WGU D053-Contemporary Topics and the Influence on Healthcare Today

Benefits of shared care plans

"Giving patients the opportunity to help develop and negotiate their care plans transforms the relationship between patients and providers. By emphasizing transparency and cooperation in developing shared care plans, your practice can reshape and improve its relationship with patients.

A human resources representative is orienting a new healthcare coordinator. As part of the terms of employment, the coordinator will be required to receive CCM credentials within three years. Which statement by the coordinator indicates a lack of understanding of this requirement?

"Prior to my first year of employment, I will qualify for certification."

TUG

(TUG) is a simple test used to assess a person's mobility and requires both static and dynamic balance. It uses the time that a person takes to rise from a chair, walk three meters, turn around 180 degrees, walk back to the chair, and sit down while turning 180 degrees.

IDEA (Ethical decison making framework) 4 steps

1. Identify the facts 2. Determine relevant ethical principles 3. Explore the options 4. Act on decision

6 Steps if you have an ethical dilemma

1. Identify the problem 2. Apply the 2014 ACA code of ethics 3. Determine nature and dimensions of dilemma 4. Generate potential courses of action 5. Consider potential consequences of each course of action for all parties involved. 6. Evaluate the selected course of action

Suicide is the ?? leading cause of death in the us

10th (for people ages 15-24 it is the leading cause of death)

An institution is being audited by the Medicaid Integrity Contractors (MICs). MIC will be conducting a deck audit of the institution's records and the institution must provide several years of documents to the contractors to be in compliance with MIC regulations. What is the lookback period for this type of audit?

5 years prior to the start date of the audit

A healthcare provider is teaching a new employee about the sharing of patient information under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Which statement by the healthcare provider is accurate? A--It may be shared for the purpose of payment. B--It may be shared with anyone employed at the facility. C--It may not be shared for the purpose of public health reporting. D--It may not be shared with law enforcement for criminal investigation.

A

A registered nurse (RN) at a local nursing home wants to advance into a management role but does not want to go back to school full-time. The RN is interested in becoming certified in care coordination and transition management (CCCTM) and decides to review the requirements of that certification. Which requirement must be met?

A minimum of 2,000 hours of care coordination and transition management

A healthcare team has seen an increase in staff turnover on the unit and decides to initiate an evidenced-based research project to examine interventions to reduce the rate. Which item should the team initially develop for this purpose?

A research question (aka ask)

Which digital technology does the health service coordinator include in the plan of care to allow for mobile monitoring of a patient diagnosed with diabetes mellitus who lives in the rural setting? A--Blood glucose monitor B--Respiratory monitor C--Pulse monitor D--Blood pressure monitor

A--A mobile glucose monitor allows close monitoring of patient data for those who reside in the rural setting and have farther distances to travel for needed health care maintenance. A mobile blood glucose monitor would allow the health care practitioner to monitor a patient's blood glucose level over time, without the need for the patient to travel.

A patient is trying to send a healthcare coordinator an email that includes scans of medical records, but is unable to do so via home computer. The patient advises the coordinator that the computers at the library are available and to expect the email soon. Which action should the coordinator take to ensure e-security practices are upheld? A--Advise the patient to wait until the home computer is available to send the email. B--Provide the patient with an FTP site to upload the scans. C--Encourage the patient to delete the email account after the scans are sent. D--Instruct the patient to email a link to download the scans.

A--Advise the patient to wait until the home computer is available to send the email.

A transgender patient is discussing the use of pronouns with the healthcare coordinator, and notes a preference for the pronoun "they." Afterwards, the coordinator conducts further research into the topic, and decides to open discussions with transgender individuals for which care is coordinated. On which level of the Cultural Capacity Continuum is the healthcare coordinator acting? A--Cultural Humility B--Cultural Awareness C--Cultural Competence D--Cultural Sensitivity

A--By seeking to understand the patient, learning new cultural aspects, and working to apply the new learning, the caretaker has reached the level of cultural humility.

A healthcare coordinator of a medical facility is discussing with providers the opportunity to participate in value-based care as recommended by the Center for Medicare and Medicaid Services (CMS). Adopting which approach allows the facility to participate in value-based care? A--An accountable care organization. B--A fee-for-service model. C--A high-volume care plan. D--An incentive for providing more diagnostic procedures.

A--CMS has developed models for providers to participate in value-based care, such as an accountable care organization (ACO). This is a network of physicians, hospitals, and other providers that coordinate to provide quality care. It ensures patients receive the most appropriate care and aims to prevent unnecessary services and medical errors.

A healthcare coordinator works closely with a registered nurse who is certified in care coordination. Which question is appropriate to ask a nurse about the care coordination certification process? A--"How long was your exam for your care coordination certification?" B--"Did you obtain your associates or bachelor's degree in care coordination?" C--"Did you pay full price for your state license in care coordination?" D--"What made you give up your nursing career for care coordination?"

A--Certification typically requires passing an exam with content specific to the necessary knowledge, competencies, and skills associated with the specialty being sought.

A healthcare coordinator is coordinating care for a patient with heart disease. The patient expresses a desire to adopt a new diet. How can the healthcare coordinator apply evidence-based practice (EBP) to acquire accurate evidence as to which diet would be appropriate for the patient? A--Share a medical journal article that has researched diets for patients with heart disease with the patient. B--Interview a patient who has made successful dietary changes to improve heart disease outcomes. C--Search online to find websites that offer suggestions on heart-healthy diets. D--Ask the opinion of colleagues about effective dieting methods for patients with heart disease.

A--EBP focuses on finding tested interventions that address a practice-related question or problem and produce desired outcomes. The most reliable results come from comparisons of quality scientific research studies. Repeated and rigorous outcome evaluation through research studies and clinical trials are needed before an intervention is accepted as evidence-based and scientifically supported.

A healthcare coordinator at a behavioral health facility is seeking to comply with federal insurance regulations to receive reimbursement for claims submitted to private insurance companies. How can the healthcare coordinator ensure the facility is in compliance with federal and state insurance regulations when submitting claims? A--Follow HIPAA privacy laws. B--Submit to transparency regulations. C--Report the medical loss ratio. D--Uphold benefit mandates.

A--HIPAA regulations dictate that patient information must be kept private, even while submitting insurance claims. The insurance company has legal access to the patient's protected health information (PHI), but only relevant PHI should be reported to the insurer.

A healthcare coordinator at a hospital is coordinating treatment for a patient who needs joint replacement surgery. The patient has a private insurance policy. How can the healthcare coordinator comply with private insurance regulations to ensure reimbursement for the surgery? A--Submit a pre-authorization for the surgery. B--Confirm that the patient does not qualify for Medicare or Medicaid. C--Have the patient confirm coverage with the insurance company. D--Contact the state insurance commissioner regarding the claim.

A--Health insurers require that certain procedures, especially high-cost services such as surgeries, receive pre-authorization by the insurer before the procedure is performed. Usually this pre-authorization is dependent on what is perceived by the clinician to be medically necessary for the patient. By submitting a pre-authorization, the healthcare coordinator can ensure reimbursement will be received for the surgery.

A healthcare coordinator of a long-term care skilled nursing facility is ensuring the facility participates in value-based care to receive the maximum reimbursement from Medicare and Medicaid. The healthcare coordinator is submitting patient data to the Centers for Medicare and Medicaid Services (CMS) to determine a quality measurement score. What is the effect of the quality measure score in a value-based care model for the skilled nursing facility? A--It adds an incentive to provide patients at the facility with better care. B--It encourages the facility to provide more care to more patients. C--It prevents submission of fraudulent claims by providers associated with the facility. D--It determines facility compliance with CMS regulations.

A--In a value-based care model, patient care data regarding safety and quality of care is entered into the electronic health record (EHR) of the patient. Quality measurement data are submitted to CMS to produce a quality measure score using algorithms. This score is compared with other similar providers and affects reimbursement rates. Higher performing providers receive a bonus; lower performing providers get reduced reimbursement or are penalized with fines. This monetary incentive encourages higher quality care.

Which strategy is demonstrated when a health service coordinator, patient, and team of other professionals develop and monitor a course of action in response to the patient's behavioral or addiction issues? (A--Interprofessional treatment planning B--Interdisciplinary rounding C--Shared decision making D--Team huddling)

A--Interprofessional treatment planning (nterprofessional treatment plans are done by engaged members of health professionals and the patient. This type of plan typically addresses behavioral or addiction treatments. A health care service coordinator can assume the role of a case manager and work with the patient and other healthcare professionals until recovery occurs.)

A healthcare worker approaches a patient's coordinator in the hallway outside the patient's hospital room and begins discussing a new medical issue the patient is faced with. To maintain HIPAA laws, which action should the coordinator take? A---Move into a secluded area before continuing the discussion. B--Leave the discussion and report the issue to supervisory staff. C--Enter the patient's room and continue the discussion. D--Discuss the patient's medical issue then report the security violation.

