Set of processes used to determine the appropriateness of medical services provided during specific episodes of care.

Answers

Answer 1

Utilization Management (UM)

composed of a set of processes used to determine the appropriateness of medical services provided during specific episodes of care. Whether the services are determined to be appropriate is based on the patient's diagnosis, the site of care, the length of stay (LOS), and other clinical factors.

What is Utilization Management (UM) ?

Utilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities

The goal is to ensure the delivery of efficient and effective health care, to reduce the misuse of inpatient services, and to promote high quality and safe patient care during the inpatient component of the care.

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Related Questions

Is lean good (educational purposes only)

Answers

Always, alwayssssssssss

Through the use of dental images, the dental radiographer can detect ________ that cannot be detected clinically.

Answers

Through the use of dental images, the dental radiographer can detect diseases, abscesses or cysts that cannot be detected clinically.

Dental radiographer generates the image of a person's teeth which help them to see the proper condition of the teeth properly.

By the use of dental imaging, people are able to find out about diseases, abscesses or cysts, decay in tooth are hidden. With the help of dental imaging, dental radiographer  can find out about developmental abnormalities also.

It also helps in the detection of bone infections, gum infections and diseases. One can identify those defects that are not visible in a visual dental examination.

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One criterion for the diagnosis of alcoholism is that consumption of alcohol prevents the person from being productive at work. This criterion is based on

Answers

Alcohol use prevents the person from being productive at work, which is one need for the diagnosis of alcoholism. The maladaptive behavior approach forms the basis of this criteria.

Maladaptive habits/behavior are ones that make it difficult for a person to cope with new or difficult circumstances. They could start after a major life change, illness, or terrible event. It can also be a behavior pattern that one can develop early. Maladaptive habits can be recognized, and they can be changed for more beneficial ones. If not, they may result in emotional, social, and health issues. There are remedies if things are getting out of hand. One can learn better ways to respond to life's obstacles with the assistance of a trained therapist. Maladaptive behaviors include withdrawal, passive aggressiveness, and avoidance.

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How can olive oil help in preventing and managing diabetes when included in the daily diet? suppose a mechanism.​

Answers

Answer:

The rise in blood sugar levels was much smaller after the meal with extra virgin olive oil than after the meal with corn oil. The findings were consistent with previous studies, which have linked extra virgin olive oil to higher levels of insulin, making it beneficial to people with type 2 diabetes.

Explanation:

Answer:

reduces glucose levels LDL (low density lipoprotien) and triglycerdes

Medicare Part D covers
A. occupational therapy visits.
B. hospital inpatient stays.
C. physician surgeries.
D. prescription drugs.

Answers

Answer:

D

Explanation:

Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs.

How can health care professionals prepare for working with various age groups?

Answers

Answer:

They can work with kids and adults and teenager's so that they can see how they have to work in each age group. They have to look at the emotions feelings actions and a bunch of different things so that they can see what working with the different age groups do so that you can become closer to what they are looking for and their needs and create a stronger bond with all of them individually.  But they can start of with maybe baby sitting to help with the younger age and or work at a assisted living facilitys so that you can see what working with the elderly agr group is also for like teenagers you could go work as a school nurse to help with the seeing what it is like.

Hope this helps! :)

When health care professionals take care of the kids and elderly, they should take care of these:

Strive to maintain their dignity as best as you can. Be mindful of their physical and mental health. Particularly in regards to mental health, you need to be mindful and observant of the health status of the individuals you are taking care of.

What are age-specific considerations?

The definition of Age-Specific Considerations in Patient Care is to provide healthcare professionals with notification, about other age groups, how to identify needs related to these age groups, and how to vary approaches to patient care with age-specific needs in mind.

Thus, it is important to prepare for work according to various age groups.

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When should the nurse advise a client being prescribed fluoxetine hydrochloride for depression to take the medication

Answers

The nurse should advise the client to take the prescribed fluoxetine hydrochloride for depression at bedtime.

