DMEC CDMS STUDY GUIDE
Psychiatric claims categories:
peer review - Answer -review by committee of similar practitioners, looks at quality and
utilization criteria
Dictionary of Occupational Titles - Answer -provides standardized occupational
information based on on-site job analyses
Job analysis - Answer -develops work samples that are realistic/responsive to local
employment
Marketing - Answer -process of creating, planning, and executing conception, pricing,
promotion and distribution of ideas, goods, and services
Work hardening - Answer -simulated real work in clinical setting
Residual impairment after MMI reached - Answer -leads to transition from temporary to
permanent disability benefits
Guides to the evaluation of permanent impairment - Answer -Used to provide employer
with degree of impairment that impacts compensation due to a claimant
Work station layout - Answer -should position items to be lifted between hand and
shoulder height (to accommodate differently sized employees)
Apprenticeship - Answer -formal instruction plus on the job training
Cross-functional - Answer -input and output relationships among organization's
departments
productivity - Answer -includes # lost workdays, rates of RTW after injury/illness, rates
of employee turnover, amount of overtime
ADA - Answer -requires reasonable accommodations that do not cause undue hardship
(cost, nature of business)
ADA company size - Answer -15+ employees
ADA cause for denying employment - Answer -very low risk but severe consequences,
or severe risk and minor consequences
, ADA does NOT require - Answer -provide treatment, waive uniform disciplinary
standards, provide stress-free environment, eliminate performance evaluations,
eliminate essential job functions, provide irregular/indefinite leave, reduce performance
standards, create a new position, or arrange a transfer when no positions are available
ADA eligibility - Answer -SUBSTANTIALLY impaired to be eligible for ADA protection.
Includes conditions that cause differential treatment but do not otherwise impact job
(e.g. burn victims).
ADA requires employers to approach employees about accommodation when: -
Answer -knows about disability, knows it is causing problems on the job, and knows that
disability prevents employee from requesting accommodation.
Most common conditions for discrimination complaint: - Answer -1) Orthopedic
problems (16%) 2) Depression 3) Hearing/vision impairments 4) Diabetes 5) Bipolar 6)
Cancer
SSA categories of functioning - Answer -1) ADLs 2) Social Functioning 3)
Concentration, Persistence, Pace 4) Deterioration in work-like settings. *Significant
impairment in any one domain qualifies
SSA Claim Denial Reasons - Answer -Impairment does not prevent individual from
doing past relevant work; impairment does not prevent individual from doing other work;
impairment is not defined as severe by SSA
AMA disability definition - Answer -Disability defined as persisting 12+ months, OR after
treatment has been exhausted (MMI)
HIPAA (Health Insurance Portability and Accountability Act) - Answer -- Created a
program for detecting fraudulent health plans
- Protects health insurance coverage after losing jobs (does not waive pre-existing
conditions); may qualify after COBRA runs out. Limits exclusions for pre-existing
conditions (can't exclude for more than 12 months). Allows enrollment if health
insurance lost, marriage, new dependent, separation, divorce, death.
- Guarantees availability of health insurance coverage for small employers
- preserves states' role in regulating health insurance
- HIPAA National Security Rule sets standards for electronic PHI protection
- HIPAA Breach Notification Rule
Nursing Home Reform Act (passed 1987, enacted 1990) - Answer -- minimum staffing
requirements for long term care facilities
Patient self-determination act (1990) - Answer -Requires giving patients written
summary of healthcare decision-making rights at time of admission and facility policies
on advance directives; ask about and document advance directives; cannot discriminate
Psychiatric claims categories:
peer review - Answer -review by committee of similar practitioners, looks at quality and
utilization criteria
Dictionary of Occupational Titles - Answer -provides standardized occupational
information based on on-site job analyses
Job analysis - Answer -develops work samples that are realistic/responsive to local
employment
Marketing - Answer -process of creating, planning, and executing conception, pricing,
promotion and distribution of ideas, goods, and services
Work hardening - Answer -simulated real work in clinical setting
Residual impairment after MMI reached - Answer -leads to transition from temporary to
permanent disability benefits
Guides to the evaluation of permanent impairment - Answer -Used to provide employer
with degree of impairment that impacts compensation due to a claimant
Work station layout - Answer -should position items to be lifted between hand and
shoulder height (to accommodate differently sized employees)
Apprenticeship - Answer -formal instruction plus on the job training
Cross-functional - Answer -input and output relationships among organization's
departments
productivity - Answer -includes # lost workdays, rates of RTW after injury/illness, rates
of employee turnover, amount of overtime
ADA - Answer -requires reasonable accommodations that do not cause undue hardship
(cost, nature of business)
ADA company size - Answer -15+ employees
ADA cause for denying employment - Answer -very low risk but severe consequences,
or severe risk and minor consequences
, ADA does NOT require - Answer -provide treatment, waive uniform disciplinary
standards, provide stress-free environment, eliminate performance evaluations,
eliminate essential job functions, provide irregular/indefinite leave, reduce performance
standards, create a new position, or arrange a transfer when no positions are available
ADA eligibility - Answer -SUBSTANTIALLY impaired to be eligible for ADA protection.
Includes conditions that cause differential treatment but do not otherwise impact job
(e.g. burn victims).
ADA requires employers to approach employees about accommodation when: -
Answer -knows about disability, knows it is causing problems on the job, and knows that
disability prevents employee from requesting accommodation.
Most common conditions for discrimination complaint: - Answer -1) Orthopedic
problems (16%) 2) Depression 3) Hearing/vision impairments 4) Diabetes 5) Bipolar 6)
Cancer
SSA categories of functioning - Answer -1) ADLs 2) Social Functioning 3)
Concentration, Persistence, Pace 4) Deterioration in work-like settings. *Significant
impairment in any one domain qualifies
SSA Claim Denial Reasons - Answer -Impairment does not prevent individual from
doing past relevant work; impairment does not prevent individual from doing other work;
impairment is not defined as severe by SSA
AMA disability definition - Answer -Disability defined as persisting 12+ months, OR after
treatment has been exhausted (MMI)
HIPAA (Health Insurance Portability and Accountability Act) - Answer -- Created a
program for detecting fraudulent health plans
- Protects health insurance coverage after losing jobs (does not waive pre-existing
conditions); may qualify after COBRA runs out. Limits exclusions for pre-existing
conditions (can't exclude for more than 12 months). Allows enrollment if health
insurance lost, marriage, new dependent, separation, divorce, death.
- Guarantees availability of health insurance coverage for small employers
- preserves states' role in regulating health insurance
- HIPAA National Security Rule sets standards for electronic PHI protection
- HIPAA Breach Notification Rule
Nursing Home Reform Act (passed 1987, enacted 1990) - Answer -- minimum staffing
requirements for long term care facilities
Patient self-determination act (1990) - Answer -Requires giving patients written
summary of healthcare decision-making rights at time of admission and facility policies
on advance directives; ask about and document advance directives; cannot discriminate