A--It is against protocol to discuss patient information in public places, so moving to a private area is required.

A nursing manager is working with an interprofessional team that includes a member with limited English proficiency. The manager would like to foster collaboration despite any language barriers to manage a system-wide change taking place in the electronic medical record (EMR). Which action should the manager take to meet this goal? A--Use multiple modes of communication with time for all to participate B--Refrain from asking the team member with limited English to respond during meetings C--Have all communication occur during the meetings D--Have each team member present in front of the group at the team meetings

A--Multiple modes of communication in different ways can foster collaboration and input from team members in the manner that is best for that group.

The healthcare coordinator has applied to take the Certified Case Manager (CCM) exam. How does the healthcare coordinator recognize the requirement has been met to acquire an evidence-based professional certification? A--Working in the field for at least one year B--Reciprocating a continuing education unit for each month the coordinator has been in practice C--Submitting letters of recommendation from the current employer D--Proving competency after choosing a topic relevant to the healthcare professio

A--One requirement for evidence-based professional certifications is that the professional has worked in the stated field for at least one year.

A healthcare coordinator has identified an issue between a patient's spouse and the patient's mental health provider. The spouse has repeatedly called the provider asking for updates on the patient's behavioral health. Since the patient has not given legal consent to share information, this has caused a clash between all three parties. The provider has asked the coordinator to mediate. How should the coordinator handle this situation? A--Discuss the applicable health consent laws with the patient and spouse. B--Give the provider a health-information sharing consent form. C--Meet with the spouse to request that the calls to the provider stop. D--Ask the patient if a new mental health provider should be selected.

A--Opening a discussion with the patient and spouse provides the opportunity for shared decision-making in addressing this issue, and allows for the opportunity to clarify the laws with both of them.

A new, culturally diverse, interprofessional team has been developed to work on an emergency management plan. Cultural differences have created conflict when the expectations and desires of various individuals are shared. Which stage of team building is being exhibited? A--Storming B--Forming C--Norming D--Performing

A--Storming

A healthcare professional is going through the process to become a certified case manager (CCM). Which process will this individual participate in to demonstrate competency? A--Completion of a standardized assessment B--Completion of an online specialty assessment C--Observation of communication with team members D--Observation of services provided to clients

A--The CCM exam is based on an ongoing nationwide validation research project. The content of the exam is the same for each administration of the exam. It will vary from administration to administration to protect the integrity of the exam.

A healthcare coordinator is attempting to implement the care transitions program at a hospital. The coordinator has scheduled a presentation with leadership to explain about the program. What information should the coordinator include in this presentation? A--Patients and caregivers are encouraged to be more involved in their care. B--Family caregivers are paid for their time and effort in providing care. C--The patient is required to stay in a skilled nursing facility during recovery. D--The program increases patient strength during bed-to-chair transfers.

A--The Care Transitions program focuses on providing family caregivers the skills to ensure the patient's needs are met as they transition from hospital to home. One of the purposes of the care transitions program is to encourage patients and their caregivers to be more active in their care.

Which coding system is regulated by the American Psychiatric Association? A--The Diagnostic and Statistical Manual of Mental Disorders: DSM-V. B--The Current Procedural Terminology C--The International Classification of Diseases

A--The DSM-V is regulated by the American Psychiatric Association.

Which classification systems identifies epidemics such as causes of illness and death? A--The International Statistical Classification of Diseases and Related Health B--The Diagnostic Classification Medical System C--The Diagnosis-Related Group

A--The ICD-10 identifies epidemics before they hit a specific region by identifying causes of illness and death.

A care coordinator is getting ready to see a new patient for a follow-up interview and notices that the computer is open to another patient's record. Which action should the coordinator take first to properly maintain the electronic medical record (EMR) of the new patient? A--Log off and back onto the computer B--Handwrite the data before computer entry C--Find the supervisor to report the issue D--Enter the patient's data accurately

A--The care coordinator would need to assure the correct patient's record is selected to maintain the integrity of the new patient's medical record. Logging off of another patient's record would need to be completed prior to entering data into a new patient's record.

A healthcare provider is working with a patient who has low back pain. The patient understands English, although English is a second language. As the healthcare provider reviews a prescription with the patient, the patient makes a statement that leads the provider to believe an interpreter is still needed. Which statement by the patient led the provider to this decision? A--"Why do I need to take this medication?" B--"How many tablets do I take?" C--"What is the frequency for taking this medication?" D--"When can I stop taking the medication?"

A--The patient has come to the healthcare provider for low back pain. This comment would lead the healthcare provider to believe the patient does not have a full understanding of the conversation and an interpreter may be needed to clarify the reason for the medication.

Which technology allows patients to access their own health information and interact with their providers? A--Patient Portal B--Virtual Reality C--Electronic Medical Record D--Personal Health Record

A--The patient portal is an interface of the electronic medical record. It is designed specifically for patient interaction with providers and allows them to access their health information.

Which issue must the health service coordinator take into consideration when applying digital technologies to a plan of care in order to protect patient confidentiality? A--Cyber attacks B--Provider experience C--Social determinants D--Insurance coverage

A--The use of digital technologies in healthcare entails careful attention to the foundational principles of privacy, confidentiality, data ownership and rights, and the process of protecting these principles within a technological environment. Poor privacy and security practices heighten the vulnerability of patient information in health information systems, increasing the risk of successful cyber attacks.

The ACMA Standards of Practice are clustered into seven areas: What are they?

Accountability Professionalism Collaboration Care Coordination Advocacy Resource Management Certification (ACMA, 2013)

A healthcare worker in a skilled nursing facility suspects that one of the elderly residents is being financially taken advantage of by a relative. To whom should the worker report this suspicion?

Adult protective services

ACA

Affordable Care Act

During a team meeting, a culturally diverse interprofessional team begins to have a disagreement regarding the best intervention for a client. Which strategy should be used first to foster collaboration in this group?

Allow team members to express opinions

Seventy-two hour rule

Any outpatient diagnostic or medical services performed within 72 hours prior to being admitted to the hospital must be bundled into one bill

APIs

Application Programming Interface

Which step of the evidence-based practice process includes combining evidence with clinical judgement and patient values? Apply Ask Acquire Assess

Apply--The Apply step of the EBP process is where one applies the evidence along with their own clinical judgement and their patient's values and preferences.

Certifications that a health care coordinator can take

As demonstrated in the video, there are certifications available to all health service coordinators in compatible fields such as case management, healthcare leadership, communication, working with digital technologies, and a number of practice-specific topics such as community care, palliative or end-of-life care, trauma-based care, and so on. For instance, the CCM is a multidisciplinary certification that prepares professionals to add case management knowledge and skills to their professional repertoire. The choice to seek certification once credentialed as a health service coordinator helps to keep a health professional's knowledge and skills current plus prepares them to expand their competencies and scope of practice.

What are the steps in the Evidence-Based Process?

Assess, Ask, Acquire, Appraise, Apply

A healthcare coordinator at an outpatient medical clinic submits a claim to a private insurance company for a procedure that a healthcare provider deemed necessary for a patient. The claim is returned from the insurance company unpaid and denied because of lack of medical necessity. How should the healthcare coordinator proceed? A--Report the insurance company to the state insurance commissioner for illegal claim denial. B--Submit an appeal to the insurance company for review of the claim. C--Let the patient know that the procedure was not covered by the insurance company. D--Document in the patient's health record that the procedure was not medically necessary.

B--A private insurer has a contract with providers. The contract usually indicates a procedure will be covered if medically necessary. If providers disagree with the private insurer as to what constitutes the clinical necessity of the patient and the insurance company denies a claim, insurers have an internal appeals processes in place to resolve these disagreements. Documentation to support the medical necessity of the surgery is submitted by the provider, and the company reviews the claim.

What are Alternative Payment Models (APMs)? A--Permanent value-based care models administered by CMS. B--Experimental and temporary value-based care models that are designed to test theories of care. C--A different way to pay providers through the old volume-based fee-for-service care model.

B--APMs are experimental and are used for data collection.

A healthcare coordinator at a renal dialysis care center is ensuring compliance with Medicare and Medicaid regulations and clinical review processes to receive maximum reimbursement for patient services rendered. What should the healthcare coordinator investigate to ensure compliance with Medicare and Medicaid regulations? A--If patients are satisfied with the renal care being provided. B--If the facility meets mandated safety standards for renal care facilities. C--If private insurance plans are being accepted for reimbursement of renal care. D--If all care providers at the facility are certified in dialysis care.

B--Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) are health and safety standards that healthcare organizations must meet or exceed to participate in the Medicare and Medicaid programs. The purpose of these health and safety standards are to improve quality and protect the health and safety of patients receiving Medicare and Medicaid coverage. A lack of compliance may affect the level of reimbursement a provider receives.