Fluoxetine hydrochloride is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class that is marketed under the brand names Prozac and Sarafem, among others. Bulimia nervosa, panic disorder, major depressive disorder, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder are among the conditions it is used to treat.

fluoxetine hydrochloride is used to treat depression, obsessive-compulsive disorder (OCD), bulimia nervosa, premenstrual dysphoric disorder (PMDD), and panic disorder

Fluoxetine hydrochloride works by increasing the amount of serotonin (a natural substance) in your brain. Serotonin aids in preserving mental stability. Serotonin levels are raised to help with the symptoms of panic attacks, bulimia nervosa, obsessive-compulsive disorder, and sadness.

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Imagine that you are working with a team of bioarchaeologists that has just excavated a medieval cemetery site in Italy. The cemetery has over 200 graves, with all sexes and ages represented in the skeletal sample. You are interested in knowing whether there were gender differences in health among members of the medieval community. How would you answer this question using the skeletal remains

Answers

Answer:

By analyzing the pelvis bone (sex determination) and the length of the diaphyseal bone and nonsynovial joints (age determination of non-adult skeletons and adult skeletons, respectively)

Explanation:

Bioarchaeologists are professionals that study human skeletons from archaeological sites. Bioarchaeologists can estimate the age and sex of human skeletons and thus determine the health and dynamics of past human populations. In regard to sex determination, the pelvis is a bone that can be used to estimate the sex of an individual with an accuracy higher than 95%. In regard to the age, characteristics associated with bone growth such as, for example, the length of the diaphyseal bone, can be good indicators to estimate the age of non-adult skeletons, while nonsynovial joints (i.e. joints without a synovial membrane) which are commonly called synarthroses or solid joints, can be used to estimate the age of adult skeletons.

If 3 grams of a drug are contained in 50 mL of solution, write the ratio.

Answers

Answer:

3:50

Explanation:

there are 3 g of a drug in 50 ml of solution, so it is 3/50. In a ratio it looks like this: 3:50

A pharmacy technician would tell a patient about a contraindication if the patient is taking

nitroglycerin for angina.
warfarin along with aspirin.
a laxative to manage constipation.
an analgesic and anesthetic for acute pain.

Answers

Answer:

pharmacy

analgesic and aneSTHETIC

The tendency of a person to catastrophize the extent of loss lowers his blood pressure.

Answers

Answer: What is the question

Explanation:

in the ear, the basilar membrane and hair cells are found in the?

Answers

Answer:

cochlea

Explanation:

Answer:

Cochlea

Explanation:

Cross-section of the cochlea. The inner hair cells are located at the termination of the "inner hair cell nerves" and the outer hair cells are located at the termination of the "outer hair cell nerve"

In a means-end chain for milk, the calcium content of milk leads to healthier bones, which leads to a display of wisdom and a comfortable life free of osteoporosis. The display of wisdom and a comfortable life component of the means-end chain is the: Group of answer choices

Answers

Answer: Leverage point

Explanation:

The display of wisdom and a comfortable life component of the means-end chain is referred to as the leverage point.

The leverage point simply means a message that is passed by the company to the customers and prospective customers or where the company shows the emotional benefits and the advantages that one gets when the product is bought from them than from other competitors.

A ________ is not typically used in the prehospital setting for oxygen administration.

Answers

A  partial re-breather mask is not typically used int he prehospital setting for oxygen administration. It is initiated for variety of reasons.

Increased metabolic demand , maintenance of oxygenation while proving anesthesia. This the most common method for home use and provide flow rate of 2 to 6 liter per minute. Allowing the delivery of oxygen while maintaining the patient's ability to utilize their mouth to talk, eat, etc.

The main purpose is  treatment for patient with acute respiratory failure and those with chronic lung disease and hypoglycemia. The maintain normal hemoglobin saturation so as facilitate normal oxygen delivery to peripheral tissues.

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The risk of getting lung cancer at some point in time in one's life for men who have never smoked is about 13 in 1000. The risk for men who smoke is just over 13 times the risk for non-smokers. What is the approximate lifetime risk of getting lung cancer for men who smoke

Answers

0.169  is the approximate lifetime risk of getting lung cancer for men who smoke.

