Healthcare Components

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Course
Time
5 hours 25 minutes
Difficulty
Intermediate
CEU/CPE
6
Video Transcription
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>> Welcome to the HCISPP Certification course
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with Cybrary Healthcare Components.
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My name is Celine Hutchinson
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and I'll be your instructor today.
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Today we'll discuss the different components
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of the health care industry.
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Health care today is very specialized with
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highly technical procedures and tools
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to enable diagnosis that is more precise,
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and with treatment that is more
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impersonal and it extends our lifespan.
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Because of this, patient's physical health
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and quality of life have been
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approved such that lifespans have increased to 70,
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80 and even 100 years.
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Healthcare organizations, also called
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health systems it integrated delivery systems,
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arose to meet economic and political pressures.
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Healthcare is very complicated, expensive,
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and rapidly changing as a result of technology,
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demographics, economics, and politics.
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Economic and political forces for change arise from
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the cost of health care and
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the complex methods of financing it.
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For example, the Affordable Care Act,
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ACA, some call it Obamacare,
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was created to provide protections and
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patients rights to make health care coverage
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more fair and easy to understand
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along with providing tax credits
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to make it more affordable.
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Consider the 2020 pandemic conditions,
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many people have lost their jobs
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in their employer sponsored health care.
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Should they require a hospital stay,
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the cost could be so dramatic that
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whatever savings one may have could be wiped out.
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The average cost of a hospital stay is
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3,900 dollars per day,
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with a total stay averaging 15,000 dollars.
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Different sources of care emerged to
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meet the demand for health care.
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They include public clinics,
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nursing homes, pharmacies, specialty hospitals,
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home-care programs, home meal programs,
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hospice, and durable medical equipment suppliers.
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Large general hospitals provide a wide range of
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acute care and other services
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spinning many parts of the continuum of care.
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Hospitals may also be specialized for
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only psychiatric or rehabilitation services.
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A healthcare system is formed when the providers of care,
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services or supplies contract
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with each other to become business associates.
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Government regulation, intermediary contracts,
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and the courts have assigned
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health care organizations responsibility
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for managing and maintaining quality,
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cost, and access to their services.
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Providers, a provider
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has different definitions in health care.
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A classical definition is
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a person who helps in identifying,
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preventing, or treating illness or disability.
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CMS, or the Center for Medicare and Medicaid Services,
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expands the definition of a health care provider as
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an individual or an institution
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that provides health care services.
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HHS, or the Health and Human Services,
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defines health care providers and
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covered health care providers as
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a provider of medical or health services and
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any other person or organization who furnishes
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bills or is paid for
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health care in the normal course of business.
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Organized physician services were
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established to provide comprehensive care as
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an independent organization
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capable of accepting contracts
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for large patient populations
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and managing their health care needs.
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Some of the most common names are
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independent physician associations or IPAs,
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medical foundations, medical service organizations,
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or MSO's, are physicians hospital organizations, PHOs.
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Organizations such as the American Cancer Society
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and American Lung Association,
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affect people's health by funding research,
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developing educational programs,
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and assisting people who need treatment.
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The National Provider Identifier is
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a unique identification number
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for covered health care providers.
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Its purposes is to improve the efficiency and
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effectiveness of
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the electronic transmission of health information.
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All individual HIPAA covered health care providers
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or organizations must obtain an MPI
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for use in all HIPAA standard transactions
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even if a billing agency prepares the transaction.
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Once assigned, a provider's MPI is
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permanent and remains regardless
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of job or location changes.
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MPI is a team position
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intelligence free numeric identifier.
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This means the numbers do not carry
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any other information about the health care providers,
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such as the state in which they
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live or their medical specialty.
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Pharmaceutical organizations.
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The pharmaceutical industry is a branch of
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the chemical industry that manufacturers drugs.
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Pharmaceutical companies are
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research and development organizations with
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unique ethical and regulatory requirements that
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must be met or people can suffer terrible consequences.
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Medical supply firms produce and
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distribute the thousands of supplies,
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drugs, and equipment that
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other health care organizations
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use to provide healthcare.
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Examples of some pharmaceutical companies are Amgen,
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Novartis, Pfizer, GlaxoSmithKline, and AstraZeneca.
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You may have heard of them.
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Pharmaceutical representatives visit and
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attempt to persuade doctors
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to provide and prescribes
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certain companies products more often than others.
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A pharmacy is defined as a store where
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medical drugs are dispensed or compounded and sold,
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like your Walgreens,
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your CVS, you're writing.
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Pharmaceutical products are listed
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in accordance with US FDA,
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Food and Drug Administration's Drug Listing Act.
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Drugs produced are identified and reported using
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a unique three segment number
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called the National Drug Code,
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or the NDC code,
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which is universal product identifier for human drugs.
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Payer organizations.
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A payer in health care generally
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refers to the entities other than
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the patient that finance
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or reimburse the cost of health services.
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A payer can be
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an insurance company authorized
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to provide health insurance,
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a health maintenance organization,
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a legal entity that is
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self-insured and provides benefits
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for health care services
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to its employees or state or
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local government that makes
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payments for health care services.
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In Ohio, there's the Ohio Healthy Start program,
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which is free or low cost for families and children.
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Family must meet the state income guidelines
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to qualify for the benefits.
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Business associates, most healthcare providers and
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health plans do not carry out all of
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their healthcare activities or functions by themselves.
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Instead, they often use
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the services of other people or businesses.
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The HIPAA privacy rule allows covered providers
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and health plans to disclose protected health information
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or PHI to these business associates
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if they can assure that
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the business associate will use the information
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for the only the purposes for which it was engaged,
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safeguard the information from misuse,
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and help the covered entity comply with
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some of the duties under the privacy rule.
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Examples of business associates include,
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health care clearinghouses,
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they translate a claim from
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non-standard format into
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a standard transaction for a payer.
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A consultant could be used to perform
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reviews or any other administrative functions.
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An attorney who's legal services
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involve access to protected health information,
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and a pharmacy who manages
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a health plan for pharmacists network.
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Now let's test your knowledge, true or false.
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An example of a business associate is an accountant.
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[NOISE] That is true.
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True or false, a patient who
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pays his own bill is considered a pair.
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That is also true.
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True or false, a pharmacy
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is a pharmaceutical organization.
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That is true, congratulations.
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In summary, we've covered
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the different components of the healthcare industry.
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These components will be important to
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you as you advance to the next module.
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See you in the next video.
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