midterm-final

What is a formulary?

A list of the MCO-approved medications

What steps can you take to help patients understand their MCO? Look up the restrictions in the MCO manual. Give them directions to approved facilities. Explain the reasons for any inconvenience. All of the above.

All of the above. (Look up the restrictions in the MCO manual, Give them directions to approved facilities, & Explain the reasons for any inconvenience.)

Choose the BEST answer. Medical documentation can: a. Decrease denials from insurance companies b. All of these c. Provide legal protection d. Improve cost control

All of these

Group Model

An example of this kind of HMO, which contracts with a single medical group for health services, is Kaiser-Permanente.

A triple option plan is also known as a(n): cafeteria plan risk pool consumer-directed health plan multi-benefit plan

CAFETERIA PLAN

Payment of a fixed fee by an insurance company to a health care provider for each patient enrolled in a health care plan, regardless of services given to the patient, is called

Capitation

Recording observations and information about patients in a medical record is known as .

Charting

Recording observations and information about patients is called

Charting

The _______ complaint is the reason the patient is seeking medical care and is included in the subjective section of the record.The chief complaint is the reason the patient is seeking medical care and is included in the subjective section of the record.

Chief

What type of coverage provides individuals with the greatest amount of freedom in spending healthcare dollars? Preferred provider organization Point-of-service plan Triple-option plan Consumer-directed health plans

Consumer-directed health plans

Medicare Part __ is a plan that subsidizes prescription costs.

D

. Which managed care model is the most restrictive? Health maintenance organization Exclusive provider organization Preferred provider organization Physician-hospital organization

Exclusive provider organization

A PHR (personal health record) is maintained by the health care facility. a. True b. False

False

Having an EMR (electronic medical record) means the information can be sent automatically to any health care network.

False

If a coworker calls and asks you to sign her charting, it is alright as long as you sign her name followed by your name. a. True b. False

False

If an error is made on a medical record, use correction fluid and write out the correction. a. True b. False

False

It is not the purpose of medical documentation to improve cost control. a. True b. False

False

Medicare is free and covers all medical expenses. a. True b. False

False

Procrastination is an effective tool that prevents errors in judgment by postponing decisions. a. True b. False

False

Protected health records (PHR) are becoming increasingly important due to the mobility of individuals and frequent changes in health care providers. a. True b. False

False

Reimbursement refers to any money that is spent in the process of doing business. a. True b. False

False

The chief complaint is found in the physician's order. a. True b. False

False

The more words used in charting, the better the quality. a. True b. False

False

The reason for attending a job fair is to interview with as many employers as possible. a. True b. False

False

Using bright colored paper when printing your resume is a good way to draw the employer's attention to it. a. True b. False

False

When using narrative charting, only abnormal findings are noted. a. True b. False

False

The ___ history is taken as part of the medical history as medical problems of relatives may show a family tendency for problems.

Familial

___ sheets are documents for tracking specific information.

Flow

A/An ___ is a prepaid medical group practice plan that provides a predetermined medical care benefit package.

HMO

In SOAPIE notes, the "I" stands for

Interventions

A _____ refers to the collection of all documents that are filed together and form a complete chronological health history of a particular patient.

Medical record

___charting includes detailed written notes on all aspects of care.

Narrative

_________information in a SOAP note includes the observations of health care personnel

O-objective

Employees who have difficulty performing efficiently on the job often have poor ___ skills, are confused about their priorities (what is most important), and may be slow in making decisions.

Organizational

_____ are health care professionals who serve as the patient's first contact when entering the health care system.

PCPs

Match the characteristics to the appropriate MCO. Click the Submit button below when you are done.

POS- Combines Elements of HMOs and PPOs EPO- Network Providers are Exclusive HMO- Focuses on Preventive Care Services IDS- PHO is an Example PPO- No Deductible if In-Network Triple Option- Flexible Benefits Plan

Identify whether each of the MCOs listed below requires the member to see only in-network providers or if they will reimburse for in- or out-of-network provider visits and services. Answer choices may be used more than once. POS EPO HMO IDS PPO TRIPLE OPTION.

POS- In-or Out-of-Network Providers EPO- In-Network Providers Only HMO- In-Network Providers Only IDS- In-Network Providers Only PPO- In-or Out-of-Network Providers Triple Option- In-or Out-of-Network Providers

Identify whether each of the MCOs listed below requires a provider gatekeeper or if patients are allowed to self-refer to specialists (this varies within the MCO). Answer choices may be used more than once. POS EPO HMO IDS PPO TRIPLE OPTION

POS- Self-Referrals EPO- Primary Care Provider Gatekeeper HMO- Primary Care Provider Gatekeeper IDS- Varies Based on Plan PPO- Primary Care Provider Gatekeeper Triple Option- Varies Based on Plan

(labor costs) refers to the individuals who work in all areas associated with the functioning of the health care delivery system

Personnel

The part of the SOAP note documents the procedures, treatments, and patient instructions that make up the patient care.

