Practice Quiz

Managed Care Nursing

Category - Overview

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During a quarterly review of an organization’s managed care chronic illness caseload, you identify the following:

Three hundred (300) medical record numbers appear 50% more often than the average for emergency room visits and hospitalizations. The total number of cases is 1,000.

Select the best description of action steps to reduce the organization’s health care costs.
  1. No action required. This is not abnormal for members with chronic illness.
  2. Run a report specific for the 300 medical records and compare with the next quarters report.
  3. Run a specific report for the 300 medical record numbers. Analyze the data for common factors, variables, variances, and outlier data against the sample average.
  4. Ensure this information is sent to the CFO. This is not relevant data for your role as a CMCN.
Explanation
Answer: C - The best description of actions steps to impact organizations health care costs includes running a specific report for the 300 medical record numbers. Analyze the data for common factors, variances and outlier data against the sample average.

This task is definitely a part of the CMCN role as it relates to health care costs and quality care monitoring.
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