RHIT Practice Exam: Chapter 5: Quality Management and Performance Improvement

C: Preadmission

Dr. Jefferson contacted another healthcare organization to schedule an episode of care service for her patient, Francis. The healthcare case manager reviewed Francis's projected needs with Dr. Jefferson, and admission criteria were established on the basis of a suggested diagnosis. The case manager then contacted the patient directly to obtain more information. The case manager also contacted a third party payer to confirm they would pay for Francis's service. What function is the case manager performing? A: Post-discharge B: Preauthorization C: Preadmission D: Pre-discharge

C: social services

During a quality improvement audit, it was noted that a medical record coder was consistently up-coding certain diagnoses. The facility is conducting investigations to determine how much money to reimburse its third-party payers for overpayment. All of the following departments would receive data about the investigation except the _______________ department. A: health information management B: compliance C: social services D: billing

C: 2 years or fewer

During the credentialing process, the applicant was granted active membership. The applicant can utilize the clinical privilege for a maximum period of how long? A: More than 10 years B: More than 3 years C: 2 years or fewer D: Fewer than 5 years

B: Darling vs. Charleston Community Memorial Hospital

In 1965, which of the following established legal liability for hospitals? A: CMS B: Darling vs. Charleston Community Memorial Hospital C: P.L. 92-603 D: JCAHO

C: Governing board

In a health care facility, who is responsible for the appropriateness and assurance of quality care? A: Hospital attorney B: Chief executive officer C: Governing board D: Medical staff

D: Concurrent

In order to assure that patient care problems can be remedied immediately, Nurse Bob should perform which type of quality data collection? A: Retrospective B: Preadmission screening C: Prospective D: Concurrent

C: meet the federal conditions of participation.

In order to receive reimbursement for treating Medicare and Medicaid patients, health care organizations must: A: be contracted with PPS reimbursement. B: accept major credit cards. C: meet the federal conditions of participation. D: be contracted to HMO.

C: Medication reconciliation

Jackie is a patient of Dr. Tracy at Jefferson Hospital. Nurse Sue reviewed with Jackie the most accurate list of all medications she currently taking (including prescribed and non-prescribed drugs, vitamins, herbs, and nutritional supplements). She then compares the list against Dr. Tracy's admission, transfer, and discharge orders. Which of the following functions was Nurse Sue performing? A: Clinical Nurse order entry B: No options are correct C: Medication reconciliation D: Building safe and effective medication plans

B: All of the above

Jola is a 13-year-old patient of Dr. Welch at Houston Hospital. Houston Hospital has implemented electronic health records. At Jola's discharge, due to downtime, a manual medication script was generated and filled at the hospital, along with a discharge summary and patient instructions that were given to the patient's family member by the discharging nurse. The patient's condition got worse and she returned to the hospital within 48 hours of discharge. Investigation revealed that the patient was discharged home with the wrong medication. Which of the following might potentially be responsible? A: Physician B: All of the above C: Pharmacist D: Hospital

A: Critical pathways

Nurse Bob wants to display goals for patients and provide the corresponding ideal sequence and timing of staff actions to achieve those goals with optimal efficiency. Which should he use? A: Critical pathways B: Critical guidelines C: Clinical pathways D: Clinical protocols

B: Severity of illness

Nurse Bob wants to use the screening criteria for utilization review that most health care facilities utilize to determine the need for inpatient services and justification for continued stay. Which of the following should he use? A: Tracer methodology B: Severity of illness C: Critical pathways D: Clinical protocols

B: was developed to publicly report valid information about the quality of care delivered in the nation's hospitals.

Public disclosure: A: established retrospective utilization management guidelines. B: was developed to publicly report valid information about the quality of care delivered in the nation's hospitals. C: grants accreditation to charitable healthcare organizations. D: provides statistical analysis of hospital quality indicators.

A: process of overseeing the medical, legal, and administrative aspects of health care management.

Risk management is the: A: process of overseeing the medical, legal, and administrative aspects of health care management. B: mechanism to monitor and ensure customer satisfaction. C: group of processes used to measure how efficiently health care is managed. D: process of determining whether health care services meet predetermined criteria.

