CAHIMS EXAM 2024.2025 |GUARANTEED PASS |ACCURATE ANSWERS, Exams of Nursing

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CAHIMS EXAM 2024.2025 |

GUARANTEED PASS |ACCURATE

ANSWERS

Primary care - ACCURATE ANSWERS✔✔ majority of patient healthcare needs, often the entry point into healthcare, includes screening, prevention, diagnosis, and treatment for acute and chronic health problems Secondary care - ACCURATE ANSWERS✔✔ generally more specialized care and can include surgery, cardiology, and other care provided by specialists Tertiary care - ACCURATE ANSWERS✔✔ complex, highly specialized healthcare, often university hospitals, requires sophisticated technology, multiple specialists and subspecialists, a diagnostic support group and intensive care facilities. Examples include trauma centers, burn centers, and neonatal care Hospitals - ACCURATE ANSWERS✔✔ physical structures that house patients who are sick or injured. Person may be admitted in one of two ways: emergency room and evaluated by a team of clinicians- if patient is sick enough then admitted, and a patient may also be directly admitted from a physician's office Rehabilitative facilities or acute rehabilitation hospitals - ACCURATE ANSWERS✔✔ provide care for patients needing comprehensive

rehabilitation and medical management often associated with stroke, joint replacement or other serious injury. After surgery or acute illness, a patient may be too frail to return home and may need to spend time in a rehabilitation center for specialized speech, physical, and occupational therapy Skilled nursing facility - ACCURATE ANSWERS✔✔ provide full medical care after a hospitalization. Also provide assistance with activities of daily living, such as meals, personal care, housekeeping, and laundry, while the patient is recovering. Manage transition of acute illness or injury to return home, Avg stay in a SNF is greater than 25 days. Provide long-term care for patients needing residential nursing services for an extended period of time Long-term acute care hospital - ACCURATE ANSWERS✔✔ specialized hospitals designed for patients who need intensive, hospital- level care for weeks or months Adult day care - ACCURATE ANSWERS✔✔ provides meals and activities during the day Independent living - ACCURATE ANSWERS✔✔ typically retirement communities consisting of condominiums or apartments. Residents can usually purchase added services such as meals or housekeeping Assisted living - ACCURATE ANSWERS✔✔ separate apartments or private rooms in a common building where a number of services, such as

Diagnostic services - ACCURATE ANSWERS✔✔ clinical services such as pathology and laboratory medicine, radiology, and nuclear medicine Diagnostic imaging facilities - ACCURATE ANSWERS✔✔ Typically perform tests such as x-rays, CT scans, MRI, mammograms, and position emission tomography scans Medical laboratories - ACCURATE ANSWERS✔✔ primarily evaluate biological specimens including blood. Divisions of a laboratory include chemistry, hematology, microbiology and toxicology Specialized medical laboratories - ACCURATE ANSWERS✔✔ dedicated to a particular type of testing. Include DNA testing, medical pathology, parasitology and mycology, and toxicology. Specialized labs also provide nonradiologic testing services Community health clinics - ACCURATE ANSWERS✔✔ Provide care to underserved populations, are run by nonprofit organizations or state and local governments Home healthcare - ACCURATE ANSWERS✔✔ Provided to patients in their home by a skilled nursing professional. Usually prescribed by PCP for: patients who are disabled or who suffer chronic debilitating illness, seniors who are still able to live at home by require regular health oversight, patients who might otherwise require a stay in a more expensive long-term care hospital or rehabilitation facility, post-

hospitalization recovery fro patients just released from a long-term care hospital or rehabilitation center who require a few weeks of regular health oversight. Combination of professional healthcare services and life assistance services- medical and psychological assessment, nursing care, wound care, medication oversight or teaching, pain management, disease education and management, therapy and rehabilitation, physical, speech, or occupational School-based health centers - ACCURATE ANSWERS✔✔ located in schools and offer a wide range of services depending on state and local policy. Provide screening and preventive care, treat minor illnesses. Offer behavioral and counseling. Linked to local HCOs for referral Employer-based health clinics - ACCURATE ANSWERS✔✔ located in an employment facility or can be mobile clinic. Focus on occupational health and injury prevention but now include preventive care, screening and chronic disease management. Allow employer to have control over healthcare costs by emphasizing wellness care, and employees to receive healthcare without taking off work VHA - ACCURATE ANSWERS✔✔ Veteran's Health Administration, provides healthcare for veterans through a series of outpatient and inpatient facilities run by the U.S. Department of Veteran Affairs. One of the largest healthcare systems in the world and provides training for a majority of America's medical, nursing, and allied health professionals Military Health System (MHS) - ACCURATE ANSWERS✔✔ part of the U.S. Department of Defense, provides healthcare to service

