Care Delivery and Reimbursement
Methods Exam-Graded A
Case Management Process- 9 processes - ANS-Screening
Stratifying Risk
Assessing
Planning
Implementing
Following Up
Transitioning
Communication post-transition
Evaluation
Screening - ANS-Patient information is reviewed to decide the patient's appropriateness
for case management services
Stratifying Risk - ANS-Classifying clients into low, moderate or higher risk categories
Assessing - ANS-A comprehensive, needs-based assessment to identify client's
problems, needs and interests
SMART acronym stands for - ANS-Specific
Measurable
Achievable
Realistic
Timely
What is the acronym SMART used in relation to? - ANS-identify attributes of effective
goals
2 types of negotiation - ANS-Aggressive/hardball
Cooperative
Which type of negotiation is not recommended? - ANS-Aggressive/hardball
What type of negotiation results in a win-win situation? - ANS-Cooperative negotiation
activities of daily living (ADLs) -6 - ANS-Bathing
Dressing
Toileting/continence
Transferring
,Hygiene/grooming
Feeding
DEATH mneumonic - ANS-ADLs:
Dressing/bathing
Eating
Ambulating
Toileting
Hygiene
IADLs - ANS-8 independent living skills more complex than ADLs
Name 4 types of disability - ANS-Workers compensation
Short term disability insurance
Long term disability insurance
Social Security disability insurance
This type of disability only covers work related injuries - ANS-Worker's Compensation
These two types of disability cover loss of work due to illness, injury or accident but if
not work-related - ANS-Short term disability and long-term disability
This type of disability provides replacement of lost wages of the medical benefit for the
work related injury - ANS-Worker's Compensation
Either of these types of disabilities only cover a portion of the wages, typically 50 to
70%, and begin after a waiting period. - ANS-Short term disability and long-term
disability
Who is mandated to pay Worker's Compensation - ANS-The employer
True or false : short term and long term disability offer medical benefit - ANS-False
True or false : there is a waiting period to access Worker's Compensation benefits -
ANS-False
True or false Worker's Compensation offers wage replacement - ANS-True
What is the waiting period for SSDI? - ANS-5 months
SSDI is funded by who? - ANS-Funded by Social Security taxes paid by workers,
employers, and the self-employed
What is the typical waiting period for short term disability? - ANS-7 to 30 days
, How long after a disability occurs does short term disability end? - ANS-90 to 180 days
after date of disability
Workers covered by this benefit cannot sue their employer for work related injuries -
ANS-Worker's Compensation
Who is 100% responsible for paying for Worker's Compensation? - ANS-The employer
Who is responsible for filing the first report of injury with the insurance carrier and the
state workers compensation agency? - ANS-The employer
This benefit provides benefits for dependents of workers killed by work related accidents
or illnesses - ANS-Workers compensation
Federal employment compensation act - ANS-Provides workers compensation for non-
military federal employees
Federal Employment Liability Act (FELA) - ANS-Ensures that railroads engaged in
interstate commerce are liable for injuries to their employees if they have been negligent
Merchant marine act Is also known as what act? - ANS-The Jones act
Merchant marine act - ANS-Provide semen with the same protection from employer
negligence as FELA provides for railroad workers
Longshore and harbor Worker's Compensation act (LHWCA) - ANS-Provides Worker's
Compensation to specified employees of private maritime employers
Black Lung Benefits Act - ANS-Provides compensation for minors suffering from black
lung
Worker's Compensation always pays primary or secondary to short term disability, long-
term disability, and Social Security disability insurance? - ANS-Primary
Temporary total disability (TTD) - ANS-The worker is totally incapacitated for work be on
the date on which the accident occurred but is subsequently able to return to work.
Permanent total disability (PTD) - ANS-The injury permanently and totally incapacitated
the injured worker from caring out gainful employment.
