Geeka

A request to the plan to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (medicare) is a/an: - Answer-a.APPEAL A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than __ calendar days from the date of the event or the date the member is made aware of the issue. - Answer-60 An LEP is assessed by CMS when a member goes___days or longer without creditable prescription drug cove...

Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. a.Training Resources b.Commission Resources c.Marketing Resources d.All of these d.All of These Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? a.Ascend b.Telephonic c.Paper d.All of these d.All of These Marketing benefits in a service area where those benefits are not available is prohibited an...

access levels - Answer-in electronic health records software, a software feature that limits access to information based on the type of information each user will need to view or modify acute care - Answer-inpatient treatment for urgent problems administrative safeguards - Answer-policies and procedures designed to protect electronic health information Administrative Simplification - Answer-HIPAA Title II rules on the uniform transfer of electronic health care data and privacy protectio...

Accounts Receivable - Answer-Patient bills for services that have already been provided that legally are due to a facility. Autopsy Rates - Answer-The percent of autopsies performed on patients who die in the hospital; reasons for not performing an autopsy in the hospital may include legal inquiry or family preference. Average Length of Stay (ALOS) - Answer-The total number of patient days in a period divided by the number of patients; for example, the ALOS for cardiology services in Febru...

Electronic Health Record (EHR) - Answer-computerized lifelong record health care record w/ data from all sources technology that intertwines health info from a variety of sources every encounter an ind has w/ the health care system is documented (labs, scripts, ER visits, etc...) New position created by EHR - Answer-*Clinical Analyst *Health Information Technician * Records and info coordinator What setting may a CHERS work? - Answer-* Dr office labs * Ref Labs * Urgent Care Centers * Nu...

Which Of the following is the best method to ensure restoration of EHR documents? a.) Back up all database information b.) Keep a a paper copy of all health information c.) Use two different EHR systems d.) Give the patient a digital copy of medical records - Answer-a.) Back up all database information A facility should back up database information on a routine basis in case of system crashes or losses Which of the following is an example of meaningful use? a.) A registered nurse...

A patient asks an EHR specialist to put PHI on an external storage device to take to another provider. According to HIPAA Security Rule, which of the following actions should the EHR specialist take? A. Ensure the information on the external storage device is protected by encrypting the device. B. Use the patient's external storage device. C. Unencrypt the information on the external storage device before giving it to the patient. D. Tell the patient that the PHI cannot be stored on exte...

A provider participates in the urgent care of another practice's patient at a hospital when the patient's assigned provider is unavailable. The provider writes a progress note and submits a claim from professional services. Which of the following actions should the provider take for correct billing? a. Process the claim without further contact with the patient b. Obtain an assignment of benefits authorization from the patient by email. c. Ask the patient to come to the clinic for follow u...

An EHR specialist should recognize that which of the following is considered an evidence? - Answer-Based source for patient health education Which of the following is an example of a performance improvement measure? - Answer-Reduction to amount of time it takes to bill somebody Which of the following administrative safeguards supports professional standards of care as it pertains to restricting access to patient health records? - Answer-Access control A provider documents a patient's d...

Why have medical practices been slow to adopt cloud storage as a way to store large amounts of data? - Answer-It presents security concerns What is one way to ensure that patients are comfortable in a medical office? - Answer-Clearly explain office policies, and encourage questions. How can EHR systems help increase patient communication and satisfaction? - Answer-patients can access their medical information and get appointment reminders by using the EHR's patient portal What differen...