CASE MANAGER CERTIFICATION
EXAM
1. Provider
2. Services
3. Setting
4. Time
5. Cost
- answers5 rights of utilization review
211
- answersfederally funded support referral services and crisis management.
25
- answersthe dollar amount the gifts are limited to to avoid conflict of interest
4 parts of clinical pathway
- answers1. timeline
2. categories of care/activities and interventions
3. intermediate and long term outcome criteria
4. variance tracking
are 4 parts of what?
55
- answersMedicare will begin coverage of home oxygen with an arterial blood gas result
at or above a partial pressure of ___mm Hg while at rest on room air.
80%
- answersmedicare covers what percent?
80%
- answersMedicare Part B only covers what percent?
,88
- answersmedicare will cover home oxygen if O2 sat is at or below _____% while at rest
on room air, exercising on room air or while asleep or a greater than normal fall in
oxygen level during sleep (a decrease in arterial PO 2 more than 10 mm Hg, or
decrease in arterial oxygen saturation more than 5%) associated with symptoms or
signs reasonably attributable to hypoxemia (e.g., impairment of cognitive processes and
nocturnal restlessness or insomnia).
A
- answersWhat part of Medicare covers skilled nursing facility?
abandonment
- answerswillful neglect of responsibility of another person by a person who is assigned
to care for that patient or by a person in a caregiving position.
access, inspect, copy
- answersHIPAA individual right #3 is the individual's right to their health information to
do what?
accountable care organizations
- answersgroups of doctors, hospitals, and other health care providers, who come
together voluntarily to give coordinated high quality care to their Medicare patients.They
decrease fragmentation and improve collaboration. Created from the affordable care
act. "medical neighborhood"
Acute care
- answersA hospital the largest Healthcare setting in the United States. Case managers
need to ensure tests are done in a timely meander results are given to provider and
Healthcare team determines the next step.
ad litem
- answersguardianship appointed to represent a child when the parents conflict or in
situations such as abuse.
adults
- answersThese learners are autonomous, goal and relevancy oriented, have
experience, care about what is practical and need respect.
advanced directive
- answerswritten statement of medical wishes in the future in the event they are unable
to make decisions for themselves. It includes a living will or a durable power of attorney.
affordable care act
- answersthis law in 2010 created the innovation center with in the center for medicare
and medicaid services which assists with research regarding quality.
, aggregate data
- answersdata that has a common variable. An example would be diabetes.
all patient refined diagnosis related groups (APDRG)
- answerstype of payment with 2 subclasses based on 1. severity of illness (organ
system failure or loss of funtion and 2. risk of mortality
Americans with disabilities act
- answersthis act established in 1990 has 5 titles.
companies cannot discriminate and must make reasonable accommodations if they
have 15 or more employees, must have access to public transportation, have access to
telecommunication devices, and seek restitution for damage caused by inaccessibility of
services.
Appeal
- answersA formal way of lodging a disagreement with a claim payment or benefit denial
arthritis impact measurement scales
- answershealth risk assessment: Disease-specific measure of physical, social, and
emotional well-being designed as a measure of outcome in arthritis.
-scales: mobility, physical activity (walking, bending, lifting), dexterity, household activity
(managing money and medications, housekeeping), social activities, activities of daily
living, pain, depression, and anxiety.
Score range: Range is 0-10 for each section. Total health score 0-60.
--> Zero represents good health status, 10 and 60 represent poor health status.
Assess, plan, implement/intervention, monitor/evaluation
- answers4 stages of case management
assult
- answersan intentional tort/act of threatening or attempting to touch without consent.
autonomy
- answersrespecting the individual's right to make their own decisions
Autonomy vs. shame
- answersErickson 1 1/5-3
B
- answersWhat part of Medicare covers durable medical equipment?
balanced budget act
- answersact that gives medicare and medicaid services authority to establish and
oversee a program that allows private, national accredited organizations to "deem"
EXAM
1. Provider
2. Services
3. Setting
4. Time
5. Cost
- answers5 rights of utilization review
211
- answersfederally funded support referral services and crisis management.
