WGU D052--NAVIGATING CARE ACROSS THE
CONTINUUM EXAM
The False Claims Act
makes it illegal to file a false claim for funds from a federal program.
The Patient Protection and Affordable Care Act implemented what?
implemented new requirements for insurance, Medicaid, and more.
The Drug Enforcement Administration and the Food and Drug Administration
regulate what?
regulate the creation and distribution of medication.
The Department of Health and Human Services and the Office of the Inspector
General help protect against what?.
Fraud
True or False. Medicare and Medicaid regulations occur at both state and federal
levels.
True
Occupational Safety and Health Administration and the Equal Employment
Opportunity Commission oversee What?? regulations.
,Workplace regulations
KNOW your shared decision and patient centered models !! FOr this class (from
FB page)
Mike Armstrong
Advocate for patient safety after having a blood test mis-read that showed he had
leukemia. Donated over 15 million dollars to John Hopkins to develop programs
for patient safety and diagnostic excellence.
Common reason for data breaches of PHI
criminal attacks (cyber attacks)
HIPAA security rule covers what
PHI (electronic format) of medical records
Social Security Act governs what
governs funding and requirements for Medicare, Medicaid, CHIP, and more.
HIPAA and the HITECH Act protect what?
protect patient privacy, requiring healthcare organizations to implement
measures to keep patient records secure.
,When considering the regulatory requirements for healthcare, which agencies
primarily oversee the use of medication?
FDA and DEA
Medicare and Medicaid focus on specific groups of people. Individuals over the
age of 65 and disabled individuals are the current focus of what?
Medicare
Medicare =
Federal coverage for people over 65, certain people under 65 with disabilities and
people of any age with end stage renal disease
Medicaid =
Cooperative federal and state healthcare coverage for low-income adults,
pregnant women, and children
Medicare part
Part A
Part B
Part C
Part D
Part A-Hospital Insurance
Part B-Medical Insurance
Part C- Medicare Advantage (HMO includes A&B)
, Part D- Prescription Drug
Qualified Medicare Beneficiary (QMB) Program:
Helps pay premiums, deductibles, coinsurance, and copayments for Part A, Part B,
or both programs
Specified Low-Income Medicare Beneficiary (SLMB) Program:
Helps pay Part B premiums
Qualifying Individual (QI) Program:
Helps pay Part B premiums
Qualified Disabled Working Individual (QDWI) Program:
Pays the Part A premium for certain disabled and working beneficiaries who have
disabilities
Medicare Part A helps cover what
Inpatient hospital care ● Skilled nursing facility care ● Hospice care ● Home
health care
Medicare Part B helps cover what
Services from doctors and other health care providers ● Outpatient care ● Home
health care ● Durable medical equipment ● Many preventive services
CONTINUUM EXAM
The False Claims Act
makes it illegal to file a false claim for funds from a federal program.
The Patient Protection and Affordable Care Act implemented what?
implemented new requirements for insurance, Medicaid, and more.
The Drug Enforcement Administration and the Food and Drug Administration
regulate what?
regulate the creation and distribution of medication.
The Department of Health and Human Services and the Office of the Inspector
General help protect against what?.
Fraud
True or False. Medicare and Medicaid regulations occur at both state and federal
levels.
True
Occupational Safety and Health Administration and the Equal Employment
Opportunity Commission oversee What?? regulations.
,Workplace regulations
KNOW your shared decision and patient centered models !! FOr this class (from
FB page)
Mike Armstrong
Advocate for patient safety after having a blood test mis-read that showed he had
leukemia. Donated over 15 million dollars to John Hopkins to develop programs
for patient safety and diagnostic excellence.
Common reason for data breaches of PHI
criminal attacks (cyber attacks)
HIPAA security rule covers what
PHI (electronic format) of medical records
Social Security Act governs what
governs funding and requirements for Medicare, Medicaid, CHIP, and more.
HIPAA and the HITECH Act protect what?
protect patient privacy, requiring healthcare organizations to implement
measures to keep patient records secure.
,When considering the regulatory requirements for healthcare, which agencies
primarily oversee the use of medication?
FDA and DEA
Medicare and Medicaid focus on specific groups of people. Individuals over the
age of 65 and disabled individuals are the current focus of what?
Medicare
Medicare =
Federal coverage for people over 65, certain people under 65 with disabilities and
people of any age with end stage renal disease
Medicaid =
Cooperative federal and state healthcare coverage for low-income adults,
pregnant women, and children
Medicare part
Part A
Part B
Part C
Part D
Part A-Hospital Insurance
Part B-Medical Insurance
Part C- Medicare Advantage (HMO includes A&B)
, Part D- Prescription Drug
Qualified Medicare Beneficiary (QMB) Program:
Helps pay premiums, deductibles, coinsurance, and copayments for Part A, Part B,
or both programs
Specified Low-Income Medicare Beneficiary (SLMB) Program:
Helps pay Part B premiums
Qualifying Individual (QI) Program:
Helps pay Part B premiums
Qualified Disabled Working Individual (QDWI) Program:
Pays the Part A premium for certain disabled and working beneficiaries who have
disabilities
Medicare Part A helps cover what
Inpatient hospital care ● Skilled nursing facility care ● Hospice care ● Home
health care
Medicare Part B helps cover what
Services from doctors and other health care providers ● Outpatient care ● Home
health care ● Durable medical equipment ● Many preventive services
