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HSM 546 Week 3 Quiz

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1.

Question :

(TCO D) Capitation will solve the issue(s) of _____.

high-utilization patterns

poor quality of care

lack of accessibility

All of the above

None of the above

2.

Question :

(TCO D) Which of the following is the leading reason for member complaints?

Student Answer:

Lack of coverage

Enrollment issues, such as a missing ID card

Claims issues

Interactions with the member’s PCP

3.

Question :

(TCO D) Discuss how information technology (IT) can make disease-management programs more successful.

Information technology can aid in helping the program by maintain the statistics, schedules, activities for each disease, provide some project management. The technology cn become an essential pat of the by help in monitoring the case time schedules and due dates as well as a quick look at the progress of your project.

Information technology (IT) contributes to disease management (DM) through a number of aspects. The use of data mining to determine patterns of care and the use of predictive modeling are paramount for a successful DM program. Automated decision-support software are also required to enable case managers and others to document interventions, track changes, communicate with other case managers, and have automated access to clinical algorithms. Also, the use of the Internet allows for added means of communication with patients and providers. Automated clinical-sensing devices used by the patient transmit data to DM case managers and allow for better clinical status tracking.

4.

Question :

(TCO D) Which of the following is not necessarily a red flag for case management?

Long hospital length of stay

Expenses beyond a certain threshold

Location of care

Early referral to a specialist

 

5.

Question :

(TCO D) Which of the following aspects of the claims capability must be counted or measured in order to allocate adequate resources and verify financial assumptions about an insured population?

Inventory receipts

Timely filing limits

Turnaround time, based on the date the MCO received the claim

Claims lag

IBNR

All of the above

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