Which is an example of a healthcare worker demonstrating the digital literacy domain of technical proficiency? A--Producing online digital tools to mentor colleagues. B--Creating solutions to solve complex problems when using digital environments. C--Looking for digital technology to reduce cyberattacks in the organization. D--Using a wide range of technologies to enhance communication.

B--Creating solutions to solve complex technical problems when using digital devices and environments shows technical proficiency in the digital literacy domain. This capability focuses on the user's proficiency with technology.

A healthcare coordinator at a behavioral health facility is discussing health goals with a patient who is seeking care for alcohol abuse disorder. The patient states, "I know I need help, but my boss doesn't want me to miss any more work than I have to. I really don't want to do any type of in-patient program." How can the healthcare coordinator apply evidence-based practice (EBP) to meet the patient's goals? A--Show the patient research articles that highlight the benefits of inventions used with in-patient care. B--Provide the patient with out-patient intervention options that most likely will allow the patient to continue to work. C--Help the patient to re-evaluate work goals to better align with treatment recommendations. D--Suggest the patient discuss the positive outcomes of interventions with the work supervisor.

B--EBP can be used to identify desired outcomes and then select interventions to achieve those outcomes. EBP focuses on the patient's values and goals to guide practice decisions. After taking into consideration these goals, decisions about evidence-based interventions can then be made using healthcare team members' practice expertise.

A healthcare coordinator is desiring to nurture a culture of evidence-based practice (EBP) with the members of a healthcare team working with a patient who has multiple sclerosis and bipolar disorder. Which would be appropriate actions to assist in applying EBP to the coordination of the patient's care? A--Invite the patient to meet with the healthcare team after treatment decisions have been made. B--Arrange for the team members to share research related to the patient's conditions. C--Encourage the patient to participate in a related research study program for experimental interventions. D--Allow each healthcare professional to develop a care plan within an expertise area independently.

B--EBP combines the three critical aspects of health provider experience, scientific research evidence, and patient values. Reliable scientific studies that relate to the patient's condition can provide evidence on past treatments, diagnoses, processes, and procedures that can be considered and used to improve outcomes.

A healthcare team member shares information with a healthcare coordinator from a reliable research study related to an intervention being considered for a patient with chronic depressive disorder. How can the healthcare coordinator utilize this research to impact the patient's care while using evidence-based practice (EBP)? A--Inform the patient that an intervention has been found in the research study that will provide an improved outcome. B--Discuss the possibility of applying the intervention mentioned in the research study with the patient's healthcare provider. C--Implement the intervention as presented in the research study as soon as possible. D--Formulate a hypothesis question about the intervention being considered in the research study.

B--Evidence should be appraised and then applied along with the patient's healthcare team's clinical judgement as well as the patient's values. This can be done by collaboration about the research and intervention with healthcare team members that have clinical expertise and are aware of the patient's values and goals.

The health service coordinator works with the public health department as a member of the opioid task force. Which is a result of the Comprehensive Addiction and Recovery Act (CARA) in combatting the opioid crisis? A-- Expanded access to health insurance plans B--Expanded access to medication-assisted treatment C--Increased access to mental health care services D--Increased access to patient-centered medical homes

B--Expanded access to medication-assisted treatment (CARA establishes a comprehensive, coordinated, balanced strategy through enhanced grant programs that expand prevention and education efforts while also promoting treatment and recovery. One provision of CARA is the launch of a medication-assisted treatment and intervention demonstration program for combatting the opioid crisis)

A patient's medical provider has recommended that a patient install a heart rate tracker smartphone app. The patient asks the coordinator about the security of the app. Which explanation should the coordinator give? A--"It wouldn't be recommended unless it was good." B--"Medical apps must meet security standards." C--"No smartphone apps are safe." D--"Only the doctor and patient will access the app data."

B--Explaining that all recommended medical apps must meet stringent safety protocols is key to easing the patient's fears.

A healthcare coordinator is submitting a claim to an insurer for reimbursement of ambulance service for a patient. Which coding classification system would the healthcare coordinator use? A--International Classification of Diseases, 10th edition (ICD-10), B--Healthcare Common Procedure Coding System (HCPCS) level II C--Current Procedural Terminology (CPT) Category 3 D--The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), Section III

B--Healthcare Common Procedure Coding System (HCPCS) level II is used for supplies, services, and products that are not related to care from a physician, such as ambulance services.

A healthcare coordinator is working with a patient who often uses a smartphone to send personal health information (PHI). The phone was recently stolen and the patient is concerned. What advice should the coordinator give the patient for the next phone? A--"Create a stronger password than the first one." B--"Install remote wiping and disabling technology." C--"Only send emails from the home computer." D--"Install antivirus software for added security."

B--If the phone is lost or stolen, this technology can help remove secure information.

A health services coordinator at a hospital is reporting data to the Centers for Medicare and Medicaid Services (CMS) to participate in value-based Medicare and Medicaid programs. Which data can be reported to receive a reimbursement bonus in a value-based care model? A--Individual provider claims submissions. B--Reduced hospital readmission rate. C--Larger volume of patients being treated. D--More diagnostic procedures being performed.

B--In value-based care, providers are monetarily rewarded for the quality of patient care they provide. Quality of care can be quantified by data submitted to the in the Hospital Readmissions Reduction Program that shows a reduction in hospital readmissions. Providers who do not meet quality performance standards are monetarily penalized.

When does the process of quality measurement begin? A--When the patient data is sent to CMS. B--When patient care data is entered into patient EHRs. C--Before the provider enters the value-based care model.

B--Patient data provides the basis for the calculation of all quality measures.

Why is maintaining compliance important in the Medicare and Medicaid programs? A--Because following rules is important. B--Because not maintaining compliance can cause harm to patients and waste valuable care dollars. C--Because noncompliance looks bad for a provider.

B--Patient harm and financial waste can occur if a provider is in a state of noncompliance.

What is the role of quality measures in value-based care? A--Quality measures guide how providers stay in compliance with the Medicare program. B--Quality measures take patient care data and output a quality score by which a provider's reimbursement bonus or penalty is determined. C--Quality measures determine whether a provider gets paid by an insurer, such as Medicare.

B--Quality measures determine providers' reimbursement bonuses and penalties.

A healthcare coordinator at a hospital is analyzing compliance with current Medicare and Medicaid regulations to ensure maximum reimbursement. Which action ensures compliance with the Paperwork Reduction Act (PRA) of 1995? A--Implementing safety and quality-control risk assessments. B--Confirming electronic submissions are being filed correctly. C--Allowing patients access to medical records upon request. D--Ensuring the public has access to emergency services the hospital provides.

B--The Paperwork Reduction Act (PRA) changed many aspects of how information was collected by the federal and state governments to provide Medicare and Medicaid reimbursement. The goal was to reduce the burden of paperwork and encourage the use of electronic filing systems. For a hospital to receive maximum reimbursement from Medicare and Medicaid, electronic submissions must be filed correctly according to current PRA guidelines

Why are ethical dilemmas so difficult to address? A--Choosing between competing biases B--Choosing between competing values C--Choosing between competing decisions D--Choosing between competing outcomes

B--The dilemma is uncomfortable and distressing because of the competing values.

People living in a rural area are struggling to gain access to needed healthcare due to the limited volume of specialists in the area. Which approach improves their access? A--Patient portals B--Telemedicine technology C--Electronic medical records D--Analytic software

B--The remote diagnosis and treatment of patients by means of telecommunications technology is what telemedicine is used for. This can allow people in rural areas to gain virtual access to specialists who are not available in their area.

A health services coordinator is working at a community clinic. A mother, who immigrated seeking asylum status, comes to the clinic with her two-year-old who has symptoms of an ear infection. She asks if there is healthcare service coverage available for her or the child. Which statement regarding coverage is accurate for this patient? A--Medicaid coverage is not available to immigrants of any status, and this restriction continues until US citizenship is obtained. B--Medicaid coverage is available and the five-year waiting period does not apply when the individual has asylum status. C--Medicaid coverage is only available for immigrants that have achieved permanent residency. D--Medicaid coverage is only available to those immigrants with a green card status.

B--U.S. immigration law allows asylees to apply for lawful permanent resident (LPR) status after they have been physically present in the U.S. for at least one year since being granted asylum.

What is the aim of value-based care? A--Improve patient independence. B--Lower healthcare costs while increasing quality. C--Connect populations with funding sources.

B--Value-based care improves patient and population health, and lowers healthcare costs.

Which digital technology can help train health care providers on updated surgical techniques to ensure that patients receive cutting edge technology when applicable? A--Robot-assist B--Virtual reality C--Three-Dimensional printing D--Nanomedicine

B--Virtual reality (VR) is currently being used in schools and healthcare to train providers such as nurses and surgeons. VR creates a realistic and stimulated environment with a low risk to patient injury.

