All of the following sets represent criteria for medical necessity and utilization review except:
Quiz Submissions - Quiz 2Question 11 / 1 pointWhich of the following is not a function of the Indian Health Service (IHS)?Question options:Assists Indian tribes in the development of their own health programsFacilitates and assists Indian tribes in coordinating health planningProvides only inpatient healthcare servicesPromotes using health resources available at federal, state, and local levels Show
Question 21 / 1 pointWhat is the term for contracts that separate certain types of healthcare services to decrease MCOs' risk? Get answer to your question and much more Question 31 / 1 pointAll of the following sets represent criteria for medical necessity and utilization review except: Get answer to your question and much more Question 41 / 1 pointThe patient belonged to a managed care plan. Prior approval for the surgery was received. What numbershould the insurance analyst record? Get answer to your question and much more Question 51 / 1 pointAll of the following are tools managed care organizations use to promote quality care in their healthcareplans except:Question options: focusNode Didn't know it? Knew it? Embed Code - If you would like this activity on your web page, copy the script below and paste it into
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What is the term that means evaluating for healthcare service the appropriateness of its setting and its level of service?Utilization Management (UM)
Wikipedia Definition: “…the evaluation of the appropriateness and medical need of health care services and procedures and facilities according to evidence-based criteria or guidelines, and under the provisions of an applicable health benefits plan.
What is the first step in determining the MS DRG assignment for this encounter?The first step would be to look at the documentation and identify the principal diagnosis for the encounter you're reviewing, any procedures the patient had performed during the encounter that are considered reimbursable, and lastly, any conditions that CMS has identified as complications or comorbid conditions (CC)/ ...
Which of the following is most likely to be considered medically necessary?Rev Cycle Final. Which of the four models for health systems predominates in the United States?In the U.S., fee-for-service care predominates, with payment tied to the volume of services provided rather than the overall value of care patients receive.
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