List three purposes for performing quality/utilization management.
What will be an ideal response?
Determining whether services and items were responsible and medically necessary and allowed under the carrier's policy provisions or, in the case of Medicare or Medicaid, allowable under the Conditions of Participation contract.
Reviewing the quality of services rendered with regard to acceptable standards of health care.
Determining whether additional inpatient hospital time is necessary to arrange for post-discharge care.
Determining whether level-of-care criteria have been and continue to be met, thus ensuring continued benefit coverage.
Providing preliminary notification to a practitioner or provider when services or items are found to be unacceptable to health care standards.
Providing an avenue of appeal in the form of a reconsideration hearing, with results provided in notification to the involved parties.
Notifying a patient of continued-stay decisions based on medical need and carrier policy.
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Which is the proper technique for preparing an amputated body part for transport?
A. Place it directly on ice and cover with sterile gauze. B. Immerse it in water and submerge the container in ice. C. Wrap it in moistened sterile gauze and place it in a bag and then on ice. D. Place it in water with dry ice, if available; if not, use cold packs.
When communicating as a medical assistant:
A) be professional. B) keep conversation focused and to the point. C) do not use slang. D) all of the above.
Which one of the following is not a benefit to the medical office for performing follow-up phone call reminders?
Less in-office administrative time. The medical assistant can provide the patient with instructions prior to the appointment. Patients are less likely to show for their scheduled appointment. The medical assistant can answer patient questions prior to the appointment.
In response to the Elixir Sulfanilamide tragedy, the FDA ____
A) sought initiation of a criminal proceeding against the head of Massengill B) brought a civil action imposing substantial civil penalties against Massengill C) relied on private whistleblowers to file suit against Massengill D) imposed a fine against Massengill for mislabeling the product as an elixir, as it contained no alcohol