In the United States, about 10 to 20% of lung cancer cases, or 20,000 to 40,000 lung cancers each year, occur in people who have never smoked or have smoked fewer than 100 cigarettes in their lifetime.

In this case, if we talk about the risk of smokers in terms of the risk of non-smokers, so the baseline risk is the risk for the non-smokers. So the baseline risk for lung cancer in men over an entire lifetime is the risk of lung cancer for men who have never smoked, over their lifetime, which is =0.013

The approximate lifetime risk of getting ling cancer, for male smokers, can be calculated as being 13 times the base risk= 0.169

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HCPCS level II codes are: a. sometimes replaced by HCPCS level III temporary codes. b. intended for use by all private and public health insurers. c. maintained by the AMA's Editorial Board, which makes decisions about additions, revisions, and deletions. d. updated by CMS when necessary, without participation by the HCPCS National Panel.

Answers

Answer:

HCPCS Level II codes are alphanumeric medical procedure codes, primarily for non-physician services such as ambulance services and prosthetic devices,. They represent items, supplies and non-physician services not covered by CPT-4 codes (Level I).

Explanation:

which of the following is an anesthetic that would be commonly stockpiled and used during a disaster

Answers

Explanation:

A cellular phone network uses towers to

transmit calls. If the equation of the circular area

transmits by the tower is represented by (x-5)2 +

ly-1)2 = 22. Can you identify if you are inside or

outside of the circular area, if your coordinate

location is (6,0)? How about if your location is

(8,2)?

Private health insurance is also called
A. individual insurance or non-group insurance.
B. VA Administration Insurance.
C. Schip Third-Party Payor Insurance.
D. Medicode insurance.

Answers

Answer:

Private health insurance is, instead, offered by a private entity instead (most often a for-profit company). You may also hear private health insurance plans called “off-exchange” plans–this means it's a major medical plan

Alopecia areata has a genetic and
basis.

Answers

Answer:

Sorry you got the wrong question

Answer:

autoimmune

Explanation:

took assignment on edge

you admitted a patient with hypotensive crisis with the following data and doctors
patient juan dela cruz 45 years old NGT for gavage feeding every 4 hours
With indwelling foley catheter for urine output monitoring
6:30 a.m. clients vs bp =70/40 rr = 15 pr = 59 o2sat = 98%
doctor's order fluid regimen
R hand start ivf off d5lrs 1 liter to run 48 hours using macro set with slide drift of levophed to ampules + 96 cc of pnss x 15 ugtts per minute
second line le start ivf pnss 1 l x 10 gttsper minute start blood transfusion of two unit prbc once available properly type and crossmatch
you receive the patient at exactly 7:00 a.m. and started the fluid regimen
8:00 a.m. started gavage feeding of 1 glass osterized feeding with 1/2 glass of plain water to dilute the feeding
8:00 a.m. urine output
8:30 a.m. pack rbc for blood transfusion available
9:00 a.m. started blood transfusion with 250 ml of 1 unit prbc to run for 4 hours no reactions noted
12:00 noon next feeding do but the patient was restless was not available to give the full feeding remaining half glass was discarded
1:00 p.m. urine collected is 200ml
1:30 p.m. finish one prbc, hooked 2nd prbc with same rate
3:00 p.m. no urine output recorded
End of Shift
instruction complete the intake and output form every two hours ​

Answers

Answer:

8

Explanation:

instruction the intake and output

Which best describes how lenalidomine and thalidomide function in the body?

Both drugs treat multiple myeloma by inhibiting inflammation, inhibiting formation of red blood cells, and modulating the immune system to kill cancer cells.
Both drugs treat leukemia by depriving the cancer cells of asparagine and preventing protein formation resulting in cellular death.
Both drugs treat breast cancer by blocking the aromatase enzyme necessary for estradiol production.
Both drugs treat lymphoma by aiding the immune system in identifying and binding to antigen proteins on the surface of cancer cells and triggering the cell to die.