D: Plan for improvement, do the improvement, check the results of action, and act on the evidence

Staff members are frustrated with the way phone messages are handled in your clinic. All incoming calls go to a designated staff person on the unit, who then places a handwritten note in the provider's mailbox. These notes are not always legible, and staff members are too busy to check their mailboxes more than once a day. These issues result in delayed responses to urgent messages, low patient satisfaction, and missed deadlines. From the options provided, determine which quality improvement model you should use to improve this situation. A: Analyze data, plan for improvement, control the improvement, sustain the improvement B: Define the problem, measure the problem, analyze the data, communicate C: Define the problem, reinforce the problem, communicate action, evaluate outcomes D: Plan for improvement, do the improvement, check the results of action, and act on the evidence

D: retrospective to a prospective payment system.

TEFRA caused the reimbursement structure to change from a: A: retrospective to a concurrent utilization review system. B: manual to an electronic billing system. C: cost-based program to a retrospective payment. D: retrospective to a prospective payment system.

A: Quality Improvement Organizations

The CMS also contracts with non-governmental agencies across the country to monitor the care provided by independent healthcare practitioners. What are these agencies called? A: Quality Improvement Organizations B: National Committee for Quality Assurance C: Accreditation Associations D: Joint Commissions

D: clinical guidelines that are mandated by the federal government.

The National Guideline Clearinghouse (NGC) provides: A: a mechanism to monitor and ensure customer satisfaction. B: data concerning the competence of health care providers. C: clinical guidelines that may be used voluntarily. D: clinical guidelines that are mandated by the federal government.

A: assault and battery.

The clinician failed to obtain a signed consent form from Bob prior to surgery. His attorney may argue that Bob is a victim of: A: assault and battery. B: failed consent. C: improper consent. D: improper consent.

D: standardize clinical decision making.

The goal of clinical practice guidelines is to: A: regulate accreditation standards. B: describe the outcomes of health care-related services. C: standardize the content of clinical pathways. D: standardize clinical decision making.

B: Prospectively

The manager of the utilization review department wants to identify patients who are not suitable for inpatient admission and then redirect them to an appropriate health care setting to obtain health care services. When would the manager need to collect data? A: Retrospectively B: Prospectively C: During long-term care review D: Concurrently

B: Executive committee

The members of which group are responsible for recommending clinical privileges to the governing body? A: Credentialing staff B: Executive committee C: Medical staff D: Credentialing coordinator

D: To reduce errors in health care

The national safety goal was established A: To identify objectives for disease prevention B: To electronically report incidents C: To provide legal immunity in healthcare settings D: To reduce errors in health care

B: ORYX initiative

The purpose of _________________ was to establish a continuous, datadriven accreditation process that uses performance measures and data focused on core measures. A: Data aggregation B: ORYX initiative C: Agenda for change D: ORION project

A: the health care facility had met accreditation and licensing standards.

The purposes of PROs include determining all of the following except whether: A: the health care facility had met accreditation and licensing standards. B: the care was provided in the most economical setting consistent with the patient's health care needs. C: services provided were medically necessary. D: the quality of services provided met professionally recognized standards of health care.

C: discharge review.

The utilization review coordinator reviews inpatient records at regular intervals to justify necessity and appropriateness of care to warrant further hospitalization. The utilization review activities being performed constitute a: A: continued stay review. B: preadmission review. C: discharge review. D: retrospective review.

B: Occurrence report

To decrease risk exposures in a health care facility, which of the following can be used to track and document incidents? A: Root-cause analysis B: Occurrence report C: Reporting sentinel events D: All options are correct

B: The number of competitors within their geographic area

To monitor and improve customer satisfaction, an organization must know all of the following EXCEPT A: What its customers want and value B: The number of competitors within their geographic area C: Exactly who its customers are D: What improvements could be made in order to better meet customer's needs

B: State and federal statutes

Under which of the following statutes must a health care facility report certain diseases and medical events such as suspected child abuse to various data banks? A: EMTALA B: State and federal statutes C: Statute of limitations D: Patient safety statute

D: group of processes used to measure how efficiently health care is managed.

Utilization management is the: A: process of overseeing the medical, legal, and administrative aspects of health care management. B: mechanism to monitor and ensure customer satisfaction. C: process of determining whether health care services meet predetermined criteria. D: group of processes used to measure how efficiently health care is managed.