The majority of Worker's Compensation injury's fall under this type of classification
disability - ANS-Temporary total disability
Temporary partial disability (TPD) - ANS-The worker is partially incapacitated for the
length of a disability
Methods Exam-Graded A
Case Management Process- 9 processes - ANS-Screening
Stratifying Risk
Assessing
Planning
Implementing
Following Up
Transitioning
Communication post-transition
Evaluation
Screening - ANS-Patient information is reviewed to decide the patient's appropriateness
for case management services
Stratifying Risk - ANS-Classifying clients into low, moderate or higher risk categories
Assessing - ANS-A comprehensive, needs-based assessment to identify client's
problems, needs and interests
SMART acronym stands for - ANS-Specific
Measurable
Achievable
Realistic
Timely
What is the acronym SMART used in relation to? - ANS-identify attributes of effective
goals
2 types of negotiation - ANS-Aggressive/hardball
Cooperative
Which type of negotiation is not recommended? - ANS-Aggressive/hardball
What type of negotiation results in a win-win situation? - ANS-Cooperative negotiation
activities of daily living (ADLs) -6 - ANS-Bathing
Dressing
Toileting/continence
Transferring
,Hygiene/grooming
Feeding
DEATH mneumonic - ANS-ADLs:
Dressing/bathing
Eating
Ambulating
Toileting
Hygiene
IADLs - ANS-8 independent living skills more complex than ADLs
Name 4 types of disability - ANS-Workers compensation
Short term disability insurance
Long term disability insurance
Social Security disability insurance
This type of disability only covers work related injuries - ANS-Worker's Compensation
These two types of disability cover loss of work due to illness, injury or accident but if
not work-related - ANS-Short term disability and long-term disability
This type of disability provides replacement of lost wages of the medical benefit for the
work related injury - ANS-Worker's Compensation
Either of these types of disabilities only cover a portion of the wages, typically 50 to
70%, and begin after a waiting period. - ANS-Short term disability and long-term
disability
Who is mandated to pay Worker's Compensation - ANS-The employer
True or false : short term and long term disability offer medical benefit - ANS-False
True or false : there is a waiting period to access Worker's Compensation benefits -
ANS-False
True or false Worker's Compensation offers wage replacement - ANS-True
What is the waiting period for SSDI? - ANS-5 months
SSDI is funded by who? - ANS-Funded by Social Security taxes paid by workers,
employers, and the self-employed
What is the typical waiting period for short term disability? - ANS-7 to 30 days
, How long after a disability occurs does short term disability end? - ANS-90 to 180 days
after date of disability
Workers covered by this benefit cannot sue their employer for work related injuries -
ANS-Worker's Compensation
Who is 100% responsible for paying for Worker's Compensation? - ANS-The employer
Who is responsible for filing the first report of injury with the insurance carrier and the
state workers compensation agency? - ANS-The employer
This benefit provides benefits for dependents of workers killed by work related accidents
or illnesses - ANS-Workers compensation
Federal employment compensation act - ANS-Provides workers compensation for non-
military federal employees
Federal Employment Liability Act (FELA) - ANS-Ensures that railroads engaged in
interstate commerce are liable for injuries to their employees if they have been negligent
Merchant marine act Is also known as what act? - ANS-The Jones act
Merchant marine act - ANS-Provide semen with the same protection from employer
negligence as FELA provides for railroad workers
Longshore and harbor Worker's Compensation act (LHWCA) - ANS-Provides Worker's
Compensation to specified employees of private maritime employers
Black Lung Benefits Act - ANS-Provides compensation for minors suffering from black
lung
Worker's Compensation always pays primary or secondary to short term disability, long-
term disability, and Social Security disability insurance? - ANS-Primary
Temporary total disability (TTD) - ANS-The worker is totally incapacitated for work be on
the date on which the accident occurred but is subsequently able to return to work.
Permanent total disability (PTD) - ANS-The injury permanently and totally incapacitated
the injured worker from caring out gainful employment.
The majority of Worker's Compensation injury's fall under this type of classification
disability - ANS-Temporary total disability
Temporary partial disability (TPD) - ANS-The worker is partially incapacitated for the
length of a disability