Patient-centered medical home - ACCURATE ANSWERS✔✔ PCMH, characterized by physician-directed medical care, a primary care physician leads a team of individuals who collectively take responsibility for the care of the patient Public health - ACCURATE ANSWERS✔✔ science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations both public and private, communities, and individuals Board of directors - ACCURATE ANSWERS✔✔ authorizes actions and oversees all business affairs of the hospital. Role is to ensure the hospital's mission, vision, and values are carried out. Also establish broad policies and objectives, select CEO, review performance, approve annual budgets, ensure financial resources are sufficient and in order Management Officers - ACCURATE ANSWERS✔✔ CEO, COO, CFO CEO - ACCURATE ANSWERS✔✔ chief executive officer, leads a healthcare organization and may report to a board of directors or trustees COO - ACCURATE ANSWERS✔✔ chief operating officer, reports directly to the CEO and is responsible for the day-to-day operations of the healthcare organization

CFO - ACCURATE ANSWERS✔✔ chief financial officer, manages the fiscal aspects of the organization, including the operating budget, contracts, income, expenditures, billing, and compensation Management for Patient Care and Information - ACCURATE ANSWERS✔✔ CMO, CIO, CMIO, CNO CMO - ACCURATE ANSWERS✔✔ chief medical officer, usually a physician serving as a liaison between upper management and the medical staff at a HCO. Responsible for clinical care, quality improvement, and sometimes graduate medical education CIO - ACCURATE ANSWERS✔✔ chief information officer, leader of health IT department. In charge of planning, choosing, installing, and supporting a healthcare organization's computer and information- processing operation CMIO - ACCURATE ANSWERS✔✔ chief medical information officer, liaison between clinicians and IT services. Reports to CIO, CMO, or CEO CNO - ACCURATE ANSWERS✔✔ chief nursing officer, head of the nursing department of a medical institution and is in charge of developing the programs, processes, and procedures for the other nurses to follow. Directly involved in projects involving nurse use of IT systems

PPO - ACCURATE ANSWERS✔✔ preferred provider organizations, subscribers utilize providers in a contracted network but have the option to pay more if they use doctors, hospitals, and other healthcare providers outside of the plan's network. Negotiates contracts with physicians who form the plan's network and who agree to charge discounted rates POS - ACCURATE ANSWERS✔✔ Point-of-service, plans combine elements of HMO and PPO plans and do offer some out-of-network coverage Cost of health insurance influenced by - ACCURATE ANSWERS✔✔ prescription costs, technology costs, aging population, prevalence of chronic conditions, government subsidies, and health plan administrative costs. Approximately 5% of people enrolled in a health insurance plan consume half of the money pooled- most contribute more than they use Employer self-insure - ACCURATE ANSWERS✔✔ finance and pay for all the healthcare expenditures of their employees Indemnity plan - ACCURATE ANSWERS✔✔ "traditional" plans based on a fee-for-service model, providers are paid according to the services they perform Authorization for service - ACCURATE ANSWERS✔✔ commonly known as preauthorization or precertification, the process of preapproving a patient for coverage of a specific medical procedure, such as surgery of prescription drug

Co-insurance - ACCURATE ANSWERS✔✔ the amount a patient is obliged to pay for covered medical services after satisfying any copayment or deductible required by his/her health insurance plan Copayment - ACCURATE ANSWERS✔✔ co-pay, a specific charge a health insurance plan may require a patient to pay for a specific medical service or supply, ie- co-pay for office visit Deductible - ACCURATE ANSWERS✔✔ a specific dollar amount that a health insurance company may require a patient to pay out-of-pocket each year before making payments for claims Eligibility - ACCURATE ANSWERS✔✔ conditions that must be met for an individual or group to be considered eligible for insurance coverage Out-of-pocket max - ACCURATE ANSWERS✔✔ an annual limitation on all cost sharing that patients are responsible for under a health insurance plan. This does not apply to premiums, balance-billed charges from out-of-network healthcare providers, or services that are not covered by the plan Premium - ACCURATE ANSWERS✔✔ the total amount paid to the insurance company for health insurance coverage, typically a monthly charge

