Exam 1 Review
Chapter 3: Freestanding Ambulatory Care
Knowledge-based questions
Non-Traditional
1.
List and describes three types of freestanding
ambulatory care setting. (p. 71)
−
Public health
− Community Health Centers
−
Federally qualified Health Centers (FQHCs)
− Rural Health Clinics (RHCs)
− Urgent Care Centers
− Ambulatory Surgery Centers (ASCs)
− Industrial/Occupational Health
− Uniersity Health Centers
− Birth Centers, Family Planning Centers
2.
Define the following terms used in ambulatory care: encounter, nurse practitioner, reason for visit, superbill.
− Encounter: Pt face-to-face w/provider
− Nurse Practitioner: RN with extra training (MS/PhD) w/limited licence practice
− Reason for Visit: Pt provides reason for care
−
Superbill: Shows service provided to Pt; Charges, Dx, and
Procedure codes
3.
Name the two main organizations accredited
ambulatory care. (p. 74)
− The Joint Commission and Accreditation Association for
Ambulatory Health Care Inc.
4.
List the major types of documentation that are basic to all ambulatory care encounters and settings.
− Registration (demographic info) and H&P
(Progress Notes, Encounter Form, Superbill)
5.
What types of patient identifiers are used in ambulatory care?
− Name / Number / Family numbering system
6.
What types of data are included in the uniform adulatory care data set, and how does this affect
the content of the ambulatory record? (p 101)
− UACDS: Pt data, Provider data, Encounter data
7.
What is the ASC reimbursement system, and how
is it used in Medicare reimbursement? (p. 92)
−
Critical thinking questions
1.
Compare and contrast the fee-for-service and
PFS/RBRVS reimbursement systems.
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2.
How does documentation in an industrial health
Center, differ from that of physicians practice and why?
3.
How is quality assessment in ambulatory care similar to and different from quality assessment in the acute inpatient setting?
Chapter 7: Mental Health: Long-Term and Acute
Services
Knowledge-based questions
1.
Explain the difference between serious emotional
disturbance and serious mental illness.
− Serious Emotional Disturbance: Condition in children, birth to 18, who in the last year have been diagnosed w/mental, behavioral, or emotional disorder that resulted in functional impairment which substantially interferes with or limits the child’s role or functioning in family, school, or community activities. (p. 216)
− Serious Mental Illness: a person who has been diagnosed w/mental, behavioral, or emotional disorder that resulted in functional impairment which substantially interferes with or limits one or more major life activities. (p. 220)
2.
Named the three most prevalent types of serious
mental illness.
− Schizophrenia, clinical depression, bipolar disorder (p.
217)
3.
What are two categories of dual diagnoses?
− Mental illness and chemical addiction
− Developmentally disabled and seriously mentally ill
− Mentally ill with dementia (p. 218)
4.
Give the term by which persons with mental illness were living in the community prefer to be called.
− Consumers, Mental health consumers, users of mental health services (p. 217)
5.
Define "outpatient commitment. "
−
The courts can place persons in outpt programs where they are monitored for medication and must maintain scheduled psyciatric appointments. Released from inpt care. (p. 214)
6.
Name the main components of the mental health consumer case record.
−
Assessment, Treatment Plan, Progress Notes, Discharge
Summary and Aftercare Plans (p. 228)

Exam 1 Review Non-Traditional
7.
What is the basis for payment in the inpatient
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2.
Discuss some of the areas in mental health services psychiatric facility prospective payment system into which health information managers may
(IPF PPS)?
−
Per diem payments are based on the pt’s age, variable per diem adjustments (lowered on days 1-22, then stabilized)
−
Medical severity DRG
−
Certain comorbidities (those of different families of disease) (p. 239) KNOW THESE
8.
What is the relationship between the treatment expand their roles.
Chapter 10: Long-Term Care
Knowledge-based questions plan and progress notes, and why is it important?
−
Treatment Plan tries to get the consumer invested in meeting the goals, so counselor works with the consumer to make up the plan (p. 229-33)
−
Progress Notes document achievement or nonachievement in the consumer’s attempts at reaching the goals as stated in the treatment plan.
9.