Plan

Managed Care plan in which the patients must pay deductibles and coinsurance in order to receive care from non-managed care providers. Point of service plan Preferred provider organization Health maintenance organization Integrated delivery system

Point of service plan

An organization that includes groups of healthcare providers who provide services for discounted fees is known as _ _ _ _ _ _ _. Preferred provider organization Exclusive provider organization Health maintenance organization Physician-hospital organization

Preferred provider organization

is defined as the amount of money remaining after all costs of operating a business have been paid.

Profit

What is the method of controlling costs and quality of care by reviewing the need of care before it is provided? Prospective review Retrospective review Utilization management Concurrent review

Prospective review

is an activity that is referred to as charting.

Recording a patient's temperature

The chief complaint would be included in which part of a SOAPIE note?

S-subjective

The format for charting of each problem is known as

SOAP

What is the best action to take if you hear about a job that has not been advertised? a. Do not waste your time because the chances are good that there is no job. b. Start watching for a posting on the Internet about the job. c. Send the employer a resume along with a cover letter stating that you understand there is an opening for which you might qualify. d. Call the employer and ask if there is a job opening

Send the employer a resume along with a cover letter stating that you understand there is an opening for which you might qualify.

All of the following are effects of managed care on a physician's practice except: Separate bookkeeping systems Tracking system for preauthorizations Additional paperwork Streamlined business processes

Streamlined business processes

_____ information is that which is sensed and reported by the patient.

Subjective

Match Type of Managed Care Plan w description 1 Gatekeeper 2 Capitation 3 Copayment 4Deductible 5 Premium 6 Coinsurance 7 Preauthorization 8 Referral Description The amount an insurance policy holder must pay in order to maintain insurance coverage. Amount the insured must pay before insurance will provide coverage. A request for a member to receive treatment from another provider. Percentage patient pays for covered services after the deductible has been met. Formal prior approval from an MCO for a patient to have a procedure done. Primary care provider who is responsible for supervising and coordinating healthcare services. Method of financing managed care, where providers accept pre-established payments for a length of time. A fee paid by the patient to the provider at the time of service.

The amount an insurance policy holder must pay in order to maintain insurance coverage.(5-premium) Amount the insured must pay before insurance will provide coverage. (4-deductible) A request for a member to receive treatment from another provider. (8- referral) Percentage patient pays for covered services after the deductible has been met. (6- coinsurance) Formal prior approval from an MCO for a patient to have a procedure done. (7-preauthorization) Primary care provider who is responsible for supervising and coordinating healthcare services. (1-gatekeeper) Method of financing managed care, where providers accept pre-established payments for a length of time. (2-capitation) A fee paid by the patient to the provider at the time of service. (3-copayment)

Which of the following statements is most accurate in describing the cost of health care? a. There has been a rise in health care costs. b. The costs of health care have stayed consistent over the past few decades. c. There has been a decrease in health care costs. d. There is no concern regarding the cost of health care.

There has been a rise in health care costs.

Staff Model HMO

This is an HMO type in which physicians are employees and medical services are delivered in HMO- owned facilities.

Network Model HMO

This type of HMO contracts with multiple independent group practices and/or organizations to provide healthcare services.

Closed Panel HMO

This type of managed care plan contracts with physicians on an exclusive basis for services and does not allow those physicians to see patients from another managed care organization.

IPA HMO

This type of managed care plan contracts with physicians who deliver care in their own offices and who can contract with multiple plans to care for all their members, as well as non-HMO patients.

A health care provider must at all times be aware and protect the privacy of the patient's record. a. True b. False

True

A patient chart refers to the collection of all documents that form a complete chronological health history of a particular patient. a. True b. False

True

A source-oriented format divides the record into different sections separated by tabs for each health care specialty. a. True b. False

True

An important part of the job search is creating a way to keep your search activities organized. a. True b. False

True

Career One Stop is a website sponsored by the U.S. Department of Labor. a. True b. False

True

Electronic health records (EHRs) can offer more than core charting. a. True b. False

True

Medical documentation is the lifeline of communication that supports the coordination of patient care. a. True b. False

True

One purpose of medical documentation is to provide legal protection if there is a lawsuit against a provider. a. True b. False

True

The progress note is the primary tool used to record, communicate, and coordinate the care given to the patient. a. True b. False

True

The security of records is the responsibility of each health care professional. a. True b. False

True

There are many ways health care professionals can contribute to the efficient and cost-effective functioning of the facility. a. True b. False

True

Which section is emphasized on a chronological resume? a. Work Experience. b. Education c. Summary of Qualifications d. Community Service

Work Experience.

