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Cards In This Set
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3.1 One of the first key issues to determine when evaluating a current QM Program is...
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3.1 The extent of leadership knowledge of and involvement in quality activities.
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3.2 The term "corporate compliance plan' refers to the healthcare organization's program to prevent...
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3.2 FRAUD and ABUSE
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3.3 A Hopsital Utilization Management Plan generally includes provision for _________.
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3.3 Transition Planning
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3.4 MCO's use of 24-hour nurse-staffed telephone hotline for care options and self management education is a type of________.
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3.4 Demand Management
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3.5 The practical Motivation for American Healthplan HMO is to develop a disease management system based on practice guidelines and clinical path is __________.
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3.5 CAPITATION
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3.6 Negligence means lack of proper care. In medical malpractice, "proper care" is determined by________.
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3.6 Medical Peers
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3.7 The written scope of care and service of a healthcare organization is best described as...
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3.7 the delineated activities performed by governance, management, clinical, and support personnel.
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3.8 The key issue in integrating the functions of utilization management, quality managment, and clinical risk management revolves around_____
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3.8 Information Management
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3.9 Inappropriateacute admission, level of care, excessive resource use are examples of...
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3.9 OVERUTILIZATION
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3.10 Utilization of resources without evidence of medical necessity.
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3.10 UNDERUTILIZATION
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3.11 Inefficiencies e.g. in scheduling of tests or treatments with added patient risk and cost.
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3.11 MISUTILIZATION
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3.12 ____refers to formal dispute resolution process conducted by an independent review organization (IRO) or individuals having no financial or professional affiliation an no stake with the outcome.
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3.12 EXTERNAL REVIEW
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3.13 _____is a function that helps ensure that the patient's needs and preferences for health services and information sharing across people, functions, and sites are met over time.
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3.13 CARE COORDINATION.
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3.14 ______ refers to management of populations patients with high risk, high cost, high maintenance chronic disorders across the continuum of care.
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3.14 DISEASE MANAGEMENT
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3.15 According to TQM Principles, managers should....
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3.15... lead with participative decision making.
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