What was a problem with the old volume-based fee-for-service model of care used by Medicare? A--It supports providers to perform redundant and potentially unnecessary care. B--It rewarded volume of care over quality of care. C--It created avenues to increase funding sources for healthcare providers.

B--Volume-based fee-for-service model of care rewards volume of care over quality of care.

Bioethics

Bioethics essentially refers to the ethics of life but has come to focus on life science ethics, including research and innovation such as genetics, cloning, stem cell research, emerging technologies such as nanotechnology in healthcare, eugenics, euthanasia, and assisted suicide, synthetic biology, human enhancement, abortion, and so on.

A healthcare coordinator provides insurance information to a family of four who are lawfully present immigrants, each having an alien registration card. Though gainfully employed, the family's status is low-income. When providing this family with government funded insurance information, which statement does the healthcare coordinator include? A--"Prior to seeking insurance through the ACA marketplace, you must submit an official health record showing previous treatments and conditions. B--"Upon initial approval, you will be required to reapply and update your immigration status every three months to remain eligible." C--"There is a five-year waiting period from obtaining your "green card" before you would be eligible to enroll in most programs, such as Medicaid or the children's health insurance program (CHIP)." D--"The subsidies in place to assist with coverage through the affordable care act (ACA) marketplace are available to immigrants regardless of status and income."

C-- 5 year waiting period (There is a restriction for lawful immigrants to become eligible for government assisted health insurance. One restriction is a five-year waiting period. Exceptions to this are immigrants who are present due to refuge or asylum. Some states have also waived the five-year waiting period for pregnant women.)

The healthcare coordinator is discussing privacy laws with a client who was admitted to the behavioral health facility following a suicide attempt. Which statements by the patient would indicate to the healthcare coordinator that there was a Health Insurance Portability and Accountability Act (HIPPA) violation? A--"I saw an email exchange that two doctors had about me. I do not think they are supposed to do that!" B--"My job is probably in jeopardy now. My boss called to get information, but they would not talk to my boss or confirm that I am here." C--"I think they are writing lies about me. I was told I cannot get a copy of my medical record until I am discharged!" D--"They think they know everything about me. Someone from the hospital called and told them about me before I was brought here."

C--(A patient has the right under HIPAA to request and receive their medical records at any time to check for accuracy and/or to share with other entities.)

A healthcare coordinator is discussing a plan of care with an Asian female patient. The patient states, "My father will not agree to this treatment. It is against our religion." What is the appropriate response by the coordinator using patient-centered care? A--"Perhaps you need to get a second opinion from another provider." B--"It is your decision whether or not to receive treatment." C--"We will talk to your provider about alternative treatment options." D--"I can discuss the importance of the care plan with your father."

C--A patient has a right to culturally and religiously accepted treatment plans. Plans should be modified to consider a patient's culture, religion, and ethnicity. When care plans cannot be modified, it is important to discuss the possible outcomes of alternative treatment.

A healthcare coordinator is coordinating discharge care with a patient who has had surgery. How can the healthcare coordinator utilize evidence-based research and data for the patient's discharge care process? A--Assess the patient's values and goals to guide discharge care. B--Apply similar methods used for previous patients to arrange for discharge care. C--Follow the established guidelines to make discharge care decisions. D--Ask the patient's physician to provide suggestions for discharge care.

C--Clinical guidelines are developed to guide the decision-making process for treatment and care. The guidelines are based on well-researched outcomes and professional expertise. These guidelines are also utilized to provide efficient and cost-effective care with the highest quality of outcomes.

Which comprehensive approach does the health service coordinator recommend to create protective environments to assist in stopping sexual violence within the community? A--Promotion of healthy sexuality. B--The mobilizing of the male youth. C--Improvement in the safety of schools. D--Encouragement of leadership in girls.

C--Correct! Improvement with safety as well as monitoring of schools is an approach to creating protective environments. Environmental approaches make it possible to address community risks and implement workplace policies.

A healthcare coordinator in a hospital is submitting a claim for reimbursement. Which coding system should be used to identify diagnostic services provided to the patient? A--International Statistical Classification of Diseases and Related Health (ICD) B--Diagnosis-related group (DRG) C--Current procedural terminology (CPT) D--The World Health Organization (WHO)

C--Current procedural terminology (CPT) codes are published by the American Medical Association and are designed to provide a uniform data set that could be used to describe medical, surgical, and diagnostic services rendered to patients.

A healthcare coordinator at a behavioral health facility is submitting a claim to an insurance company for reimbursement for treatment for a patient who has schizophrenia. Which coding system should be used by the healthcare coordinator to identify the patient's disorder? A--The American Psychiatric Association (APA) B--The Healthcare Common Procedure Coding System (HCPCS) C--Diagnostic and Statistical Manual of Mental Disorders (DSM-5) D--The International Statistical Classification of Diseases and Related Health (ICD-10)

C--Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic codes are regulated by the American Psychiatric Association and are used in psychiatric care environments. The DSM-5 has three sections. Section II provides codes, descriptions, and origins of neurodevelopmental and psychological disorders, such as schizophrenia.

How many quality measures are there across all Medicare value-based care models? A--150 B--No more than 10 per state. C--As many as the designers of the value-based care models determine there needs to be in order to successfully gauge quality in a model. D--50

C--Each value-based care model can have dozens or more quality measures if necessary.

A healthcare coordinator is addressing an autonomical concern that has arisen with a new patient. The coordinator has listed the facts related to the issue, explored the options available to assist in remedying the situation, and has made decisions on actions to take. According to the IDEA (Identify the Facts, Determine Relevant Ethical Principles, Explore the Options, Act on Decision) Framework, which two areas should the healthcare coordinator take into consideration when acting upon the decisions made? A--Revision and appeal B--Ethics and morality C--Empowerment and relevance D--Observation and deliberation

C--Empowering the others involved to assist with rectifying the situation and ensuring the actions taken are based on evidence and principles are both key to ethical decision-making, as based on the IDEA Decision-Making Framework.

A care coordinator who recently moved to a new metropolitan area has been assigned to an area of the city that has a majority Hispanic population. Since the coordinator has little experience working with this population, she decides to take several actions before starting the job. Which of these actions demonstrates that the coordinator is dedicated to being cultural responsive when treating patients? A--Watching Hispanic-focused TV shows and videos on medicine. B--Taking classes on the history of Hispanic cultures and language. C--Conducting research on Hispanic cultural expectations of healthcare. D--Polling Hispanics in her neighborhood on healthcare preferences.

C--In conducting research on the cultural expectations Hispanics have for their healthcare, the coordinator is demonstrating dedication to cultural competence in treating this population.

The health service coordinator provides care to patients with drug addiction. Which legislation could specifically effect the plan of care for patients impacted by opioid addiction? A--Dying with dignity legalization B--The Affordable Care Act C--Medicinal marijuana legalization D--Medicare for All Act 2019

C--Medical marijuana legalization (The opioid epidemic is a sociopolitical driver for healthcare processes. The legalization of medicinal marijuana may be a form of treatment for the opioid crisis. Although more research is needed, NIDA-funded research suggested that states that utilizes medical marijuana experienced about 20% less mortality rates due to opioid overdoses. This was in comparison to states that do not utilize medical marijuana.)

The health service coordinator uses the PHC Framework for Ethical Decision Making when assisting patients experiencing a moral dilemma. Which question does the coordinator ask to gather and clarify facts when implementing this framework in the clinical setting? A--What principles are in play? B--What is the key issue? C--What is the patient's current quality of life? D--What world views need to be acknowledged?

C--Step 4 of the PHC framework is to gather and clarify facts regarding medical indications, quality of life, patient preferences, and contextual factors. Asking about the patient's current quality of life is an appropriate question when gathering and clarifying facts in this situation.

A patient was recently diagnosed as diabetic. Due to their refugee status, the patient was homeless and explained that they did not have access to a refrigerator to store insulin. Which socio-political driver is preventing this patient from following the plan of treatment? A--Ethnic background B--Culture C--Environmental D--Geographic region

C--This is a social determinant of health. They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care.

A public health professional is tasked with developing a health campaign to address the recent increase in sexually transmitted infections at a high school. Which student factor should be considered when determining a strategy for this campaign? A--Overall physical health B--Immunization records C--Socioeconomic status D--School attendance

C--This is a social determinant of health. They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care.

A health services coordinator is seeking assistance for a single mother who has insurance with her employer but cannot afford the premiums to cover her two children. Which program provides this coverage?

CHIP

A healthcare professional is involved with a daycare and notices that a group of children does not have health insurance. The parents do not qualify for Medicaid. The healthcare professional provides resource information to the parents. Which resource information should be provided?

