DOMAIN 1 QUIZ: Care Delivery & Reimbursement Methods

Question 1

Interdependent care delivery that brings various professionals together to coordinate services is:

a. a utilization team
b. a multidisciplinary team
c. comprehensive care
d. a managed care team

Answer 1

b. A multidisciplenary team

Question 1

One of the best ways to prepare a client for transition to a home care setting is to:

a. initiate transition planning on the day of discharge
b. provide the client/support system with a medication list
c. provide cost savings informtation for various providers
d. schedule follow up with client/support system 72 hours post discharge

Answer 1

b. Provide the client/support system with a medication list

Question 2

Which of the following is a true statement regarding the coordination of care:

a. the care coordinator may override the wishes of the physician when it comes to discharge planning from an acute care facility
b. effective care coordination requires that a client follow the plan of the care coordinator exactly
c. often times complex healthcare problems can be remedied by simple solutions
d. clients with chronic conditions have greater need for care coordination

Answer 2

d. Clients with chronic conditions have a greater need for care coordination

Question 3

According to the Medicare Payment Advisory Commission (MedPAC), two main strategies for effective care management include improving discharge/transitional planning process and:

a. using systemic care transition programs that engage client/support systems in self management
b. avoiding redundancy and duplication of services
c. effective coordination of services during and after an episode of care
d. sharing data and information using electronic health records and person health records

Answer 3

c. Effective coordination of services during and after an episode of care

Question 4

To manage transitions of care successfully, the case manager must:

a. involve the client/support system
b. rely solely on the initial assessment
c. ensure patient education is initiated on discharge
d. verbally review discharge medications

Answer 4

a. Involve the client/support system

Question 5

During the assessing phase, the primary objective of the case manager includes:

a. customizing assessment tools for the client
b. identification of the clients needs
c. determining potential for return to work
d. planning for the next level of care

Answer 5

b. Identification of the clients needs

Question 6

Which of the following is true in reference to the Triple Aim and prioritizing issues:

a. reimbursement is the primary concern
b. case managers should always put quality first
c. better quality and efficiency lead to higher costs
d. patient satisfaction leads to improved outcomes

Answer 6

d. patient satisfaction leads to improved outcomes

Question 7

When addressing client/support system issues and concerns post discharge, it is important to:

a. resolve the issues during contact with the client/support system
b. modify the client/support systems transition plan if needed
c. refer them back to the provider or insurer
d. allow adequate time for adjustment to occur following discharge

Answer 7

b. Modify the client/support systems transition plan if needed

Question 8

Referral to community services and/or support groups is an appropriate case management intervention based on:

a. internal health risk management programs
b. wellness and health maintenance
c. external health risk management programs
d. illness and health

Answer 8

d. illness and health

Question 9

Which type of case management focuses on enhancing self-care skills of families regarding their well-being and health:

a. community/public health
b. hospital based
c. disability
d. pediatric

Answer 9

a. community/public health

Question 10

A strategy that can be used by a case manager during a case conference to resolve a problem and reach an agreement is:

a. resolution
b. brainstorming
c. compromise
d. reconciliation

Answer 10

b. brainstorming

Question 11

Interdisciplinary care that aims to relieve suffering and improve quality of life is:

a. primary care
b. hospice care
c. palliative care
d. end-of-life care

Answer 11

c. palliative care

Question 12

In order to identify the best care setting or level of care option for the client, a case manager would:

a. abide by the insurance plan mandate
b. recommend which setting best meets the clients needs
c. consider only providers within a 5 mile radius
d. follow the preferences of the client/support system

Answer 12

b. recommend which setting best meets the clients needs

Question 13

Providing immediate intervention once an injury or illness occurs and returning the individual to work in a timely manner is a function of the:

a. disability case manager
b. geriatric case manager
c. disease manager
d. ergonomist

Answer 13

a. disability case manager

Question 14

For the medically stable client able to participate in three hours of therapy a day, the plan for discharge would be a(n):

a. acute rehabilitation facility
b. long-term acute care hospital
c. sub-acute rehabilitation facility
d. long-term care facility

Answer 14

a. acute rehabilitation facility

Question 15

A transition may take place only after:

a. the client/support system, payor representative, employer, and health care team have approved the transition plan
b. the health care team at the next level of care or setting has accepted the responsibility for the continued care of the client
c. the specialty care provider signs a release allowing the client to be discharged
d. an ergonomic assessment of the workplace is completed

Answer 15

b. the health care team at the next level of care or setting has accepted the responsibility for the continued care of the client

Question 16

Resolution of conflicting priorities for a client with multiple comorbidities should include:

a. developing a plan with the client/support system
b. identifying the most important condition
c. a comprehensive resource folder
d. weekly home visits

Answer 16

a. developing a plan with the client/support system

Question 17

Which of the following groups is at high risk for polypharmacy:

a. geriatrics
b. millennials
c. pediatrics
d. adolescents

Answer 17

a. geriatrics

Question 18

In order to prevent rehospitalizations, it is important that the care coordinator:

a. oversees the discharge/transitional planning process
b. allows members of the team to practice independently
c. reacts to an episode of care as soon as possible
d. be aware of the rehospitalization statistics of her/her facility

Answer 18

a. oversees the discharge/transitional planning process

Question 19

In the role of a community case manager, which of the following is an important characteristic:

a. working collaboratively with the other health care professionals
b. recognizing the importance of working with additional medical providers
c. providing information about how to avoid hazards
d. making health care decisions for clients when they return home

Answer 19

a. working collaboratively with other health care professionals

Question 20

Case managers develop a client’s plan of care that addresses:

a. the clients primary and secondary risks
b. all of the clients key actual and potential problems and needs
c. the problems and needs for which they were admitted to the health care organization
d. the clients most critical and important problems first

Answer 20

b. all of the clients key actual and potential problems and needs

Question 21

Recent studies have shown that care coordination:

a. may increase health care claim costs
b. may result in conflicts with physicians any payors
c. increases client satisfaction
d. results in longer lengths of stay in acute facilities

Answer 21

c. increases client satisfaction

Question 22

To ensure the clients appropriate transition, the case manager must communicate with the client/support system and the:

a. referral source
b. payor representative
c. legal representative
d. next level of care

Answer 22

d. the next level of care

Question 23

Which of the following must occur prior to a client discharge from an acute care setting:

a. the length of stay for the diagnosis has been reached
b. the hospital defines the next location of care
c. the payor has ultimate authority for transition
d. the client and family must receive specific medication instructions prior to discharge

Answer 23

d. the client and family must receive specific medication instructions prior to discharge

Question 24

Effective transition interventions:

a. depend solely upon the cooperation of the payor
b. require governmental approval
c. provide for necessary readmissions
d. respond to changes in clients needs

Answer 24

d. respond to the changes in clients needs

Question 25

The key activities in revising a client’s case management plan of care are:

a. screening, assessing, planning, and implementing
b. monitoring, re-evaluation, agreement, and revision
c. discussing, determining and developing
d. client buy-in, communication, and revision

Answer 25

b. monitoring, re-evaluation, agreement, and revision