Medicare Part B - ACCURATE ANSWERS✔✔ medical insurance for outpatient service, covers doctor services, laboratory and diagnostic imaging services, home health services, and other ambulatory services. Patients are required to pay a monthly premium and annual deductible Medicare Part C - ACCURATE ANSWERS✔✔ Medicare Advantage Plans- HMO type plans that are offered by private companies that have been approved by Medicare. Plans provide A, B, and sometimes D,a nd may offer extra coverage for vision, hearing, and dental. Enrollees pay a premium to the private companies for their coverage and also pay a deductible Medicare Part D - ACCURATE ANSWERS✔✔ prescription drug coverage, enrollment is voluntary, pay a premium to an insurance company or other private company that is approved by Medicare, and a monthly Medicare premium withheld from SS payment Medical billing cycle - ACCURATE ANSWERS✔✔ Scheduling, registration, delivery of medical services, charge capture, coding, claim processing, explanation of benefits, reimbursement, patient billing and generation of patient statements, final statement Medical code sets - ACCURATE ANSWERS✔✔ ie- ICD-10- set of medical codes for complaints, diseases, injuries, symptoms, and abnormal findings. More precise than ICD-9= more accurate billing process. ICD-10 structure- 1 to 3 are category, 4 to 6 are etiology, anatomical site, severity, or other clinical detail, and 7 are extension. CPT= current procedural terminology used to document medical procedures

Reimbursement - ACCURATE ANSWERS✔✔ healthcare provider received reimbursement for medical services delivered. Types- Fee-for- service, self-pay, managed care reimbursement, capitation, episode-of- care, global payment, prospective payment (DRG, APC) Fee-for-service - ACCURATE ANSWERS✔✔ third-party payers reimburse a provider for each service, according to a fee schedule, which is a list of allowable services and procedures, developed from historical claims data using the average of the usual, customary, and reasonable charges submitted by providers, ie not cosmetic plastic surgery Resource-based relative value scale - ACCURATE ANSWERS✔✔ type of fee-for-service reimbursement, payments are based on the cost of services in terms of effort, overhead, and malpractice insurance Self-pay - ACCURATE ANSWERS✔✔ patients pay directly for the services they receive Managed care reimbursement - ACCURATE ANSWERS✔✔ managed care organizations (MCOs) contract with providers to limit fees. MCO may use fee-for-service methodology following a discounted fee schedule or may use an episode-of-care reimbursement such as prospective or global payment. MCO provide an incentive to patients to use resources effectively by lowering in-network costs or raising costs for out-of-network care

APC - ACCURATE ANSWERS✔✔ ambulatory payment classification, U.S. government's way of paying for facility outpatient services for Medicare. Outpatient prospective payment system applicable to only hospitals, code determines amount paid ERISA - ACCURATE ANSWERS✔✔ Employee Retirement Income Security Act of 1974, sets minimum standards for employer-provided health plans. State laws may not preempt federal regulations that require employers to provide an appeals process and also allow employees to sue for benefits COBRA - ACCURATE ANSWERS✔✔ Consolidated Omnibus Budget Reconciliation Act of 1986, amendment to ERISA that allows employees to continue their healthcare insurance in certain cases, including voluntarily leaving a job, involuntary job loss, the death of a spouse, and divorce. Usually pay some of premium. Companies with fewer than 20 employees are not generally required to offer COBRA benefits HIPAA - ACCURATE ANSWERS✔✔ Health Insurance Portability and Accountability Act of 1996, provides protection for the privacy of an individual's health information- notifies patients of privacy rights, allows patients to see their medical records, implements privacy procedures, provides training for employees, designates someone to oversee privacy procedures, keeps patient records secure WHCRA - ACCURATE ANSWERS✔✔ Women's Health and Cancer Rights Act, provides coverage of certain post-mastectomy benefits for women who undergo mastectomy, including reconstructive surgery and treatment of complications

ACA - ACCURATE ANSWERS✔✔ Patient Protection and Affordable Care Act of 2010, improves access to health insurance for children, young adults, and people who have been denied insurance due to a preexisting condition. Insurance companies are no longer allowed to impose lifetime limits on most benefits ARRA - ACCURATE ANSWERS✔✔ American Recovery and Reinvestment Act of 2009, "stimulus package", funding to states for infrastructure and jobs and increased funding for healthcare research HITECH - ACCURATE ANSWERS✔✔ Health Information Technology for Economic and Clinical Health Act, billions in funding to guide important initiatives to improve healthcare through the use of health IT. Seeks to improve patient care and promote patient-centered healthcare through the use of interoperable EHRs. Information should follow the patient, make the right data available to the right time to the right people. Goals- improve individual and population health outcomes, increase transparency and efficiency, improve ability to study healthcare, and improve care delivery Meaningful use - ACCURATE ANSWERS✔✔ a set of standards being developed by the U.S. Department of Health and Human Services, in collaboration with CMS and ONC, to govern use of EHRs. Compliance with criteria to earn incentive payments paid by CMS. Focus is to promote the application of EHRs in ways to improve the outcomes of care. Stage 2 in 2014 requires providers offer secure electronic messaging to patients, enable patients to securely view online, download, and transmit their health information