CSBI HFMA Exam Questions With 100% Verified Answers

CSBI HFMA Exam Questions With 100% Verified Answers Population Characteristics - ANSWER demographics - education level, age; socioeconomics morbidity related to ethnic and gender gaps, social morbidity, social determinants of health Political Climate - ANSWER elected officials, current party dominance, social healthcare policy, interest groups Technology development - ANSWER engineering science, information science, applied mathematics, IoT coverage and access Physical Environment - ANSWER Pollution, sanitation, workplaces, neighborhoods What are the challenging areas of healthcare continuum of care? - ANSWER 1-Lack of Coordination 2-Healthcare Users on their own 3-Service Coordination What are the types of service on health continuum? - ANSWER 1-Well - preventative care, primary care 2-At Risk - acute care 3-At risk mild - specialty care 4-Early Chronic - chronic care 5-Late Chronic - long-term care 6-Terminal - end of life care Supply Sensitive Care - a driver of utilization - ANSWER Care decisions are strongly influenced by capacity, rather than medical evidence or severity of illness. Decisions depend on the number of available hospital beds, clinics, CT scanners, doctors.. Also based on competition, supplier promotional efforts and influences in supply variations impacting cost of care delivered. Preference Sensitive Care - a driver of utilization - ANSWER Care selection and selection frequency driven in large measure by the physician opinion. What are misalignment with healthcare user and hospitals? - ANSWER 1-focus on cost 2-drivers of service utilization 3-financing mechanism What are the Foundational Ideas for Change? - ANSWER 1 - Triple Aim 2 - Transparency in cost - gave way to Meaningful Use and now Promoting Interoperability 3 - Understand Production Cost - gave way to Activity Based Costing (ABC type analysis) 4- Community Based Services Disruptive Innovation - ANSWER disrupts and replaces existing markets with ways of working or products previously not thought of as possible, now are possible due to new technology or other catalysts. Disruptive Innovation - ANSWER Examples are- telehealth, retail health, pharma firms exploring more direct connections with healthcare users, PHI - ANSWER Protected Health Information PHI - ANSWER a subset of patient level data, composed of 18 unique identifiers - any of the 18 identifiers by themselves or in combination must be removed to de-identify the individual/patient. HIPAA - ANSWER Sections include privacy rule and security HIPAA - ANSWER Applies to organizations that are defined as a covered entity and directly to business associates as well HIPAA - ANSWER Signed into law in 1996, and revised by 2013 Omnibus Rule HITECH - ANSWER Allows for sanctions for non-compliance, including fines of up to $1.75 million and 10 years prison HITECH - ANSWER Covers application to both CE and individuals HITECH - ANSWER Covers application of the rule to business associate contractors HIPAA & HITECH - ANSWER Covers how PHI is handed and protected. Top Challenges confronting Hospital - ANSWER 1 - Financial challenges 2- Governmental Mandates & Patient safety and quality 3- Personnel shortage What are the main functions for organization? - ANSWER operations, finance, and marketing Operation - ANSWER function that meets the demand for product or service by the market. In healthcare, this includes all production services Finance - ANSWER Must have this function to ensure monetary resources are available to conduct operation. Accounting is only one component. Marketing - ANSWER function that is focused on understanding what the marketplace seeks, anticipate shifts, and ensure a strong presence. Role of Case/Care Managers - ANSWER These workers in combination with nurse educators will play an important role in ensuring expeditious and efficacious movement of healthcare users in the care system. Will be driven to focus on 30-day readmissions. Role of Case/Care Managers - ANSWER These professionals are at the front lines in providing situational evaluation and action activities related to potential clinical issues and social determinants of health likely to affect readmission. Proactive in healthcare user education and providing guidance on follow-up and continuing care. Role of Nurse - ANSWER Non-physicians performing some management of health conditions a step further. Moving beyond the traditional role of supportive bedside care and following physician orders. Role of Internal Financial Payor Experts - ANSWER Will work closely with external counterparts. Have transparency through the collaborative discovery and sharing of information. These professionals must increase understanding of and capabilities at pricing contract risk. Role of Supply Support Decisions - ANSWER Related to operational management decisions of supply chain. Increased focus on procurement sourcing and management of suppliers and supply lines rather than on inventory and processing orders. Supply acquisition and equipment decisions friction contribute to inefficiency and cost. Role of Quality Performance Improvement Specialists - ANSWER work will be performed in direct collaboration with clinicians, decision support professionals and patient access team members. Role of Providers, Suppliers, and Payers - ANSWER Linked together in service of the healthcare user. Transparency by all parties is vital to provide high value and meet need for related costs.