Answers

Answer:

Multiple myeloma is a B-cell malignancy characterized by an excess of monotypic plasma cells in the bone marrow. The molecular mechanisms that are involved in disease progression depend on the interaction between the multiple myeloma cells and the bone microenvironment. Because these mechanisms have been well characterized, it is possible to develop regimens that are more specific to pathways involved in the pathogenesis of multiple myeloma than is typical for conventional chemotherapy in disease management. Thalidomide and immunomodulatory drugs (IMiDs) have now been shown to block several pathways important for disease progression in multiple myeloma. First established as agents with antiangiogenic properties, thalidomide and IMiDs inhibit the production of interleukin (IL)-6, which is a growth factor for the proliferation of myeloma cells. In addition, they activate apoptotic pathways through caspase 8-mediated cell death. At the mitochondrial level, they are responsible for c-jun terminal kinase (JNK)-dependent release of cytochrome-c and Smac into the cytosol of cells, where they regulate the activity of molecules that affect apoptosis. By activating T cells to produce IL-2, thalidomide and IMiDs alter natural killer (NK) cell numbers and function, thus augmenting the activity of NK-dependent cytotoxicity. Data delineating these events have been derived from experiments done in resistant and sensitive multiple myeloma cell lines. Although thalidomide and IMiDs demonstrate similar biologic activities, IMiDs are more potent than thalidomide and achieve responses at lower doses. Lenalidomide, a thalidomide derivative, has also been shown to have a different toxicity profile. Our understanding of the mechanism of action of these agents has provided a platform for exciting clinical trials evaluating combinations of thalidomide and lenalidomide with both conventional chemotherapy and newer targeted agents.

Explanation:

what are tubes that carry blood back to the heart ?
a. arteries
b.veins
c.pipes
d.tubes​

Answers

Answer:

arteries and veins

Explanation:

those two are the answers

Answer:

I think it's veins.

Explanation:

Arteries carry the blood away from the heart and the veins carry the blood back to the heart.

1-Which of the following is a feature of Irreversible Cell Injury:
a) Glycogen stores are depleted
b) Cytoplasmic sodium increases
c) Nuclei undergo karyorrhexis
d) Intracellular pH diminishes
e) Blebs form on cell membranes

Answers

Answer:

Cytoplasmic sodium increase.

Explanation:

Pls mark as brainliest

Answer:

cevap bursa cytoplasmic sodium increases

Order: Pfizerpen (penicillin potassium) 200,000 units IM q6h

a) Which concentration is best to administer the dose?

Answers

Answer:

Explanation:

I'm only like 60% sure so you might want to double check this.

Think:

Need 400 mg

Have 100 mg per mL ( Need four times that amount )

Calculate:

Dosage on hand       Dosage desired

                             =

Amount on hand      X Amount desired

Cross multiply  100 mg  400 mg

                          1 mL X  =mL

                          100 X = 400

                          100 X  = 400

Simplify             ----------------------

                          100         100

                          X 4 mL

Withdraw 4 mL of reconstituted Zithromax using 5 mL syringe

Further dilute and give IV

Since single-dose vial, discard any remaining drug

Hopefully this helps!

what is the WHO formula for ORT​

Answers

Answer:

ORS consists of 4 constituents: 1. sodium chloride, 3.5 grams; 2. trisodium citrate, dihydrate, 2.9 grams; 3. potassium chloride, 1.5 grams; 4.

Explanation:

I think .... im not sure though

why do
do halo-halo stores sprout during summer​

Answers

That is the time and season they sprout
Because of the time and the season

“Diseases of the present age are very different from diseases of the past.

Answers

Answer:

Yes, the diseases of present age are different from those of past. In past, diseases that spread by poor sanitati.

Explanation:

Side effects associated with keratolytics include _______

Answers

Answer:

Explanation:

I think so it might be I think so it might be

What is one way nursing assistants can assist residents with normal changes of aging related to the urinary system

Answers

Nursing assistants can assist residents with normal changes of aging related to the urinary system by helping the residents go to the bathroom frequently.

