CMSA Final Exam – Questions & Answers (Graded A+)
CMSA Final Exam – Questions & Answers (Graded A+)
A component of case management that ensures smooth transitions of uninterrupted care is called: - ANSWER - Care Coordination
A systems oriented approach to case management which focuses on...
CMSA Final Exam – Questions &
Answers (Graded A+)
A component of case management that ensures smooth transitions of uninterrupted care is called: - ANSWER - Care Coordination
A systems oriented approach to case management which focuses on health insurance plans and management of member benefits: - ANSWER - Managed Care
What do care coordination, case management and managed care have in common? - ANSWER - The patient, coordination of services and a goal of cost-effective care
The approach to case management that deals with the hospitalized patient is: - ANSWER - Within the Ways Case Management
The approach to case management that deals with patients in the outpatient setting is called: - ANSWER - Beyond the Walls Case Management
Current case management practice and models as we know them today came about following the implementation of: - ANSWER - Fee-for Service Plans
Capitation Factors that impact models of case management include: - ANSWER - The patient population, the care provider, the reimbursement method, the context of the care
setting
Roles of the case manager include: - ANSWER - -Patient Advocate
-Protector of Privacy
-Coordinator of Care
Costs that are clearly saved or avoided in a case are the: - ANSWER - Hard Savings
A positive fiscal outcome of optimal case management is: - ANSWER - Decreased length of stay
The __________ is the case manager's most important obligation. - ANSWER - patient
Utilization Management includes which of the following: - ANSWER - -Monitoring of intensity of service
-Monitoring severity of illness
-Monitoring of medical necessity and the appropriateness of level of care
The two main types of insurance companies in the United States are: - ANSWER - Commercial and Governmental Government insurance plans are public programs and include: - ANSWER - Medicare, Medicaid and Military
_____________ is a set amount of money specified by each health plan that the member must pay at the time healthcare services are rendered. - ANSWER - Copayment
The monthly fees that insurance companies charge the member for services is the ________________. - ANSWER - Premium
A "Stop Loss" protective strategy: - ANSWER - Is purchased by the insurance company to protect itself against extremely expensive cases
The Prospective Payment System (PPS) provides that hospitals are reimbursed according to: - ANSWER - Diagnosis-Related Groups (DRG's)
Diagnosis -Related Groups (DRG's) were originally designed as: - ANSWER - A Patient Classification System
The method of reimbursement which pays the healthcare provider based on the submitted claim is the ________________ and is considered an old method of payment. - ANSWER - Fee-For-Service Reimbursement
An individual eligible for health benefits under a health plan is a/an: - ANSWER - -
Participant
-Beneficiary
-Member
Medicare eligibility is based on: - ANSWER - Age, work history, certain disabilities and Kidney Failure
Renal patients on hemodialysis for 3 months are eligible for Medicare: - ANSWER - Regardless of age
Medicare Part A includes coverage for: - ANSWER - Inpatient hospital care
Examples of Medicare Part B coverage include: - ANSWER - Physician visits, blood tests, outpatient surgical services
Medicare Part D provides coverage for: - ANSWER - Prescription Medications
Which of the following statements is/are true regarding Medicare Lifetime Reserve Days? - ANSWER - -The beneficiary has the right to choose when to use a reserve day
-It is one of the 60 extra days of hospital care for which Medicare pays
-There are only 60 reserve days in a beneficiary's lifetime
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