Comprehensive Guide to Healthcare Concepts and Terminology, Exams of Social Sciences

Download Comprehensive Guide to Healthcare Concepts and Terminology and more Exams Social Sciences in PDF only on Docsity! CCM EXAM QUESTIONS AND ANSWERS Fmla - Answers -Entitles eligible employees to take unpaid, job protected leave for specified medical and family reasons Eligibility for FMLA - Answers -Worked past 12months, worked 1250hrs in those 12 mo, employer of at least 50 employees Stages of cm process - Answers -1.case selection 2.problem is 3.case plan development 4.case plan implementation 5.case plan eval 6.case plan reassessment 7.case closure CPT - Answers -Current procedural terminology DRG - Answers -Diagnosis related groups Cost Benefit Analysis - Answers -Process of evaluating and assessing scenarios to determine relative value of an intervention when measured against predetermined criteria Medigap - Answers -Private insurance to help pay for services Medicare didn't pay for.must be 65/older and enroll within 6mo the from enrolling in part B Medicare select - Answers -Stricter supplement plan to Medicare. Strict with providers and facilities but has more affordable premiums than medigap POS - Answers -Point of service. Combo plan of honk and ppo. Has network of providers and Pcp serves as gatekeeper Self insured - Answers -All or part of coverage risk is assumed by employer with a certain cost limit, if an employee reaches this limit the employers purchases a stop loss plan Stop loss plan - Answers -Purchased by self insured group once their max is reached. This plan will then pay for the remainder of that employees claim Number of weeks allowed for FMLA - Answers -12work weeks in 12 months EEOC - Answers -Governs law interpretation and settled employee employer disputes OSHA - Answers -Governs any employer who operates in a business that affects commerce. Requires safe place to work Quality Indicators - Answers -Specific and measurable guides for eval/monitor aspects of patients care