MEDR 4514 — Module 3
public health department
an organization that provides a variety of services to promote the health of the community as a whole, such as immunizations and disease screenings, in addition to health care for individuals - freestanding ambulatory care setting - usually an agency of state or local government
When did Congress pass legislation that allowed community health centers (and also migrant health centers) to become federally qualified health centers (FQHCs)? How did this impact their reimbursement?
1989; this allowed them to receive enhanced reimbursement for Medicare and Medicaid services
rural health clinic (RHC)
a health care setting that (in addition to physician services) utilizes advanced practice clinicians such as physician assistants and nurse practitioners, and is located in an underserved rural area - makes health care services available to non-urbanized communities as defined by the US Department of Commerce census bureau
The Early and Periodic Screen, Diagnostic, and Treatment service is a Medicaid program for: a. all Medicaid beneficiaries b. all Medicare beneficiaries c. children younger than 21 d. children younger than 18
c. children younger than 21
Which information is most likely to be included in the appointment system? a. physician orders b. problem list c. demographic data d. allergies
c. demographic data
The major difference between freestanding ambulatory care and hospital-based ambulatory care is: a. services b. patients c. ownership d. providers
c. ownership
All of the following are examples of typical organizational formats for ambulatory records except? a. source oriented b. problem oriented c. patient oriented d. integrated
c. patient oriented
The setting where care for an urban, underserved population would most likely be provided is: a. public health department b. rural health clinic c. urgent care centers d. community health centers
d. community health centers
How does freestanding ambulatory care differ from hospital-based ambulatory care?
freestanding ambulatory care sites are not owned by or operationally integrated with a hospital
What was the concept of a family planning center established?
in 1970?, by the US Department of Health and Human Services' Office of Population Affairs Title X (family planning) funding
freestanding ambulatory care
outpatient care provided to patients in a non-hospital setting
What services do industrial or occupational health centers provide?
- care for work-related injuries - new employee evaluations - return-to-work physicals following an accident - immunizations - screenings -- auditory tests for employees at risk for hearing loss -- medical surveillance screening for employees with exposure to or who work with identified hazards
federally qualified health center (FQHC)
a nonprofit or public organization that provides or arranges for comprehensive health care services to a medically underserved area or population - offers a sliding fee scale - provides comprehensive services - has an ongoing quality assurance program - has a governing board of directors (- freestanding ambulatory care setting)
group practice
a physician private practice that usually involves three or more physicians, either all of the same specialty or of different specialties - physicians practicing together usually share records, equipment, and offices and have an arrangement to divide the profits of the practice
solo practice
a physician private practice where the physician practices alone
physician private practice
a setting in which physicians practice in their own business rather than working for an organization such as a clinic or urgent care center owned or operated by others - freestanding ambulatory care setting - most common provider of ambulatory care - can be solo or group
ambulatory surgery center (ASC)
a setting providing for surgery on an ambulatory basis - usually has at least one full-time operating room - provides surgical privileges to physicians in the community - is often licensed by the state
The Office of Inspector General (OIG) is responsible for protecting the integrity of which of the following? a. Mediare programs b. Insurance programs c. Federal Qualified Health Centers d. Community centers
a. Mediare programs
Physician reimbursement is based on: a. resource-based relative value scale b. reference-based relative value scale c. encounter form d. fee sheet
a. resource-based relative value scale
urgent care center
an ambulatory care setting in which patients are seen on a walk-in basis without appointments and provide the same services as physicians' offices - these centers provide service for longer hours than most private physician practices — most are open seven days a week plus holidays
birth center
an ambulatory center that provides labor and delivery services in uncomplicated deliveries - provide a homelike atmosphere for deliveries - provide contraceptive and other family planning services
community health center
an ambulatory setting developed in the 1960s as a result of federal social legislation to provide care to indigent people ins a specified people - subsequent legislation expanded their scope to any medically underserved area or population - their purpose is to meet the medical needs of people who, because of their location and inability to pay, may not receive the care they need
university health center
an ambulatory setting in which care is provided to students while they are enrolled in college and, in some cases, to faculty and staff
family planning center
an ambulatory setting that provides family planning services — they offer: - various FDA-approved contraceptive methods and counseling - breast and cervical cancer screening - pregnancy testing and counseling - screening for sexually transmitted infections - patient education
industrial or occupational health center
an ambulatory setting where care is provided to employees at their place of work at at an employer-contracted site
The reason for the patient visit typically is record in what part of the health record? a. Registration information b. History and physical c. Laboratory reports d. Progress notes
b. History and physical
Which of the following is not considered to be a mid-level provider/advanced practice clinician? a. nurse practitioner b. dental hygienist c. physician assistant d. certified nurse midwife
b. dental hygienist
Which form typically would be included in a pediatric health record and may not be found in other patient records? a. immunization records b. growth chart c. return-to-work d. radiology reports
b. growth chart
A _______ is a list of the patient's diagnoses and problems that is compiled over time. a. progress note b. problem list c. superbill d. encounter form
b. problem list
The main factor usually considered in choosing a coding system for ambulatory care is: a. what is easiest for the physicians b. what is required by third-party payers c. what is easiest for the coders d. what is required by the state health department
b. what is required by third-party payers
What types of patients do ambulatory care settings see?
patients of all ages who are not critically ill may be well patients, such as well-baby care and health screenings — most are ambulatory sick who have - minor acute problems, such as sore throats and earaches - chronic conditions, such as heart disease and diabetes some facilities only see a certain type - birth centers: only see pregnant women - ambulatory surgery centers: only see patients with surgically treatable diseases types of patients seen affects information that must be maintained - birth centers: must provide information on labor and delivery - pediatric clinic: must provide information on immunizations, growth, and development
Historically, where has been the most common setting in which ambulatory care is provided?
physician private practice
Where do the majority of patients receive care? (What type of freestanding ambulatory care settings?)
physician private practice
What freestanding ambulatory care setting places an emphasis on preventive services? What types of preventive services does it emphasize?
public health department - immunizations - disease screenings - notifying contacts of patients with infectious conditions (e.g., tuberculosis, syphilis) to prevent further spread of the condition throughout the community
What services do university health centers provide?
some provide only minor services, while others provide the full scope of care — the extent of their services often depends on the size of the university and the range of services available to students outside of the university community services may include - immunizations - new employee evaluations - treatment for injuries and exposures - training and wellness programs
What are the various types of freestanding ambulatory care?
there are 11 various types: - physician private practice - public health department - community health center - federally qualified health center (FQHC) - rural health clinic (RHC) - urgent care center - ambulatory surgery center (ASC) - industrial or occupational health center - university health center - birth center - family planning center
Why did birth centers arise?
to counteract what was thought to be rigidity by hospitals in providing birthing options — hospitals, historically: - would not allow family or other support persons within the labor and delivery suites - would not allow alternative caregivers such as midwives perform deliveries
Why did ambulatory surgery centers (ASCs) arise? What fed their growth?
to meet the need for a less expensive setting than the hospital for low-risk surgical procedures its growth was fed by the Omnibus Reconciliation Act of 1980, which set up a Medicare payment system specifically for ASCs
Why did urgent care centers arise?
to meet the need for care outside of regular physicians' office hours — prior to urgent care centers, patients sought care in expensive hospital emergency departments