CHIP

An important pathway towards healthcare coordination credentialing involves understanding exam logistics. Where does a potential applicant get this information?

Candiate handbook

Which core function requirement set by the CMS's "EHR Incentive Programs to the Promoting Interoperability Programs" focuses on healthcare metrics? Public Health and Clinical Data Registry Reporting Collecting and Reporting on Quality of Care Measures Health Information Exchange Coordination of Care through Patient Engagement

Collecting and reporting--This core function focuses on data analytics and Meaningful measures for healthcare processes, outcomes, patient preferences, and organizational structure.

Conscientious objection

Conscientious objection (CO) is the refusal to perform a legal role or responsibility because of personal beliefs

Which patient has a biological determinant to health? A patient who lives in a highly polluted city A patient who has a family member with heart disease A patient with elevated blood lead levels A patient who smokes a pack of cigarettes every day

Correct! A patient who has a family member with heart disease has a biological determinant to health.

Which agency ensures that a disabled patient cannot be denied treatment due to inaccessible medical equipment? The U.S. Department of Health and Human Services The American Hospital Association The U.S. Department of Justice The Office for Civil Rights

Correct! The U.S. Department of Justice states that it is unacceptable for a provider to deny treatment due to inaccessible medical equipment, examination tables, or concern for staff in transferring a patient with a mobility disability.

Which type of care planning often includes trauma-informed and motivation-based approaches? Integrative treatment planning. Preoperative care planning. Chronic care planning. Care transition planning.

Correct! Trauma-informed care and motivation-based treatment are key aspects of the integrative treatment planning process to help patients come to terms with past events and motivate them to manage their own health.

Access to health care consists of four components: Coverage: facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status. Services: Having a usual source of care is associated with adults receiving recommended screening and prevention services. Timeliness: ability to provide health care when the need is recognized. Workforce: capable, qualified, culturally competent providers"

Coverage, Services, Timeliness, Workforce

Which access to healthcare components facilitates entry into the healthcare system? Services Coverage Timeliness Workforce

Coverage--The coverage component facilitates entry into the healthcare system. Uninsured people are less likely to receive medical care and more likely to have poor health status.

What is a Bachelor of Science in Health Services Coordination (BSHSC)?

Credential

What is the point of credentialing?

Credentials are evidence that a health professional has the required education, training, and experience to practice their role within a particular state.

Which category of cultural capacity requires lifelong learning? Cultural competence Cultural humility Cultural sensitivity Cultural awareness

Cultural humility--A cultural humility perspective requires a commitment to lifelong learning, exercising self-reflection and critique, being comfortable with not knowing, and recognizing the dynamics of power and privilege.

A health services coordinator is working with a client who has a history of violence. The client makes a statement that is concerning and would require a duty to warn. The coordinator relays the information to the case manager. Which statement by the client meets that duty? A--"I wish my ex-wife was dead, I hate her so much." B--"I feel like using my terrorist contacts to destroy the whole town." C--"I sometimes want to get a gun and shoot up a school or something." D--"When I get out of here, I will go to my parent's house and strangle my mother."

D

A healthcare organization is hosting an in-service to be given by local law enforcement. The objective is to educate hospital staff on the warning signs of human trafficking in the community. Which statement indicates that more training is needed? A--Suspicious tattoos or branding are sometimes noticed by healthcare providers on victims. B--Girls who have been in sex trafficking may be pregnant or have an abortion at a young age. C--Risk factors for becoming a victim of trafficking include being a runaway or from a foster home. D--Trafficking victims are seldom taken for emergency care and seeing one in a hospital is unlikely.

D

The health service coordinator recognizes conscientious objection as an ethical decision based upon personal beliefs and values. However, which situation would the health service coordinator question? A--A provider who refuses to perform an abortion. B--A nurse who refuses to participate in a legal assisted suicide. C--An officer in the military who refuses to bomb an enemy village. D--A parent who refuses a blood transfusion for a child with a life threatening condition

D--A child's right to life must be considered before the religious beliefs of the parents. Because children are unable to give competent consent, during a life-threatening emergency, life-saving treatment should be administered, regardless of the patients' wishes.

Where is a good place to look for information on the Medicaid compliance requirements of an individual state? The CMS compliance website The compliance websites of the state Ask a friend Both CMS and state compliance websites

D--Both CMS and state compliance websites will help you find information on how to stay in compliance with the federal and state regulations surrounding state Medicaid programs.

What is considered appropriate credentials of a healthcare coordinator? A--Required across the United States by every healthcare setting and shows that the healthcare professionals who are employed there have met minimum national standards. B--Granted by the state in which the healthcare professional practices after the professional has passed the state boards. C--Regulated by federal government agencies and are issued after proficiency has been established. D--Accepted as evidence that the education, training, and experience required for a healthcare professional to practice has been met.

D--Credentials are provided to individuals who have completed the requirements (education, experience and/or training) needed to fulfill their role in a particular state.

A healthcare coordinator in a hurricane-prone area is working with hospital staff to prepare in case of a severe weather event. Which of these HIPAA practices is within the purview of the coordinator in situations like these? A--Evaluating the feasibility of moving patients. B--Ensuring staff has met all security protocols. C--Developing the hospital disaster recovery plan. D-Backing up patient data files regularly.

D--HIPAA protocols include policies and procedures for data backup, so that recovery can happen efficiently in the event of an emergency.

Which initiative promotes the consideration of patient health and well-being when developing and adopting any new government policy to address social determinants? A--Affordable Care Act B--Death with Dignity Legislation C--Medicare for All Act of 2019 D--Health in All Policies

D--Health in All Policies (One strategy that has emerged in response to social determinants is the Health in All Policies initiative through the National Prevention Strategy. This initiative promotes the consideration of health and well-being when developing and adopting any new government policy.)

A healthcare coordinator employed by an urgent care facility is reviewing cases with the Managing Director that had been reported to legal authorities. Which patient case is yet to be mandated by law? A--A four-year-old Caucasian male presents with bruises in different stages of healing. B--A twelve-month-old who weighs two pounds more than their birth weight. C--An 83-year-old male cared for by his children presents malodorous and not dressed for the season. D--A 20-year-old Asian American female is suspected of being forced into human trafficking.

D--Human trafficking is not mandated in all 50 states. Though human trafficking mandating is increasing throughout the United States, it is not country wide currently.

During a recent appointment with a homeless patient, a care coordinator showed momentary disgust with the patient for the dirty and unkempt condition of his wound. Although the coordinator apologized immediately, the patient got angry and left, saying the coordinator did not understand what his life was like. How can the coordinator avoid making a similar mistake in the future? A--Engage in conscious partiality. B--Avoid stereotyping of patients. C--Display overt behaviors. D--Reflect on implicit biases.

D--Identifying implicit biases that could lead to behaviors like this and addressing them is the recommended way to mitigate similar experiences in the future.

A comprehensive treatment plan is being developed for a 23-year-old female patient who is addicted to cocaine. The patient states that she has flashbacks of being sexually abused by her father during adolescence. Which type of care planning should this patient receive? A--Advanced care planning B--Chronic disease management treatment planning C--Care transition planning D--Integrative treatment planning

D--Integrative treatment planning includes trauma-informed care and motivation-based treatment to help patients come to terms with past traumatic events and develop motivation to manage their health.

A healthcare coordinator is analyzing quantitative research about a change in practice to improve outcomes for patients that are at a post-surgical fall-risk. Which quantitative research and data source provides the best source of evidence to impact and validate fall prevention practices and interventions? A--A clinical trial using new methods to reduce the risk of post-surgical falls. B--A case report series about patients that fell after surgery. C--A cohort study that follows a population of patients that implemented post-surgical fall-prevention methods. D--A meta-analysis of studies about preventing post-surgical falls.

D--Meta-analysis studies provide the highest and best source of evidence. These analyze several related studies with a similar hypothesis and are often part of systematic reviews.

Which netiquette rule would be broken if a healthcare coordinator posts the same note to a patient portal three times? A--Do not abuse your power. B--Make yourself look good online. C--Know where you are in cyberspace. D--Respect other person's time and bandwidth.

D--Posting the same note more than once disrespects another person's time and bandwidth. The word bandwidth refers to the storage capacity of a hosting system. A coordinator who posts the same note more than once, accidentally or otherwise, is wasting the time of the patient and other healthcare professionals using the portal.

A patient had a stroke that resulted in an absence of brain activity. The patient's children approach the coordinator, each with their own ideas of what should happen to their parent. What should the coordinator do? A--Ask each sibling to describe the patient's end-of-life wishes. B--Research relevant case laws before making any decisions. C--Encourage the siblings to make a decision on the patient's care together. D--Identify if the patient has advanced medical directives.

