WGU D052 Navigating Care Across the Continuum 350 Questions & Answers | Latest 2023/24 | Updated & Verified | Guaranteed Success | 51 Pages

When considering the regulatory requirements for healthcare, which agencies primarily oversee the use of medication? - FDA and DEA The FDA (Federal Drug Administration) and DEA (Drug Enforcement Agency) focus on medication compliance and medication utilization. How would you follow up on a denied claim? - Make sure resubmissions are marked as "corrected claim" and include the reference number from the denied claim. What information should you supply when you are calling to discuss a claim? - Client's date of birth, the organization's tax ID or NPI, info from the claim about date of service and coding, how much is being billed. What are the possible outcomes of the phone call that Barbara Griswold describes? - A corrected claim will need to be submitted, you may need to speak with a supervisor, or you may need to file an appeal. Which statement about the role of the healthcare services coordinator (HSC) is true? - The goal of the HCS is to improve the quality of client care and reimbursement practices through accurate documentation and to assist the client to improve the quality of life across the continuum of care. The goal of care coordination is to improve the quality of care delivery and resource management, ensure correct documentation is available for coding, and assist the client throughout the continuum of care. What do the terms HIPAA and PHI stand for? - Health Insurance Portability; Accountability Act and Personal Health Information HIPPA and PHI are two areas where everyone is responsible for protecting the information for the client. When considering the regulatory requirements for healthcare, which agencies help protect against fraud? - The Department of Health and Human Services (DHHS) and the Office of the Inspector General (OIG)