what?
A. when people follow the rules everyone gets paid.
B. when an individual reaches the optimum level of wellness everyone benefits.
C. when an individual reaches the optimum functional capability everyone benefits.
D. Both B and C.
D. Both B and C.
What factors affect revenue and expenses?
A. number of patients
B. Insurance sources and payer mix
C. Types of services offered and Use of different services
D. All of the above
D. all of the above
True or False: Only case management departments within an ACO can impact the revenue cycle by implementing programs that monitor the overall utilization of services, determine the appropriateness of admission and/or care and administer a closely regulated denial avoidance process.
False
Skills and behaviors learned throughout development that enable an individual to effectively exist in an environment.
Adaptive behavior
Degree to which a client correctly follows and exhibits expected health behaviors.
adherence
Critical access hospitals are paid under what system?
A. PPS
B. DRGs
C. percent of costs
D. none of the above
C. Percent of costs
What are base payment rates of DRGs affected by?
A. only having low cost cases
B. The number of low-income patients in that location called disproportionate share hospital adjustment
C. Geographic location (cost of living adjustment factor)
D. Both B and C
D. both B and C.
Contract between two parties in which one party with stronger bargaining power sets the terms and conditions and the other party is expected to agree with and adhere to the contract.
adhesion contract
System developed by Johns Hopkins University that captures the morbidity burden of populations to help explain and predict how healthcare resources are delivered and consumed.
adjusted clinical group system
Case managers need a working knowledge of ____ including:
clinical documentation required to support medical necessity &
coding information needed to optimize DRG assignment
A. PPS System
B. IPPS rates
C. DRG System
D. DSH adjustment
C. DRG System
Which method of reimbursement is made based on a predetermined fixed amount?
A. PPS
B. Bundled payments
C. DRGs
D. None of the above
A. PPS
Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount.
Which organization seeks to:
Define measures and standards
Serve as a critically important foundation for initiatives
Enhance healthcare value
Make patient care safer
Achieve better outcomes?
A. NQF
B. QIO
C. RAC
D. AHQA
A. National Quality Forum (NQF)
What guides the level of care determination in a hospital?
A. The discharge plan
B. The patient and family
C. The physician’s expectation of a two midnight or longer hospital stay
D. Too many factors to count
C. The physician’s expectation of a two midnight or longer hospital stay.
