WGU D052 - Navigating Care Across the Continuum Study guide with Complete Solutions

WGU D052 - Navigating Care Across the Continuum Study guide with Complete SolutionsWGU D052 - Navigating Care Across the Continuum Study guide with Complete SolutionsWGU D052 - Navigating Care Across the Continuum Study guide with Complete Solutions Define compliance - ANSWER-is the process of following rules, regulations, and laws that relate to healthcare practices. Compliance in healthcare can cover a wide variety of practices and observe internal and external rules. What is the importance of accurate documentation? - ANSWER-Good documentation is important to protect your patients. Good documentation promotes patient safety and quality of care. Complete and accurate medical recordkeeping can help ensure that your patients get the right care at the right time. Why is noncompliance an important concern for health service coordinators? - ANSWER-is the willful refusal to follow recommended care plans and can be the result of many different circumstances What are bundle payments? - ANSWER-is the reimbursement of health care providers (such as hospitals and physicians) "on the basis of expected costs for clinically-defined episodes of care." What is the purpose of clinical reviews? - ANSWER-Clinical care review is the process of retrospectively examining potential errors or gaps in medical care, with a goal of future practice improvement. What is HEDIS? - ANSWER-Healthcare Effectiveness Data and Information Set, comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance. Explain Third Party Insurance Reimbursement - ANSWER-Third-party payers pay for covered insurance expenses for an insurance recipient or a designated beneficiary. Co-insurance - ANSWER-Requires the insured individual to pay a fixed percentage of the loss after the deductible has been paid Co-payment - ANSWER-a specific amount of money a patient pays for a particular service deductible - ANSWER-Amount you must pay before you begin receiving any benefits from your insurance company