Nursing assistants complete an education program that is state approved and need to pass their state's competency exam to become licensed.

Hospitals and residential care are the workplaces for nursing assistants. they work in nursing at these places. They are a part of a big care team.

Nursing assistants, help patients in their daily activities like eating, bathing, dressing, etc. They attend to the needs of patients and help them. They also observe and record the conditions of patients.

During aging, there are changes related to the urinary system. People face bladder control issues and cannot hold urine for a much longer time, so nursing assistants can assist residents who face such issues by helping them go to the bathroom frequently.

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Shirya is at the dentist getting a cavity filled. The doctor injects her with a local anesthetic. Which drug did Shirya most likely receive?

lidocaine or procaine
methohexital or lorazepam
lorazepam or procaine
fentanyl or methohexital

Answers

Answer:
Lidocaine
Hope this helps u
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use standard reduction potentials to calculate the standard free energy change in kj for the reaction: 2cu2 (aq) co(s)2cu (aq) co2 (aq) answer: kj k for this reaction would be than one. true or false? children without insurance are more likely to have developmental delays that often contribute to difficulties in education and gaining employment. An ERISA employee benefit plan, the United Mind Workers of Vermont (UMW) plan, fired its auditor and hired the Locan Firm as a replacement. Locan has only one office, which is located in Burlington, VT. Locan wants to do things right and not violate any independence rules.Answer the following questions "yes" or "no."Should Locan first consider Department of Labor (DOL) independence regulations? if we fail to reject the null hypothesis that the coefficient k = 0 then we conclude candy company is considering purchasing a second chocolate dipping machine in order to expand its business. the information has accumulated regarding the new machine is: The width and length of Mayce's backyard and Gavin's backyard areshown below.Mayce's Backyard5.8 yd4.5 yd8.7 ydGavin's Backyard12 ydHow many times larger is the area of Gavin's backyard than the areaof Mayce's backyard? find the probability that a normal variable takes on values more than 3 5 standard deviations away from its mean. (round your answer to four decimal places.) What can you weave into your game in order to make it easier to pinpoint a particular audience?a specific narrativea secret cheata hidden treasurea helpful wizard preregistration occurs at which point in the scientific process? according to research by pronin and colleagues (2006), imagining an event before it occurs can lead people to how does the total enzyme concentration affect kcat (turnover number) and vmax? FILL IN THE BLANK A _______ test seeks to discover whether a message is communicating something close to what the advertiser desired while a ______test evaluates if an ad is remembered. 1) Why is it so important for managers to understand how the foreign exchange market works? What is the role of the U. S. Dollar in the relationship between the yen and the peso?2) Following the election of Donald Trump, the value of the Mexican peso has fallen relative to the U. S. Dollar. Why do you think this happened? What do you expect will happen to the dollar/peso relationship going forward?3) What should Nintendo do now? How should the company react to the continued pressure on the peso? pretrial publicity reflects a clash between the _______________________ amendments. The average daily volume of urine produced by a normal adult is approximately: A. 200 mL. B. 500 mL. C. 1200 mL. D. 2500 mL When applying sterile drapes to create the sterile field on the patient,which of the following principles is most important?A) The circulating nurse should monitor the scrub person's gowned arms when reaching over the unsterile parts of the patient.B) Gently shake and fan out the drapes to open up the folds before approaching the patient.C) Drape the patient starting with the incision area and proceeding to the periphery.D) All of the options reflect violations of sterile technique. Many statistical packages have three types of equation-building procedures. They are: a forward, linear, and non-linear b simple, complex, and stepwisec inclusion, exclusion, and lineard forward, backward, and stepwise find the numerical value of the log expression how did the aca deal with the paradox of choice and the decision fatigue Find the gradient vector field of f.\(f(x,y,z) = 3\sqrt{x^{2}+y^{2}+z^{2}}\)