D--The first step for the coordinator would be to identify if the patient had made end-of-life wishes known via advanced medical directives.

A healthcare coordinator is preparing to train a new coordinator on the Medicare codes for patient illnesses. From which government agency would the coordinator pull this information? A--Department of Health and Human Services. B--Health Resources and Services Administration. C--Office for Civil Rights. D--Centers for Medicare & Medicaid Services.

D--This agency administers and enforces administrative rules, transaction standards, and code sets for the US.

Which digital literacy capability includes the ability to use digital technologies to support or create new ideas, methods, solutions, and decisions? A--Communication, collaboration and participation. B--Digital identity, well-being, safety, and security. C--Teaching, learning and self-development. D--Creation, innovation and research.

D--This capability supports new ideas, embraces and moves through change, and supports new innovations and technological improvements.

A patient who has Medicare had a coronary artery bypass graft surgery to treat coronary artery disease. The healthcare coordinator at the hospital is ensuring compliance with Medicare claim policies to receive reimbursement for the procedure. What is required for reimbursement of the patient's procedure? A--Proof that the patient does not financially qualify for private insurance coverage. B--Proof that surgery was experimental or investigational. C--The patient's postsurgical assessment showing improvement in the patient's coronary artery disease. D--Detailed documentation of medical necessity in the patient health record.

D--Validating medical necessity is required for reimbursement of medical services from Medicare. Services must be reasonable and necessary for the diagnosis or treatment process to qualify for reimbursement.

A hospitalized patient asks the healthcare coordinator if her seven-year-old daughter who is in the lobby can come up and visit her. However, visitation for minor children under the age of 12 is not allowed. What would be an appropriate response to provide patient-centered care? A--"For your protection, visitors under the age of 12 are not allowed to visit under any circumstance." B--"I can make an exception this time and allow her to visit for just a few minutes." C--"Ok. Let me ask the nurse manager if that will be permissible for a few minutes." D--"We can contact the social worker to discuss a plan for your daughter to visit."

D--the social worker should be contacted by the patient or family members to discuss plans for minor visitors under the age of twelve.

Into which area of cognition does the "bandwagon" cognitive bias fit? Belief bias Informational bias Decision-making bias Memory bias

Decision-making bias--The "bandwagon" bias means that people feel a need to conform and act in accordance with others and rely on other people's judgment when deciding how to act.

Name the 5 components of coding compliance

Detection: The practice of regular audits to identify coding proficiency and errors. Correction: Regular audits of patient records and the practice of correcting errors. Prevention: The use of professional development to ensure coders have current information on the field. Verification: The use of documentation to ensure effective trails of services, errors, and corrections. Comparison: The ability to compare patterns overtime to detect proficiency and errors.

An 85-year-old patient with a left hip replacement currently lives in a rehabilitation unit and has been struggling with reaching goals set by the physical therapy staff. The patient has started to refuse daily physical therapy due to soreness and stiff muscles. What should the nursing staff and physical therapy do together to help the patient reach the goals needed to go home?

Discuss pain control with patient

interdisciplinary rounds

Doctor rounds have been done for several decades, especially in hospital settings. However, interdisciplinary rounds are relatively new and have several positive outcomes that benefit the entire healthcare system, especially at the micro-level. A key purpose of interdisciplinary rounds is to ensure patient-centered, coordinated care. "Coordination of care should begin with a review of the patient's current status with input from each team member. This should be followed by a discussion and clarification of the patient's goals and expected outcomes of care. Finally, a comprehensive plan of care should be developed or modified as appropriate"

A healthcare provider at an out-patient clinic just received training in the trafficking victims protection act (TVPA) and is evaluating a patient. A man identified as the patient's boyfriend is translating for her. The patient shows many symptoms that could indicate an abusive situation; however, the provider is suspicious that human trafficking may be involved. Which patient finding raises suspicion?

Does not have money or identification in her possession

A healthcare organization is considering a bring your own device (BYOD) program for all healthcare practitioners to complete day-to-day tasks. This work will include patient health information. Which action should be taken prior to implementation of this project?

Employ an acceptable use policy to determine which devices can be used

Which of the following practices are mandated specifically by HIPAA? Password Protocol. Hashing. Encryption. Masking.

Encryption--Encryption is a mandated process in which data is run through a mathematic algorithm to change it into something indecipherable but also provides an encryption key and a paired decrypting key so the data can be decrypted.

A 55-year-old patient had a recent motor vehicle accident that resulted in multiple fractured bones, including the pelvis and a hip. The patient has been placed in a long-term health center for rehabilitation but is uncooperative. Which action should the case manager discuss first to determine the problem?

Explore the level of pain management

Which is an example of a physical determinant of health? Access to healthcare services Access to emerging technologies Exposure to toxic substances Exposure to crime

Exposure to toxic substances is a physical determinant of health.

A healthcare professional neglected to accumulate continuing education credits needed to maintain the accredited case manager (ACM) certification. What is the expected outcome for this lapse?

Extension with certifying organization approval

True or False? An Exclusive Provider Network (EPOs) is a payroll deduction that allows patients to use the money to pay for medical expenses.

False--Flexible Spending Accounts are payroll deductions that allows patients to use the money to pay for eligible medical expenses.

True or False? Detection is the practice of using professional development opportunities to educate coders about the practice.

False--Professional development is a prevention method the ensures coders have current information on coding practices.

An 18-year-old pregnant woman wants to improve her diet by eating fresh fruits and vegetables. The nearest grocery store is 18 blocks from her home and she has limited transportation. Which social determinant of health is an issue for this woman?

Food desert

The World Health Organization has a primary goal of achieving the healthy cognitive development and improved education outcomes in socioeconomically disadvantage children. Which intervention activity is effective in meeting this goal?

Food supplement provision

A physician wants to keep in contact with other providers using a quick and easy communication method that protects both privacy and security. Which method should be used to meet these goals?

Hospital text messaging app

What is the acronym INTERACT

INTERACT® is an acronym for "Interventions to Reduce Acute Care Transfers." The interventions is a quality improvement program designed to. improve the identification, evaluation, and communication about changes in resident status.

Seven stages of CPD (Continuous professional development)

Identify: Understand where you've come from, where you are and where you want to be. Plan: Plan how you can get to where you want to be, with clear outcomes and milestone to track progress. Act: Act upon your plan, and be open to learning experiences. Reflect: Make the most of your day-to-day learning by routinely reflecting upon experience. Apply: Create opportunities where you can translate theory into practice and put your learning to work. Share: Share your learning in communities of practice to generate greater insight and benefit from the support of your community. Impact: Measure the overall impact your learning has had on the work you do.

Acessible principle

In this principle, healthcare professional members of the team trained to work together collaboratively and dynamically at the top of their skill set, according to clearly defined roles and responsibilities.

What is ICE?

Institute for Credentialing Excellence

Integrated care plan (ICP)

Integrated care plans are similar to shared care plans in that they are developed by the entire integrated care team in consultation with the patient and family. The emphasis of integrated care is on the whole spectrum of patient needs that are addressed by one team, such as behavioral health needs in the form of mental health and/or substance use needs to be combined with chronic health physical needs; or multiple chronic conditions combined with old age, and so on. "An integrated care plan (ICP) is a living document that captures information and decisions regarding how a care team intends to (and does) deliver evidence-based, coordinated, continuous and person-centered care to a particular patient over time and across professionals and settings. ICPs are used to organize and monitor integrated care delivery. ICPs incorporate elements of the following tools: Clinical guidelines (i.e., standards of care based on evidence); Treatment plans (i.e., goals of treatment, treatment options, possible side effects, and Expected length of treatment for a particular phase of care such as systemic treatment or survivorship); Disease pathways (i.e., the sequence of assessments and interventions for patients with a particular diagnosis); and Personalized care plans (i.e., care goals and interventions are developed jointly with the patient)" (Cancer Care Ontario, n.d., p. 4).

What shift in care for people with behavioral issues did the Patient Protection and Affordable Care Act catalyz

Integrated care--Integrated care provides both physical primary care and behavioral care, by a collaborative patient-centered, interprofessional team.

Interprofessional Treatment Plans

Interprofessional treatment plans are also done by an engaged team of health professionals with a patient. Treatment plans can be developed in response to any illness, but often refer to behavioral or addiction treatment where patients work with a central case manager (a health service coordinator could assume this position) plus a team of other professionals and programs. The treatment plans would be developed by this cohesive team and be monitored throughout time until recovery occurs.