B: Identify the specific customer needs in order to improve customer satisfaction with services

What action(s) would assist the manager of the health information management department in improving customer perception of the quality of services provided by the department? A: Establish a weekly turn-around time for all dictated reports B: Identify the specific customer needs in order to improve customer satisfaction with services C: Refuse to fax patient information to protect patient confidentiality D: Refuse to let other departments into medical records department

B: Organizes similar ideas into logical groupings

What does affinity grouping do? A: Displays frequencies of responses B: Organizes similar ideas into logical groupings C: Plots the points for two variables to determine whether they are related to each other D: Generates a large number of creative ideas from a group

D: Generates a large number of creative ideas from a group

What does brainstorming do? A: Plots the points for two variables to determine whether they are related to each other B: Displays frequencies of responses C: Organizes similar ideas into logical groupings D: Generates a large number of creative ideas from a group

D: Check sheet

What type of data collection tool will be useful in collecting the number of charts reviewed for coding accuracy, the type of errors, and the number of errors made by each coder? A: Tally sheet B: Histogram C: Interview D: Check sheet

C: Bar chart

What will be the most effective data presentation tool to use in comparing staff productivity? A: Run chart B: Cause and effect C: Bar chart D: Pareto chart

A: Conditions of Participation

Which agency requires that providers and organizations develop, implement, and maintain an effective organization-wide, data-driven quality assessment and performance improvement program? A: Conditions of Participation B: The Joint Commission C: AMA D: HIPAA

A: Credentialing

Which department will most likely be responsible for taking corrective action regarding the following quality indicator? "Ninety-five percent (95%) of physician appointments/reappointments will be completed within 90 days of receipt of all required application materials." A: Credentialing B: Risk management C: Utilization management D: Quality improvement

A: Nominal group technique

Which of the following data organization methods is a tool that can be used to organize, categorize, and reduce information to a more usable form? A: Nominal group technique B: Bar graph C: Control chart D: Matrix

D: Initiation, Planning, Execution, and Closure

Which of the following describes project life cycles for managing performance improvement? A: Identify, Organize, Process, and Implement B: Design, Analyze, Compare, and Communicate C: Research, Measure, Outcome and Communicate D: Initiation, Planning, Execution, and Closure

A: Utilization review

Which of the following functions became mandatory under Title XVIII of the Social Security Act? A: Utilization review B: Quality assessment C: Risk management D: Quality improvement

C: IRB approval is required

Which of the following is NOT a quality improvement component? A: Action is within the existing standards of care B: Data is confidential C: IRB approval is required D: Current practice is intended to improve

B: Decision matrix

Which of the following is a multidimensional evaluation tool that can be used to organize and categorize information into a more usable form for selecting the best possible improvement to the existing process? A: Cause and effect diagrams B: Decision matrix C: Flow chart

B: Flow chart

Which of the following is a sequential representation of steps in a decisionmaking process? A: Bar graph B: Flow chart C: Line graph D: Run chart

B: Validate clinical data

Which of the following is not the role of a HIM professional in a quality improvement process? A: Trend data B: Validate clinical data C: Collect data D: Organize data

B: Tracer

Which of the following methodologies does the Joint Commission typically use during an on-site survey as they follow selected patients through the continuum of care in order to analyze organizational efficiency? A: Standards of care B: Tracer C: Standard deviation D: SWOT

B: The Joint Commission (TJC, formerly JCAHO)

Which of the following organizations was a forerunner for the evaluation of quality medical care in health care organizations? A: Professional Standard Review Organization (PSRO) B: The Joint Commission (TJC, formerly JCAHO) C: Centers for Medicare and Medicaid (CMS) D: Quality Improvement Organization (QIO, formerly PRO)

D: Accreditation

Which of the following processes is not mandatory for health care facilities? A: Certification B: AHA registration C: Licensure D: Accreditation

B: Which staff member failed to track the chart to the correct station?

Which of the following questions is most focused on quality assurance? A: How do you reduce health information disclosure errors in your organization? B: Which staff member failed to track the chart to the correct station? C: How can we create environment that allows staff to report error? D: What can we do to increase ROI fee collection?

