ACMA CASE MANAGEMENT
CERTIFICAN STUDY HELP
When does care coordination begin and end - ANSWER-Prior to admission for elective
procedure - 30-90 days after discharge.
Pay for performance models have a greater emphasis on - ANSWER-Value based
purchasing, readmission, Hospital acquired conditions
What factors effect value based purchasing? - ANSWER-quality of care,, reduce
adverse events/safety, improving patient experience, efficiency/delivering low cost care.
What does the Acronym LACE stand for in the Lace Assesment tool.. - ANSWER-
LENGTH of Stay, ACUITY of Admission, COMORBIDITY, EMERGENCY Deoartment
Visits.
What are the 8 ps in The Society for Hospital Medicines Project Boost Risk Assesment -
Readmission Assement - ANSWER-Problems with Medications, Psychological,
Principal Diagnosis,
Physical Limitations,
Poor Health Literacy,
Patient Support,
Prior Hospitalization,
Palliative Care
Components of RED ( Reengineered discharge) - ANSWER-Asses need for translator,
sched f/u appointments,
f/u on outstanding test results,
coordinate post d/c out-patient services,
obtaining medications
national d/c guidelines,
d/c teaching,
educate on what to do if problems arise,
assess pt understanding,
d/c summary to outside providers, d/c follow up call.
After Hospital Care Plan (AHCP)
In regards to Value Based Pricing/payments, What factors weigh heavily in clinical care
outcomes? - ANSWER-mortality
What is the required assessment for admission to a nursing home for a patient with a
diagnosis of mental retardation or mental illness to assure appropriate placement -
, ANSWER-Federal Pre-Admission Screening and Resident Review. Some states may
require additional screening tools.
What factors effect social determinents of health? - ANSWER-economic stability,
neighborhood and built environment, education, food, community and social context,
health and health care.
Physician certification or recertification for admissions longer than ____ days requires
what documentation? - ANSWER-20 days.
Reason for hoslitalization estimated length of continued stay, post acute plans,
if patient is only waiting on SNF placement must indicate reason for delay.
What is a condition code 44? - ANSWER-For Medicare services, when a UM review
team has determined that an order for inpatient admission is not medically necessary.
Order can be changed to observation. The admission will be billed under part B
Medicare only
What requirements must be met to bill a Condition Code 44? - ANSWER-The change
must be made prior to discharge.
The claim has not been submitted, The MD concurs with the UM decision,
occurrence is documented in the medical record.
What are the key elements of CM planning? - ANSWER-Patient engagement,
dynamic process (ability to change plan as needed),
patient centered,
collaborative (team),
fiscally responsible.
Required assessment for admission to a nursing home for a patient with a diagnosis of
mental retardation - ANSWER-Federal Pre-Admission Screening and Resident Review.
Some states may require additional screen in ng tools.
In regards to Value Based Pricing/payments, what factors are considered in Patient
experience of Care - ANSWER-staff communication,
receiving written d/c information, warning signs,
explanation of medications,
pain management,
overall experience.
In regards to Value Based Pricing/payments, what factors are used to determine payout
based on efficiency. - ANSWER-spending per beneficiary, 3 days prior to admission to
30 days post d/c.
Resource utilization,
length of stay,
post acute services.
CERTIFICAN STUDY HELP
When does care coordination begin and end - ANSWER-Prior to admission for elective
procedure - 30-90 days after discharge.
Pay for performance models have a greater emphasis on - ANSWER-Value based
purchasing, readmission, Hospital acquired conditions
What factors effect value based purchasing? - ANSWER-quality of care,, reduce
adverse events/safety, improving patient experience, efficiency/delivering low cost care.
What does the Acronym LACE stand for in the Lace Assesment tool.. - ANSWER-
LENGTH of Stay, ACUITY of Admission, COMORBIDITY, EMERGENCY Deoartment
Visits.
What are the 8 ps in The Society for Hospital Medicines Project Boost Risk Assesment -
Readmission Assement - ANSWER-Problems with Medications, Psychological,
Principal Diagnosis,
Physical Limitations,
Poor Health Literacy,
Patient Support,
Prior Hospitalization,
Palliative Care
Components of RED ( Reengineered discharge) - ANSWER-Asses need for translator,
sched f/u appointments,
f/u on outstanding test results,
coordinate post d/c out-patient services,
obtaining medications
national d/c guidelines,
d/c teaching,
educate on what to do if problems arise,
assess pt understanding,
d/c summary to outside providers, d/c follow up call.
After Hospital Care Plan (AHCP)
In regards to Value Based Pricing/payments, What factors weigh heavily in clinical care
outcomes? - ANSWER-mortality
What is the required assessment for admission to a nursing home for a patient with a
diagnosis of mental retardation or mental illness to assure appropriate placement -
, ANSWER-Federal Pre-Admission Screening and Resident Review. Some states may
require additional screening tools.
What factors effect social determinents of health? - ANSWER-economic stability,
neighborhood and built environment, education, food, community and social context,
health and health care.
Physician certification or recertification for admissions longer than ____ days requires
what documentation? - ANSWER-20 days.
Reason for hoslitalization estimated length of continued stay, post acute plans,
if patient is only waiting on SNF placement must indicate reason for delay.
What is a condition code 44? - ANSWER-For Medicare services, when a UM review
team has determined that an order for inpatient admission is not medically necessary.
Order can be changed to observation. The admission will be billed under part B
Medicare only
What requirements must be met to bill a Condition Code 44? - ANSWER-The change
must be made prior to discharge.
The claim has not been submitted, The MD concurs with the UM decision,
occurrence is documented in the medical record.
What are the key elements of CM planning? - ANSWER-Patient engagement,
dynamic process (ability to change plan as needed),
patient centered,
collaborative (team),
fiscally responsible.
Required assessment for admission to a nursing home for a patient with a diagnosis of
mental retardation - ANSWER-Federal Pre-Admission Screening and Resident Review.
Some states may require additional screen in ng tools.
In regards to Value Based Pricing/payments, what factors are considered in Patient
experience of Care - ANSWER-staff communication,
receiving written d/c information, warning signs,
explanation of medications,
pain management,
overall experience.
In regards to Value Based Pricing/payments, what factors are used to determine payout
based on efficiency. - ANSWER-spending per beneficiary, 3 days prior to admission to
30 days post d/c.
Resource utilization,
length of stay,
post acute services.