Which of the following areas would apply to the HIPAA (Health Insurance Portability and Accountability Act of 1996) Privacy and Security Rules? a. maintaining a copy of all incident reports b. keeping a record of how many times an employee was late c. a patient's right to request access to and copies of his or her medical record d. ergonomic evaluations of the office layout

a patient's right to request access to and copies of his or her medical record

Which of the following should be done if someone charts an entry that occurred after the action that you intended to chart? a. Write "late entry" and then chart. b. Cross off the charting, enter your charting, and have the other person rewrite their entry below yours. c. Draw an arrow to show your entry should be placed before the later entry. d. Write your entry in pencil.

a. Write "late entry" and then chart.

Which of the following would have access to a patient's information? a. the patient's spouse b. a coworker c. an individual with power of attorney d. the patient's parents

an individual with power of attorney

The ____ is the health care professional's impression of what is wrong with the patient.

assessment

A payment methodology in managed care which consists of pre-established payment for services provided over a period of time is known as _ _ _ _ _ _ _ _ _ _ _ _. capitation fee-for-service sliding scale point of sale

capitation

Recording observations and information about patients in a medical record is known as _____

charting

Which of the following categories incurs the highest percentage of health care costs? a. acute injuries and accidents b. maternal-child care c. geriatric care d. chronic conditions

chronic conditions

Which of the following best describes the contents of a functional resume? a. statements about how the individual will function on the job. b. clusters of skills and abilities acquired in different ways. c. a well-developed work experience section. d. an emphasis on education.

clusters of skills and abilities acquired in different ways.

What is the term used to identify the percent of every service that a patient is responsible for paying? Deductible Copayment Coinsurance Fee-for-service

coinsurance

The amount of money a patient pays at the time of service is known as: coinsurance deductible copayment capitation

copayment

Medical ____ refers to notes and documents that health care professionals add to the medical record.

documentation

Which of the following costs would be categorized as a labor cost? a. buildings are upgraded b. employees are paid wages c. the storeroom supplies are restocked d. medications are ordered

employees are paid wages

Reimbursement that occurs when the physician determines what actions to take and the insurance company is then billed to pay for the services is known as __ for service.

fee

Health care institutions are grouped into categories based on the type of ___ they receive.

funding

A ___ includes a personal, familial (medical problems of relatives that may show a family tendency for problems), and social history (if and how much patient smokes, drinks alcohol, or takes illegal drugs) of the patient.

history

A medical _______ includes a personal, familial (medical problems of relatives that may show a family tendency for problems), and social history (if and how much patient smokes, drinks alcohol, or takes illegal drugs) of the patient.

history

____ care is the promotion of cost-effective health care through the management and control of its delivery.

managed

A/An ___ is a health services delivery organization that offers the option to its members to choose to receive a service from participating or a nonparticipating provider.

point-of-service plan (pos)

Some insurance companies require __ before they will pay for certain nonessential medical services and referrals to specialists.

preauthorization

____ medical records are organized around the patient's health problems.

problem-oriented

To improve personal efficiency, the greatest time and effort should be spent on using what processes? a. problem-solving b. corner-cutting c. quality assurance d. evaluation

problem-solving

Which of the following is a potential disadvantage of a computerized charting system? a. decreased communication among health care team members b. increased recording time c. problems with patient confidentiality d. less access for research and quality improvement programs

problems with patient confidentiality

___ notes are written chronological statements about a patient's care.

progress

When services have been given and the payment not received, the amount owed is recorded in what is called an account

receivable

The ___ history is taken as part of the medical history to determine if the patient smokes, drinks alcohol, or takes illegal drugs.

social

It is recommended that job seekers prepare a personal inventory that includes: a. a list of what they are looking for from an employer b. only their technical health care skills c. the classes they took in school d. technical skills, as well as personal traits that they can apply on the job

technical skills, as well as personal traits that they can apply on the job

is a possible corrective action when a HIPAA (Health Insurance Portability and Accountability Act of 1996) regulation is broken.

termination of employment

Which of the following is an example of an account payable? a. the Medicare payment received by a provider of care b. the interest that could be earned if money due was received and invested c. the balance due on a purchased item d. any money spent in the process of doing business

the balance due on a purchased item

Jason plans to use to Internet to make his resume available for employers. Which of the following types of websites would most likely result in an interview for Jason? a. a free national general resume-posting site b. a resume-posting site that charges a fee c. the websites of local health care facilities d. a national health care resume-posting site

the websites of local health care facilities

The Privacy Rule allows a patient to request a copy of his or her medical record. a. True b. False

true

Which of the following is reported to be the most effective way for recent graduates to find effective job leads? a. review employment ads in the newspaper b. review national job websites on the Internet c. work with their school's career services department d. ask their friends who are already working

work with their school's career services department