The key elements of an empathic inquiry approach to SDOH interviewing include:

Introduction Creating clear expectations Asking permission Acknowledging sensitive content and supporting autonomy by giving permission to opt-out of any questions Listening with empathy using reflective listening Listening for opportunities to affirm the patient's strengths Summarize Using an open-ended question to ask about the patient's priorities Arranging follow-up Thanking the patient for their time and participation

HCPCS Level II

Medical and surgical supplies

Difference between Medicare and Medicaid

Medicare is a federal-only health insurance program that covers Americans who are either over the age of 65, has a disability, or experiencing kidney failure and undergoing End-Stage Renal Dialysis (ESRD). Medicaid is a combined state-federal health insurance program that covers financially challenged individuals and is largely administered and directed by the states. Both programs fall under the oversight and direction of the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) (Centers for Medicaid & Medicare Services, n.d.).

The health services coordinator has just completed training regarding Medicare and Medicaid coverage for hospitalized patients. Which statement aligns with the training?

Medicare pays for specific hospital services for individuals over the age of 65.

A healthcare coordinator is now working for a hospital where Medicare reimbursement is dependent upon quality reporting, use of Electronic Health records, and clinical indicator achievement. Which reimbursement system is referenced?

Merit Based incentive payment system

The hospital's information technology (IT) department is reviewing its mobile device security policies and procedures for devices used in patient care settings. They plan to follow National Institute of Standards and Technology (NIST) guidelines when establishing their policies. Which NIST standard should they use?

Mobile devices should be individually authorized to access PHI

Which professional standards are intended to advance health equity, improve quality, and help eliminate healthcare disparities? CMSA Standards for Cultural Competency NASW Standards and Indicators for Cultural Competence ACMA Advocacy Standards National CLAS Standards

National CLAS Standards--The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for organizations to deliver effective, understandable, and respectful services at every point of patient contact.

A registered nurse has been working in the case management field for nearly five years and wishes to indicate professional expertise to potential employers. Which action meets this goal?

Obtaining certification in specialized practice

PCMH

Patient Centered Medical Home

PACT

Patient aligned care team

The primary purpose of credentialing is to protect what?

Patient safety

PICO

Patient, Intervention, Comparison, Outcome

PCPC is based on these seven shared principles of primary care: what are they?

Person and family-centric Continuous Comprehensive and equitable Team-based and collaborative Coordinated and integrated Accessible High value

Where is the most accessible EBP evidence located? Library Point of care Team rounds Internet

Point of Care--EBP must fit into the routine workflow of health professionals within a system and be readily available at the point of care.

Which HIPAA Rule mandated patient access to their own information? Enforcement Rule. Breach Notification Rule. Privacy Rule. Security Rule.

Privacy Rule--The Privacy Rule focused on the security of protected health information (PHI) and also mandated patient access to their own information.

Project RED (Re-Engineered Discharge)

Project RED is another transition-related program initiated at Boston University Medical Center (Boston University Medical Center, 2014) that provided extra information and support with the goal of reducing readmissions back to the hospital. The interventions include a reinforced discharge teaching, a post-hospital care plan, follow-up care with the patient via telephone, virtual patient advocates that engage with patients about their post-discharge self-care plans, and connecting with the patient's primary care provider.

4 Quadrant model of ethics and law

Quadrant I: Ethical and Legal This is the ideal state—where actions and decisions made by HSC with their patients and care team are both ethical and legal and benefit the patient. Quadrant II: Ethical and Illegal This is an uncomfortable extreme state and one to be avoided, yet it may present itself within the practice or community setting. "In the United States, ethical but illegal behavior can be described as civil disobedience" (Forrestal & Cellucci, 2016, p. 90). An example was the arrest of healthcare professionals who protested when North Carolina did not approve Medicaid expansion in 2013. "In the protestors' view, civil disobedience was necessary to protest the loss of benefits (such as preventive care) for their poor patients" (Forrestal & Cellucci, 2016, p. 90). Other practice-related examples could be assisted suicide for terminal patients or an abortion for a young rape victim in states where they are illegal. Quadrant III: Unethical and Legal This quadrant is a gray area that leaves room for unethical behavior as long as it is legal. Examples include uncaring, though not overtly rude or discriminatory, rough behavior toward a patient that could be considered legal but definitely not ethical. Or if a patient requests an alternative treatment that is legal but seems counterproductive to their care team and raises concerns for the patient's health and well-being. Another would be to charge a lot of money for an essential drug since it is legal to do so, even though it means that the drug would be too expensive for low-income patients, making it unethical. Obviously, unethical behavior is not acceptable in health professionals and must be avoided to maintain codes of ethics and standards of practice. Quadrant IV: Unethical and Illegal Health professionals "fall into this quadrant when they deliberately commit acts that are criminal, morally corrupt, and socially unacceptable. Examples include preparing inflated fee schedules, submitting fraudulent reports, and issuing inflated patient or client bills" (Forrestal & Cellucci, 2016, p. 91). Other examples include narcotic theft by health professionals or patient requests to withhold information that must be ethically and legally shared, such as suspected child abuse, domestic abuse, or exposure to serious communicable diseases. Health professionals must follow both ethical and legal mandates to provide optimal responsible patient care. It is important that HSC keep these points in mind whenever they must make a decision related to patient care, asking themselves, "Is it ethical? Is it legal?"

What is a concrete strategy that may convince administration to consider adopting EBP strategies within the workplace? Patient Voice Internal Validity Clinical Expertise Return on investment

ROI--Evidence of the value and ROI of EBP can be persuasive in showing improvements in outcomes, costs, and patient satisfaction.

Name the 5 R's of Cultural Humility

Reflection--approach every encounter with humility and understanding that there is always something to learn from everyone. Respect--treat every person with the utmost respect and strive to preserve dignity at all times Regard--hold every person in their highest regard while being aware of and not allowing unconscious biases to interfere in any interactions. Relevance--expect cultural humility to be relevant to the patient and apply this practice to every encounter Resiliency--embody the practice of cultural humility to enhance personal resilience and globally focused compassion.

A patient's family member arrives at the local pharmacy to pick up the patient's new prescriptions. The pharmacist wants to maintain compliance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Which action should the pharmacist take?

Release the prescriptions to the family member

What makes an intervention evidence-based and scientifically supported?

Repeated and rigorous outcome evaluation through research studies and clinical trials are needed before an intervention is accepted as evidence-based and scientifically supported.

A 10-year-old is in a therapeutic after-school program for troubled youth. The child confides to the healthcare professional that the mother's boyfriend has been touching the child, something that is very uncomfortable to the youngster. What is the appropriate next step?

Report the incident to authorities

Which cultural humility principle is intrinsically focused? Regard Reflection Respect Resiliency

Resiliency--Resiliency is the only intrinsic principle where one embodies the practice of cultural humility

Which compliance measure should be done annually by all healthcare organizations? Staff Training Risk Assessment Policies and Procedures Data Backup

Risk Assessment--An annual risk assessment of physical, technical, and administrative threats should be done to determine whether systems and data are a security risk and how vulnerable they are to attack according to HIPAA.

"Rounding" (at a hospital setting)

Rounding is the process whereby a team of care providers stops by each of their patients' rooms periodically to check on how each patient is doing/feeling, to monitor their progress, and to determine if any adjustments may be needed to the patient's existing treatment plan. The reading for this section describes how interdisciplinary rounds can be a valuable strategy used in collaborative interprofessional teams to communicate, share expertise and information, and discuss care options with patients and their families.

A health services coordinator is addressing the needs of a pediatric patient living in a foster home. The coordinator reviews the patient history with the goal of meeting the Core Set of Children's Health Care Quality Measures for Medicaid and CHIP. Which action by the coordinator aligns with this goal?

Scheduling a primary care appointment to ensure the patient receives missing immunizations

Shared Care Plan

Shared care plans are complex planning tools that incorporate input from the entire interprofessional team, including the patient and their families. "A shared care plan is a patient-centered health record designed to facilitate communication among members of the care team, including the patient and providers. Rather than relying on separate medical and behavioral health care (treatment) plans, a shared plan of care combines both aspects to encourage a team approach to care"

Which collaborative strategy directly supports a patient with evidence-based options to consider their choices and personal preferences?

Shared decision making

A healthcare service coordinator is working closely with an older adult patient who has chronic illnesses. Which collaboration strategy is used to promote communication between the patient and the provider to increase the patient's knowledge about particular health conditions? Integrated care planning Shared decision making Team huddling Shared care planning

Shared decision making (Shared decision making is a powerful strategy in which benefits include enabling evidence, knowing the patient's preferences, increasing the patient's knowledge base, and increasing communication among the patient and the patient's clinician)

A healthcare professional provides evidence-based information to a patient about available health options, then assists the patient with a choice of treatment. Which collaboration strategy is the healthcare professional demonstrating? Interdisciplinary rounding Shared decision making Team huddling Shared care planning

Shared decision making (shared decision making occurs when health professionals work with patients to make the best decisions about their own health and healthcare options. This is the hallmark of good clinical and ethical practice)

Shared Decision Making

Shared decision-making occurs when health professionals work with patients to help them make the best decisions about their own health and healthcare options.