B: National Practitioner Data Bank

Which of the following systems can the hospital query to identify quality of care of a prospective applicant? A: Fraud and Abuse Data Bank B: National Practitioner Data Bank C: Privacy Integrity Information Breach Data Bank D: Healthcare Integrity and Protection Data Bank

A: Change management

Which of the following terms refers to the process of planning for change? A: Change management B: Change agent C: Benchmarking D: TQM

A: Benchmark

Which of the following tools can best be used to compare one's performance to high quality performers? A: Benchmark B: Brainstorm C: Flowchart D: Affinity diagram

B: Continued stay

Which of the following utilization review activities is being performed when a patient's record is reviewed at regular intervals to determine the appropriateness of care rendered and bed utilization? A: Retrospective B: Continued stay C: Preadmission D: Admission

D: Bar graph

Which of the ollowing can be used to show the frequency for each interval or category of nominal, ordinal, and discrete date? A: Pareto diagram B: Frequency polygon C: Scatter diagram D: Bar graph

B: ODPHP within DHHS

Who is responsible for Healthy People 2020? A: Office of the Inspector General B: ODPHP within DHHS C: The Joint Commission D: National Committee for Quality Assurance

A: Retrospectively

You are assisting the nursing department in writing indicators to determine appropriate ratios and formulas and to determine data collection time frames. One important aspect of care is the documentation of patients' education. More specifically, the nursing department would like to assess its documentation of education on colostomy care for patients with new colostomies. Concerning the preceding scenario, what would be the most effective time frame for collecting the requested data? A: Retrospectively B: Ongoing C: Concurrently D: Prospectively

C: Pert chart

________ is an effective tool that can be used if a more quantitative approach is required during a project planning, because it can identify those activities that must be completed on time in order for the entire project to meet its final deadline. A: Cause and effect analysis B: Bar graph C: Pert chart D: Flowchart

D: Critical path method

A pert chart is also known as A: Intensity of service B: Affinity diagram C: Severity of illness D: Critical path method

D: Framework

Health care performance improvement philosophies most often focus on all the following performance measurements EXCEPT A: Process B: Outcome C: Structure D: Framework

B: form usage.

The Joint Commission specifies that all of the following aspects of performance standard must be routinely evaluated, except: A: drug usage. B: form usage. C: medical record. D: blood usage.

C: Preadmission

The utilization manager reviews the record to determine which health care setting will be appropriate for the identified procedure. Which of the following functions is the manager performing? A: Focused B: Continued stay C: Preadmission D: Retrospective

C: Admission

To ensure the patient will leave the hospital as scheduled, effective discharge planning begins at which of the following? A: Discharge B: Preadmission C: Admission D: Preauthorization

B: Does not require subject's consent

Which of the following is not a research related framework? A: Desire to be published or presented B: Does not require subject's consent C: Intended to create generalized knowledge D: Designed to test new methods

A: Negligence and malpractice

A physician accidentally prescribed the wrong medication to a patient, which caused the patient to be in a coma for 3 days. Which of the following court actions can the patient seek? A: Negligence and malpractice B: Jail sentence C: Criminal action D: License revocation

D: Volunteer

A review process conducted at the request of a healthcare facility seeking accreditation or certification is an example of which of the following review types? A: Compulsory B: Required C: Mandatory D: Volunteer

C: Prospective analysis

All of the following are methods that can be used in monitoring data quality EXCEPT A: Quantitative analysis B: Qualitative analysis C: Prospective analysis D: Legal analysis

B: No, because quality improvement committee meeting minutes are protected from subpoenas

An attorney subpoenas the quality improvement committee meeting minutes of Houston Community Hospital. Should the minutes be released? A: Yes, or the hospital will risk being in contempt of court B: No, because quality improvement committee meeting minutes are protected from subpoenas C: Yes, because all subpoenas must be honored D: No, the attorney needs a court order because a subpoena is not adequate

A: Peer review

As related to quality patient care, physicians who are members of the ambulatory care clinics meet monthly to review documentation of treatment plan and patient outcomes. This type of review, in which a physician's health care documentation is reviewed by his/her professional colleagues, is known as what? A: Peer review B: Concurrent review C: Retrospective review D: Focused audit review

D: 36

At most, TJC accreditation is granted for ___ months. A: 18 B: 48 C: 12 D: 36

B: Prospectively

Bob, who is the manager of the utilization review department, wants to monitor and evaluate the prevention of inappropriate admissions. When should Bob collect data? A: Continued stay B: Prospectively C: Retrospectively D: Concurrently

A: Granting approval for healthcare organization to provide services to a specific group of beneficiaries

Certification can be described as A: Granting approval for healthcare organization to provide services to a specific group of beneficiaries B: The process of meeting a prescribed set of standards or regulations to maintain active accreditation, licensure, or certification status C: The act of granting a healthcare organization permission to provide services of defined scope in a limited geographical area D: An act of granting approval to a health care organization

D: TEFRA

Congress passed which of the following programs to mandate medicare cost control? A: HEDIS B: TJC C: CMS D: TEFRA