25
- answersthe dollar amount the gifts are limited to to avoid conflict of interest
4 parts of clinical pathway
- answers1. timeline
2. categories of care/activities and interventions
3. intermediate and long term outcome criteria
4. variance tracking
are 4 parts of what?
55
- answersMedicare will begin coverage of home oxygen with an arterial blood gas result
at or above a partial pressure of ___mm Hg while at rest on room air.
80%
- answersmedicare covers what percent?
80%
- answersMedicare Part B only covers what percent?
,88
- answersmedicare will cover home oxygen if O2 sat is at or below _____% while at rest
on room air, exercising on room air or while asleep or a greater than normal fall in
oxygen level during sleep (a decrease in arterial PO 2 more than 10 mm Hg, or
decrease in arterial oxygen saturation more than 5%) associated with symptoms or
signs reasonably attributable to hypoxemia (e.g., impairment of cognitive processes and
nocturnal restlessness or insomnia).
A
- answersWhat part of Medicare covers skilled nursing facility?
abandonment
- answerswillful neglect of responsibility of another person by a person who is assigned
to care for that patient or by a person in a caregiving position.
access, inspect, copy
- answersHIPAA individual right #3 is the individual's right to their health information to
do what?
accountable care organizations
- answersgroups of doctors, hospitals, and other health care providers, who come
together voluntarily to give coordinated high quality care to their Medicare patients.They
decrease fragmentation and improve collaboration. Created from the affordable care
act. "medical neighborhood"
Acute care
- answersA hospital the largest Healthcare setting in the United States. Case managers
need to ensure tests are done in a timely meander results are given to provider and
Healthcare team determines the next step.
ad litem
- answersguardianship appointed to represent a child when the parents conflict or in
situations such as abuse.
adults
- answersThese learners are autonomous, goal and relevancy oriented, have
experience, care about what is practical and need respect.
advanced directive
- answerswritten statement of medical wishes in the future in the event they are unable
to make decisions for themselves. It includes a living will or a durable power of attorney.
affordable care act
- answersthis law in 2010 created the innovation center with in the center for medicare
and medicaid services which assists with research regarding quality.
, aggregate data
- answersdata that has a common variable. An example would be diabetes.
all patient refined diagnosis related groups (APDRG)
- answerstype of payment with 2 subclasses based on 1. severity of illness (organ
system failure or loss of funtion and 2. risk of mortality
Americans with disabilities act
- answersthis act established in 1990 has 5 titles.
companies cannot discriminate and must make reasonable accommodations if they
have 15 or more employees, must have access to public transportation, have access to
telecommunication devices, and seek restitution for damage caused by inaccessibility of
services.
Appeal
- answersA formal way of lodging a disagreement with a claim payment or benefit denial
arthritis impact measurement scales
- answershealth risk assessment: Disease-specific measure of physical, social, and
emotional well-being designed as a measure of outcome in arthritis.
-scales: mobility, physical activity (walking, bending, lifting), dexterity, household activity
(managing money and medications, housekeeping), social activities, activities of daily
living, pain, depression, and anxiety.
Score range: Range is 0-10 for each section. Total health score 0-60.
--> Zero represents good health status, 10 and 60 represent poor health status.
Assess, plan, implement/intervention, monitor/evaluation
- answers4 stages of case management
assult
- answersan intentional tort/act of threatening or attempting to touch without consent.
autonomy
- answersrespecting the individual's right to make their own decisions
Autonomy vs. shame
- answersErickson 1 1/5-3
B
- answersWhat part of Medicare covers durable medical equipment?
balanced budget act
- answersact that gives medicare and medicaid services authority to establish and
oversee a program that allows private, national accredited organizations to "deem"