A refugee is diagnosed with type 2 diabetes. When questioned about dietary habits, the patient discloses eating rice at every meal and rarely eats fruits and vegetables. This is what was provided on a daily basis in the refugee camp. What is the underlying reason for maintaining this diet?

Socio-economic norms

A healthcare coordinator supervises other coordinators working at a free clinic. The supervisor becomes concerned when they overhear a subordinate speaking disparagingly about a client, stating, "I can't believe that last patient asked me about free medication when their cellular phone is better than mine!" Which issue should the supervisor address in relation to this comment?

Suspension of judgment

For which virtual care platform has CMS recently expanded reimbursement? Monitoring systems Handheld devices Smartphones Telemedicine/Telehealth

Telemedicine/Telehealth--The CMS expanded its reimbursement for remote care services in 2019 through telemedicine or telehealth appointments.

What is BOOST

The Better Outcomes for Older Adults through Safe Transitions (BOOST) project was developed in response to an abundance of research indicating the period of time around hospital discharge often is stressful and dangerous for older patients

Where can a provider gain knowledge of the wealth of compliance requirements surrounding the Medicare program? A state compliance website The CMS compliance website Asking friends

The CMS compliance website will help you become familiar with the large number of compliance requirements of the Medicare program.

Which regulatory organization introduced the Meaningful Measures framework for healthcare reporting?

The CMS introduced Meaningful Measures, which identifies the highest priorities for quality measurement and improvement.

Care Transitions intervention program (CTI)

The Care Transitions Intervention Program (CTI) combines elements of person-centered care, health coaching, self-management, and transitions care. "During a 4-week program, patients with complex care needs and family caregivers receive specific tools and work with a Transitions Coach®, to learn self-management skills that will ensure their needs are met during the transition from hospital to home.

Emergency medicaid

The EM program accounts for about $2 billion in spending annually and offers reimbursement to hospitals providing emergency services to approximately 100 000 individuals who would otherwise qualify for Medicaid but for their immigration status. (Undocumented immigrants are not eligible for full Medicaid coverage, and legal immigrants must generally wait 5 years after entry into the United States before they become eligible.)

Who creates and monitors Medicare regulations? A--Both states and the federal government B--States C--The federal government

The Federal Government--Medicare is a federal healthcare program under the jurisdiction of the federal government.

Health Service Coordinator role

The inclusion of health service coordinators on interprofessional collaborative teams is also relatively new, a change that offers patients personalized, well-supported care, which can be invaluable in their healing, recovery, and restored good health.

A new healthcare coordinator is employed by a local hospital. The coordinator has researched evidence-based practice standards addressing transitions of care since that topic makes up a major portion of the job. Why are standards associated with transitions of care considered so crucial?

There are vulnerable points in the healthcare continuum

A hospital manager is preparing an inservice to inform nurses of the new requirements to obtain certifications for healthcare coordination. What is the reason for the new requirements?

They allow individuals to demonstrate competency in current practice.

Comprehensive and equitable principle

This principle focuses on achieving excellent, equitable outcomes for individuals and families; employs a systematic approach to measuring, reporting, and improving population health, quality, safety, and health equity.

Team-based and collaborative principle

This principle focuses on addressing the whole person with appropriate diverse clinical and supportive services; looks for the impact of social determinants of health and societal inequities, and tailors care delivery accordingly; connects patient to resources.

Continuous principle

This principle focuses on care being readily accessible, in person and virtually for all individuals regardless of linguistic, literacy, socioeconomic, cognitive, or physical barriers; facilitates access to broader healthcare system, acting as a gateway to high-value care and community resources; provides individuals with easy, routine access to their health information.

Person and family centric principle

This principle focuses on dynamic, trusted, respectful, and enduring relationships among individuals, families, and their clinical team members; there is continuity in relationships and in knowledge of the individual and family/care partners that provides perspective and context.

Coordinated and integrated principle

This principle focuses on how the team integrates activities of those involved in an individual's care, across settings and services; helps patients and families navigate the recommendations they receive from clinicians and professionals; patient is actively engaged in transitions of care to achieve better health and seamless care delivery across the life span.

High value principle

This principle focuses on the whole person; is grounded in mutually beneficial partnerships among clinicians, staff, individuals and their families, as equals; and care delivery customized based on individual and family strengths, preferences, values, goals, and experiences.

HIPAA Tiers of Violation-Name the 4 Tiers

Tier 1: A violation that the covered entity was unaware of and could not have realistically avoided, even if a reasonable amount of care had been taken to abide by HIPAA rules. Tier 2: A violation that the covered entity should have been aware of but could not have avoided, even with a reasonable amount of care; this falls short of willful neglect of HIPAA rules. Tier 3: A violation suffered as a direct result of "willful neglect" of HIPAA rules but an attempt has been made to correct the violation. Tier 4: A violation of HIPAA rules constituting willful neglect where no attempt has been made to correct the violation.

HIPAA Titles The HIPAA Act is a legislated law that consists of five important titles:--Name them

Title I: Protects health insurance coverage for workers and their families that change or lose their jobs. It limits new health plans' ability to deny coverage due to a pre-existing condition. Title II: Prevents health care fraud and abuse; medical liability reform; administrative simplification that requires the establishment of national standards for electronic health care transactions and national identifiers for providers, employers, and health insurance plans. Title III: Guidelines for pre-tax medical spending accounts; provides changes to health insurance law and deductions for medical insurance. Title IV: Guidelines for group health plans; provides modifications for health coverage. Title V: Governs company-owned life insurance policies; it makes provisions for treating people without United States Citizenship and repealed the financial institution rule to interest allocation rules (Edemekong & Haydel, 2019, p. 1).

Which initiative looked at how patient's experience of care, cost per capita, and the health of populations could serve as best measures for optimal healthcare? Social Determinants of Health Health in All Policies Triple Aim Framework County Health Rankings & Roadmap Program

Triple Aim Framework--The Institute for Healthcare Improvement initiated the Triple Aim Framework to identify the best measures for optimal healthcare.

Both federal and state governmental entity produced compliance requirements for a state's Medicaid program. True False

True--Both the federal and state governments produce compliance requirements for state Medicaid programs.

Medicare and Medicaid providers who fall out of compliance are often fined, jailed, and prohibited from receiving state and federal funds. True or False?

True--Medicare and Medicaid violations result in fines, legal ramifications, and the suspension/ineligibility of services.

True or False--Outpatient care, chemotherapy drugs, and Medicaid and Medicare services are services that are coded under the Healthcare Common Procedure Coding System.

True--The HCPCS codes outpatient care, chemotherapy drugs, and Medicaid and Medicare services.

Which group of people faces the most challenges for U.S. health insurance coverage? U.S.-born children of immigrant parents. Legal immigrants. Undocumented immigrants Pregnant immigrants.

Undocumented immigrants--Undocumented immigrants have more limited access to commercial health insurance through employers and to public insurance through Medicaid and the Children's Health Insurance Program.

A rural clinic works with a large Burmese population that has several dialectics within the community. The clinic is struggling to meet the demand for interpreters. What is the most cost-effective method for the clinic to meet the needs of this community?

Use an electronic interpretive device

What are the 5 questions health professionals can use to guide shared decision making?

What will happen if we wait and watch? What are your test or treatment options? What are the benefits and harms of these options? How do the benefits and harms weigh up for you? Do you have enough information to make a choice?

A care coordinator is developing a research-based approach to patient discharge from the hospital. The coordinator wants to collaborate with others across the healthcare network to integrate services. Which care coordination core competency will further this goal?

Working in interdisciplinarya teams

YODA Ethical Decision-making framework

You Observe Deliberate Act

Social determinants of health (SDOH)

are the conditions in which people are born, grow, live, work and age. They include factors like socioeconomic status, education, neighborhood, and physical environment, employment, and social support networks, as well as access to health care"

Chronic Care Management (CCM)

critical component of primary care that contributes to better health and care for individuals

DRG

diagnostic related group

health disparities

differences in health outcomes among groups

Continuous professional development (CPD)

is the ongoing investment in human resources by providing training and development opportunities.

Health in All Policies has five key elements for policy developers to consider

promoting health and equity, supporting intersectoral collaboration, creating co-benefits for multiple partners, engaging stakeholders, and creating structural or process change. (Public Health Institute and American Public Health Association, 2013).

National Transitions of Care Coalition (NTOCC)

provide tools and guides for patients and their families, health professionals, policymakers, and the media to ease patient transitions between home and healthcare institutions or between institutions

an interprofessional collaborative team can be defined as

providers from different professions cooperate by establishing a means of ongoing communication with each other and with the patient and family to create a management plan that integrates and addresses the various aspects of the patient's healthcare needs

SDOH

social determinants of health