Question 1

Describe the two basic approaches to utilization management: prospective and retrospective review.​

Accepted Answer

​Prospective re-view/precertification: the service is examined before it is provided. Data is collected, usually by a nurse, from the patient and the physician. The facts of the individual case are compared to the appropriateness criteria. If the standards are met, the nurse can usually approve the service. If the standards are not met, a physician advisor may be asked to review the case and make a determination. Types of activities typically undergoing prospective review include authorization for referral, authorization for a procedure, preadmission review before hospitalization, and second surgical opinion.
Retrospective review: in this methodology, care is looked at after it is given. Usually a sample of cases is selected. Data is then collected from medical records, and the information from the record is compared to the appropriateness standards. Feedback is then given to the appropriate caregiver regarding inappropriate care provided.

Question 2

​A(n) _______________________ is a secure method of patient access to his or her own information through a facility's electronic information system.

Accepted Answer

​patient portal

Question 3

A physician assistant is a registered nurse who has had additional training in areas such as family or pediatric care.

Accepted Answer

A) True 
 B)False  False

Question 4

Two approaches to utilization management in ambulatory care are prospective and retrospective review.

Accepted Answer

A) True 
 B)False

Question 5

The Joint Commission accredits ambulatory health care facilities under the same standards as hospitals.

Accepted Answer

A) True 
 B)False

Question 6

Match each description with the correct item
- Organization that provides services to promote the health of the community, such as immunizations and disease screening

Accepted Answer

A)   Community health center
B)   Physician private practice
C)   Urgent care center
D)   University health center
E)   Public health departmentF)  Birth centerG)  Ambulatory surgery centerH)  Industrial health center

Question 7

Match each description with the correct item
- Setting that provides surgery on an ambulatory basis, without an overnight stay

Accepted Answer

A)   Community health center
B)   Physician private practice
C)   Urgent care center
D)   University health center
E)   Public health departmentF)  Birth centerG)  Ambulatory surgery centerH)  Industrial health center

Question 8

_________________________ are guidance documents published by Medicare Administrative Contractors (MACs) that include information on codes that indicate medical necessity of services. These policies apply to services covered under Medicare in the region served by the contractor.​

Accepted Answer

The answer of _________________________ are guidance documents published by Medicare...

Question 9

When the consent for treatment is generated at an ambulatory surgery center, who is responsible for explaining the risks and alternatives associated with the surgery and for obtaining the patient's consent prior to the procedure?

Accepted Answer

A)    nurse
B)    surgeon
C)    admission clerk
D)   anesthesiologist

Question 10

Match each description with the correct item
- Ambulatory setting in which care is provided to employees at their place of work or at an employer-contracted site

Accepted Answer

A)   Community health center
B)   Physician private practice
C)   Urgent care center
D)   University health center
E)   Public health departmentF)  Birth centerG)  Ambulatory surgery centerH)  Industrial health center

Question 11

Match each description with the correct item
- Ambulatory care setting in which patients are seen without appointments

Accepted Answer

A)   Community health center
B)   Physician private practice
C)   Urgent care center
D)   University health center
E)   Public health departmentF)  Birth centerG)  Ambulatory surgery centerH)  Industrial health center

Question 12

Match each description with the correct item
- Setting in which physicians practice independently rather than being employed by an organization

Accepted Answer

A)   Community health center
B)   Physician private practice
C)   Urgent care center
D)   University health center
E)   Public health departmentF)  Birth centerG)  Ambulatory surgery centerH)  Industrial health center

Question 13

______________________ are patients who arrive without an appointment or who receive an appointment at the last minute.​

Accepted Answer

The answer of ______________________ are patients who arrive without an...

Question 14

An appointment scheduling method in which all patients are assigned in a large block for the same appointment time (e.g., 9 a.m. for all morning appointments) then seen on a first-come, first-served basis is called a
______________.

Accepted Answer

A)    standard scheduling system
B)    walk-in scheduling system
C)    block appointment system
D)    capitation appointment system

Question 15

A family numbering system is a simple way of organizing records because the numbers rarely change.

Accepted Answer

A) True 
 B)False

Question 16

?Describe three main items that should be included in labor and delivery record documentation.

Accepted Answer

The answer of ?Describe three main items that should be...

Question 17

Which of the following is NOT a characteristic of urgent care centers?

Accepted Answer

A)    Generally no appointment system
B)    Extended hours/days of operation
C)    Often "not­for­profit," charging reduced fees
D)    Provide routine care or treat minor emergencies

Question 18

A ___________________________ is a plan for ensuring that a facility or practice is following all laws and regulations, including those pertaining to reimbursement under Medicare and Medicaid.

Accepted Answer

A)    public health plan
B)    strategic plan
C)    follow-up plan
D)    compliance plan

Question 19

The _________________________ is a joint federal and state government initiative to identify fraud and abuse in the Medicaid system​

Accepted Answer

The answer of The _________________________ is a joint federal and...

Question 20

Services provided by an NP or PA while a physician is on-site and services are termed ________ and are fully reimbursed.

Accepted Answer

A)   LCD 
B)    EPSDT
C)    "incident to"
D)    locum tenens

Exam 3: Freestanding Ambulatory Care

Describe the two basic approaches to utilization management: prospective and retrospective review.​

​A(n) _______________________ is a secure method of patient access to his or her own information through a facility's electronic information system.

A physician assistant is a registered nurse who has had additional training in areas such as family or pediatric care.

Two approaches to utilization management in ambulatory care are prospective and retrospective review.

The Joint Commission accredits ambulatory health care facilities under the same standards as hospitals.

Match each description with the correct item - Organization that provides services to promote the health of the community, such as immunizations and disease screening

Match each description with the correct item - Setting that provides surgery on an ambulatory basis, without an overnight stay

_________________________ are guidance documents published by Medicare Administrative Contractors (MACs) that include information on codes that indicate medical necessity of services. These policies apply to services covered under Medicare in the region served by the contractor.​

When the consent for treatment is generated at an ambulatory surgery center, who is responsible for explaining the risks and alternatives associated with the surgery and for obtaining the patient's consent prior to the procedure?

Match each description with the correct item - Ambulatory setting in which care is provided to employees at their place of work or at an employer-contracted site

Match each description with the correct item - Ambulatory care setting in which patients are seen without appointments

Match each description with the correct item - Setting in which physicians practice independently rather than being employed by an organization

______________________ are patients who arrive without an appointment or who receive an appointment at the last minute.​

An appointment scheduling method in which all patients are assigned in a large block for the same appointment time (e.g., 9 a.m. for all morning appointments) then seen on a first-come, first-served basis is called a ______________.

A family numbering system is a simple way of organizing records because the numbers rarely change.

?Describe three main items that should be included in labor and delivery record documentation.

Which of the following is NOT a characteristic of urgent care centers?

A ___________________________ is a plan for ensuring that a facility or practice is following all laws and regulations, including those pertaining to reimbursement under Medicare and Medicaid.

The _________________________ is a joint federal and state government initiative to identify fraud and abuse in the Medicaid system​

Services provided by an NP or PA while a physician is on-site and services are termed ________ and are fully reimbursed.

Describe the two basic approaches to utilization management: prospective and retrospective review.

A(n) _______________________ is a secure method of patient access to his or her own information through a facility's electronic information system.

_________________________ are guidance documents published by Medicare Administrative Contractors (MACs) that include information on codes that indicate medical necessity of services. These policies apply to services covered under Medicare in the region served by the contractor.

______________________ are patients who arrive without an appointment or who receive an appointment at the last minute.

The _________________________ is a joint federal and state government initiative to identify fraud and abuse in the Medicaid system