How did the "duty to warn" originate, and how does it affect confidentiality of mental health
information? (p. 250-51)
−
1976 Ruling Tarasoff v. Regents of U. of California.
Psychiatrist failed to notify authorities when pt threatened harm to someone specific and followed thru on the threat.
10.
What are the URS tables?
−
Uniform Reporting System: System thru which State
Mental Health Authority (SMHA) reports aggregate data to
SAMHSA (Substance Abuse-Mental Health Services
Administration
11.
Provide examples of the national outcome measures (NOMs) for which client-level data are reported.
−
Data Infrastructure Grants (DIGs) support Commun.
Mental Health Centers (CMHCs) in reporting measures to build database which adds value in decision support at state and national levels. (p. 248)
National Outcome Measures: (p. 247)
Critical thinking questions
1.
− Employment/School Attendance
− Stability in Housing
− Criminal Justice Inolvement
− Readmission to State Hospital
Discuss how the mental health consumer empowerment movement may have affected development of mental health data collection systems.
1.
What two primary agencies regulate long-term
care facilities?
−
State Public Health, CMS
2.
What are the primary reimbursement categories for care of residents in long-term care facilities?
−
M’caid per diem, Resource Utilization Group (RUG) Part A
3.
Who determines how long-term care facilities are reimbursed under the Medicaid program?
− The state determines how long-term reimbursement will happen.
4.
What are the three categories for which ratings are provided in the five-star rating system for nursing homes?
−
Health Inspections,
−
Staffing,
−
Quality Measures
What are some of the specific long-stay quality measures used in the system?
−
ADL -- Mobility,
−
Pressure ulcers, -- Restraints,
−
UTI, -- pain,
− catheterization
5.
What is the single most important content characteristic of a care plan in a long-term care facility is subject to federal regulations?
−
Individualization of care is the single most important content characteristic
6.
List common electronic software applications in long-term care.
−
RAVEN
7.
Federally mandated:
−
Resident Assessment Instrument (RAI) Process o
Minimum Data Set (MDS) o
Care Area Assessment (CAA) process (old RAPs) o
Utilization Guidelines (in RAI manual)
−
Comprehensive Resident Assessment
−
OBRA Assessments

Exam 1 Review Non-Traditional
−
CATs = Care Area Trigger: Identify residents who have or are at risk for developing specific developmental problems and need further assessment.
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−
Volunteers offer companionship, comfort, transportation, light housekeeping, sometimes direct Pt care.
7.
Discuss bereavement services provided by hospice.
− The Pt’s family works w/counselors preparing for and up
Critical thinking questions to 1 year after the Pt’s death. (p. 473)
8.
Describe the four levels of hospice care for
1.
How is ICD coding of relevance to the long-term
2.
care setting? Compare its impact in long-term care to acute care.
Why is there a greater focus on concurrent documentation monitoring the long-term care
Medicare Conditions of Participation. (p. 474)
− Routine Home Care
− General Inpt Care
− Continuous Care
− Inpt Respite Care
9.
Describe aspects of the hospice utilization review setting is compared to evaluating documentation in the closed medical record?
program. (p. 482,3)
−
3.
Consider additional research is necessary to discover the principal uses of the MDS in the longterm care industry (a) by the individual provider, (b) by the state agency, and (c) by CMS.
Critical thinking questions
Chapter 13: Hospice
1.
Provide examples of some of the data it can be collected by hospices.
2.
Describe the functions of the quality assessment/performance improvement program.
Knowledge-based questions
1.
True or False: Hospice takes care of only cancer patients.
−
False
2.
Provide examples of how hospice tries to eat
terminal symptoms for patients. (p. 465)
−
Analgesics, position changes, back rubs, massage, O2, tranquilizers, antidepressants, music, conversation, companionship
3.
List the members of the interdisciplinary team in
hospice. (p. 465)
−
Dr (employed by Hospice) -- Volunteer Coordinator
−
Nurse -- Pharmacist
−
Social Worker -- Bereavement Counselor
−
Pastor/Counselor -- Hospice Aide
−
-- Volunteer
4.
What is the role of the primary caregiver?
Most of the Pt’s care: Tx, meds, baths, watch for changes, notify hospice of changes.
5.
Describe how a Medicare patient elects to receive
hospice care. (p. 468)
−
“Electing the Hospice Benefit”
6.
Describe the role that volunteers play in hospice care.