RHIA Quality and Performance Improvement

Which department will most likely be responsible for taking corrective action regarding the following quality indicator? QUALITY INDICATOR:Number of insurance claims requiring resubmission due to errors (not related to coding) will not exceed 3%.

business office In a typical health care facility, the business office would handle any claims rejected for noncoding errors.

A __________________ is used to study variations in performance over time, and its source. scatter diagram run chart Pareto chart control chart

control chart

A plaintiff must establish which burden of proof to recover damages for medical negligence or malpractice? (4)

1. a breach of the duty to care by the defendant 2. damages or injury resulted from the defendant's negligence 3. a duty of care relationship between the defendant and patient 4. causation existed for harm to the plaintiff from the defendant's conduct

The PQRS is a reporting system established by the federal government for physician practices who participate in Medicare for quality measure reporting. Beginning in 2017, this program transitioned into

MIPS

NDC

National Drug Code

A _________________ illustrates those components with the greatest potential for improvement. scatter diagram run chart Pareto chart control chart

Pareto chart

What quality indicator would identify improvement needs in hospital electronic transmission of health care claims and remittances to allow interoperability with ICD-10 codes?

an increase in 5010 rejections Version 5010 is the updated set of HIPAA electronic transaction standards, taking the place of version 4010. These rejections would be for failure to have updated.

What is the best tool for differentiating between common cause variation and special cause variation?

control chart A control chart is used to study variations in performance over time, and its source.

The process of reviewing and validating qualifications, granting professional or medical staff membership, and awarding delineated privileges is called the

credentialing. It is the responsibility to confirm, from appropriate authorities, that the candidate has the proper credentials before granting privileges.

The Six Sigma methodology differs from other quality improvement models by defining improvement opportunities using

critical-to-quality tree. Critical-to-quality (CTQ) trees are used to take apart a broad range of customer requirements into quantifiable elements, often used as a part of Six Sigma methodology for prioritization.

When a decision is made to restrict or deny clinical privileges during the recredentialing or reappointment process to a medical staff member, _______________ must be offered.

due process The candidate must be provided with complete and accurate explanation for the restriction or denial to ensure fairness.

All of these are quality improvement strategies EXCEPT providing patient education computer-based reminder alerts error-based penalties performance-based bonuses

error-based penalties Quality Improvement Strategies use positive reinforcement and support to increase productivity and accuracy.

Integration of decision support systems and best practices in medicine is known as the practice of

evidence-based medicine. Evidence-based medicine is the foundation of clinical decision support systems

When you and your team have identified a problem and must determine the cause or causes of that situation, completing a(n) ________ can help.

fishbone diagram A fishbone diagram is used to determine the cause or causes of a condition or situation.

Which of the following is incorrect about control charts? itemizes all steps within a process for analysis enables the organization of large numbers of ideas and prioritize them identified cause and effect of concerns focuses attention on process variation over a time period

focuses attention on process variation over a time period Control charts are used for the recognition of variations.

Which department will most likely be responsible for taking corrective action regarding the following quality indicator? QUALITY INDICATOR:The number of DRG validation changes made by the QIO will not exceed 2%.

health information HIM professionals are the most knowledgeable of diagnosis-related groups (DRG)

The Joint Commission's emphasis on improving quality of patient care for a participating facility is exemplary through the required self-assessment process tool known as

intracycle monitoring.

Traditional management functions, such as ________, must be applied to performance improvement initiatives

planning Proper planning contributes heavily to productivity and efficiency.

What are the Joint Commission's three initial core measure sets for hospitals?

pneumonia, surgical infection prevention, and acute myocardial infarction.

A ________________________ illustrates the possible relationships between the elements or variables being studied. control chart run chart scatter diagram Pareto chart

scatter diagram

Example: The average percent of patients exceeding acceptable waiting time was 3.7%. The calculated UCL (upper control limit) is 9.4. When you plot the upper and lower limits, what would you suggest as the reason for the June variation? common cause variation unable to determine with the data given special cause variation root cause variation

special cause variation Data points that lie outside the upper or lower control limits may signal special cause variation.