Part 7 Flashcards
The principal process by which organizations optimize the continuum of care for their patients is _____.
A. utilization management
B. services management
C. case management
D. resource management
case management
Monitoring the patient throughout the entire episode of care is considered this case management step:
A. Care planning at the time of admission
B. Review the progress of care
C. Preadmission care planning
D. Discharge planning
Review the progress of care
Follow-up on a patient after discharge to ensure that the transition has gone smoothly and that the patient is receiving all of the services required is considered this case management step:
A. care planning at the time of admission
B. review the progress of care
C. post-discharge planning
D. discharge planning
post-discharge planning
A multidisciplinary outline of anticipated care within an appropriate period to aid a patient in moving progressively through a clinical experience that ends in a positive outcome is called a _____.
A. critical pathway
B. care plan
C. care assessment
D. continuum of care pathway
critical pathway
During a hospitalization the case manager is concerned that Sam’s intensity of service is not meeting the criteria for continued hospitalization. The case manager speaks to Sam’s physician, who updates the patient’s care plan to reflect the high-level care being provided to the patient. Which part of the case management process is being performed?
A. preadmission care planning
B. care planning at the time of admission
C. review the progress of care
D. discharge planning
review the progress of care
The totality of healthcare services provided to a patient and his family in all settings, from the least to the most extensive, is called
a. Episode of care
b. Continuum of care
c. Services of care
d. Settings of care
Continuum of care
Community hospital has received a large number of claims denials for CT scans that were provided to patients. After review of the denied claims, the hospital has determined that clinical indications for the CT scan were not present. Which of the following reasons for clams denials does this scenario exemplify?
A. Best practices for billing were not used
B. Patient preferences were ignored
C. The scans did not meet medical necessity
D. No order was present in the record for the scans
The scans did not meet medical necessity
The outcome of which flow of care is an improvement in the patient’s condition that allows discharge to the patient’s home or to a different care setting?
A. Assessing the patient’s needs
B. Planning care, treatment, and services
C. Coordinating care, treatment, and services
D. Providing care, treatment, and services
Coordinating care, treatment, and services
CLIA and the CDC have established protocols for _____.
A. core measures
B. surgery protocols
C. emergency departments
D. laboratory departments
laboratory departments
Which of the following is a core process step that consists of the establishment of an interactive treatment plan that is specific, individualized, and based on a thorough assessment of the patient’s physical, emotional, social, cognitive, and cultural needs?
A. Assessing the patient’s needs
B. Planning care, treatment, and services
C. Coordinating care, treatment, and services
D. Providing care, treatment, and services
Planning care, treatment, and services
