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Course 2B_L2 - Quiz 2

 

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1)
This lesson makes the point that anyone who has successfully passed an audit of their treatment records in the past, will NOT need to make modifications in how they document treatment under a managed care contract.
 
True False
 
2)
How many Core Concepts were identified in this lesson, which drive the managed care company's decision to approve or deny treatment?
 
3
7
5
4
 
3)
This lesson tells us that _________________ is the key to obtaining appropriate levels of care and keeping your money when you are audited.
 
memorizing the Level of Care (LOC) criteria
learning how to document
your relationship with the Care Manager
 
4)
This course tells us that a major factor in the managed care company's decision to approve or deny a request for treatment is . . .
 
whether or not the client is expected to move out of the Service Area during the timeframe covered by the authorization.
whether or not the client is expected to file a grievance if the treatment request is denied.
whether or not the client is making progress.
whether or not the client has had a change in diagnosis during the past 90 days.
 
5)
Which item is NOT listed as a Core Concept, utilized by the HMO to make treatment decisions?
 
Functionality
Progress
Medical Necessity
Treatment Goals and Interventions
Age and Health Status
 
6)
As we look at good TREATMENT RECORD characteristics, Medical Necessity, the authorization to deliver services at a particular Level of Care, and our documentation in the treatment record are NOT necessarily connected.
 
True False
 
7)
Because of potential legal complications or the possible need to testify in court, we should NOT be specific about the functional deficits of the client, or the basis for his diagnosis, when we write in the treatment record.
 
True False
 
8)
In this lesson, we describe several ways that HMOs manage their own RISK, which ultimately affect the providers. Which of the items below is NOT mentioned as one of those HMO activities which affect us.
 
the redesign of the delivery system - including moving money around from one kind of program to another
the HMO's focus upon good outcomes and treatment effectiveness - wanting more 'bang for the buck'
the HMO's decisions about the Medical Necessity of treatment for clients, which may contradict the provider's professional beliefs
the Care Management process
an HMO requirement that we become intimately familiar with Federal regulations for managed care programs
 

 

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