HCA 416 FINAL EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS GRADED A++
OLAP, OLTP
Where Does Data Come From? ( 2 terms Acronyms)
Health related event
Where is Healthcare Data Created From?
Patients health record
Where Does Healthcare Data Come From? (primary source)
Healthcare information database
Where Does Healthcare Data Come From? (secondary)
Provides additional care for patients with complex needs or posthospital services
What is Case Management do?
Medicare COP and TJC standards
What is Case Management Required by?
Ensure that facilities and resources are being used properly
What is Utilization Management?
Unmet patient needs
What is Underutilization?
Care or services not medically necessary
What is Over Utilization?
Maintain or increase quality of care
, What is the Goal for Utilization Management?
Measurement of how organizations and providers use resources, assessment of
how well those resources are being used, improvement of resource use
What are the 3 Familiar building blocks of performance management?
Oversight committee
What are Hospitals required to have as a part of Utilization Management?
CMS and state insurance comission
Who governs UM health plans? (2 terms, "and")
Prospective Review, Concurrent Review, Discharge Planning/Case Management,
Retrospective Review
What are the names of the 4(5) activities UM function involves in? "/"
Initiated before patient actually receives health services
What is Prospective Review?
Intensity of services, Severity of illness
What is IS/SI criteria? (2)
UM activity that is conducted at the time a patient is admitted usually within 24
hours
What is Concurrent Review?
Non-physician, UM staff
Concurrent Review has a 2 stage review process:
____-____ personnel conduct initial and subsequent reviews
________ screens patient health record for documentation to establish compliance with
medical necessity criteria
COMPLETE SOLUTIONS GRADED A++
OLAP, OLTP
Where Does Data Come From? ( 2 terms Acronyms)
Health related event
Where is Healthcare Data Created From?
Patients health record
Where Does Healthcare Data Come From? (primary source)
Healthcare information database
Where Does Healthcare Data Come From? (secondary)
Provides additional care for patients with complex needs or posthospital services
What is Case Management do?
Medicare COP and TJC standards
What is Case Management Required by?
Ensure that facilities and resources are being used properly
What is Utilization Management?
Unmet patient needs
What is Underutilization?
Care or services not medically necessary
What is Over Utilization?
Maintain or increase quality of care
, What is the Goal for Utilization Management?
Measurement of how organizations and providers use resources, assessment of
how well those resources are being used, improvement of resource use
What are the 3 Familiar building blocks of performance management?
Oversight committee
What are Hospitals required to have as a part of Utilization Management?
CMS and state insurance comission
Who governs UM health plans? (2 terms, "and")
Prospective Review, Concurrent Review, Discharge Planning/Case Management,
Retrospective Review
What are the names of the 4(5) activities UM function involves in? "/"
Initiated before patient actually receives health services
What is Prospective Review?
Intensity of services, Severity of illness
What is IS/SI criteria? (2)
UM activity that is conducted at the time a patient is admitted usually within 24
hours
What is Concurrent Review?
Non-physician, UM staff
Concurrent Review has a 2 stage review process:
____-____ personnel conduct initial and subsequent reviews
________ screens patient health record for documentation to establish compliance with
medical necessity criteria
