Master RHIA Prep

Stare Decisis

"let the decision stand;" principle states that in cases in a lower court involving a fact pattern similar to that in a higher court, lower court is bound to apply the decision of the higher court

accounting rate of return (ARR)

(projected annual cash inflows) - (applicable depreciation) / initial investment

What are necessary to maintain an accurate MPI in an EHR environment:

- Standardizing registration procedures - Training all registration staff - Identifying registration entry points Controls for accuracy of the MPI include limiting access to the index and limiting the ability to make changes to a few key personnel. The first step to maintaining an accurate index is to obtain the correct information at admission or registration (Reynolds and Sharp 2016, 130).

According to the records kept on filing unit performance over the past year, the filing unit has filed an average of 1,000 records per day. You have three full-time equivalent (FTE) record filers in the department who are productive 88 percent of each workday (that is, 12 percent unproductive or 12 percent PFD). Based on this information, what is the average number of records filed per productive hour in the file unit as a whole?

143 records per hour First calculate the number of productive hours in a day: 88% × 8 hours = 7.04 hours/day. Then divide the 1,000 records/7 hours = 142.9 or 143 charts/hour for the three filers (Horton 2017, 185-187).

Coding accuracy is best determined by: A. A predefined audit process B. Medicare Conditions of Participation C. Payer audits D. Joint Commission Standards for Accreditation

A

Uniform Ambulatory Care Data Set (UACDS)

A data set developed by the national committee on vital and health statistics consisting of minimum data set of patient/client specific data elements to be collected in ambulatory care

Aimed at increasing the affordability and rate of health insurance coverage for Americans and reducing the overall costs of health care

ACA

All of the following are examples of 501(c)(3) organizations, except: AHIMA Habitat for Humanity the Red Cross the American Cancer Society

AHIMA

Which of the following examples illustrates data that have been transformed into meaningful information?

ALOS at Holt Hospital is 5.6 days Data are the raw elements that make up our communications. Humans have the innate ability to combine data they collect and, through all their senses, produce information (which is data that have been combined to produce value) and enhance that information with experience and trial-and-errors that produce knowledge. The average length of stay is specific to 5.6 days at Holt Hospital. This is meaningful information because it is a statistic for a specific location. The other distractors are merely data as they have no context (Amatayakul 2017, 284).

Rapid cycle improvement model

Accelerated version of the PDCA model but focuses on small changes that can be implemented immediately and careful measurement of the effect of these changes Steps: Setting the aim Defining the measure Selecting process change Test the changes

What must be reported to the medical examiner?

Accidental deaths

What is a measure of efficiency for revenue cycle?

Accounts receivable days

During the voluntary review process the performance of healthcare entity is measured against ?

Accreditation standard

Long-term care hospitals must meet state requirements for ________ and have an agreement with ________ in order to receive payments.

Acute care hospitals; Medicare Long-term care hospitals (LTCHs) must meet state requirements for acute care hospitals and must have a provider agreement with Medicare in order to receive Medicare payments (James 2017a, 305).

A physician query may not be appropriate in what instance

Acute respiratory failure in a patient whose lab report findings appear to not support this diagnosis A query may not be appropriate because the clinical information or clinical picture does not appear to support the documentation of a condition or procedure. In situations in which the provider's documented diagnosis does not appear to be supported by clinical findings, a healthcare entity's policies can provide guidance on a process for addressing the issue without querying the attending physician (Hunt 2016, 276-277).

What type of access safeguard is more people-focused in nature? a. Technical b. Administrative c. Physical d. Addressable

Administrative safeguards are people-focused and include requirements such as training and assignment of an individual responsible for security

What type of safeguards comprise over half of all the safeguards included in the security rule?

Administrative safegurards

If an analyst wishes to predict future ancillary charges for hip replacement patients based on the age of the patient, which of the following is a correct statement?

Age is the independent variable; ancillary charges is the dependent variable When examining the correlation between two variables, the strength and direction of the relationship is measured. The next step in exploring the relationship between two variables is to analyze the ability of the value of one variable to predict an outcome or value of a second variable. In this scenario, the variable that is used to predict is called the independent variable (that is, age), and the outcome or variable to be predicted is called the dependent variable (that is, ancillary charges) (White 2016a, 122).

What is an advantage of the unit numbering system?

All records for a specific patient, both inpatient and outpatient, are kept together One benefit of the unit numbering system is that all records for a specific patient, both inpatient and outpatient, are kept together (Reynolds and Sharp 2016, 128).

Compliance Audit

An audit to measure the compliance of the organization with some established criteria (e.g., laws and regulations, or internal control policies and procedures).

The relationship between patient gender and readmission to the hospital is best displayed using a: a. Frequency chart b. Contingency table c. Bar chart d. Pie chart

Answer: B Contingency tables are a useful method for displaying the relationship between two categorical variables. Contingency tables are often referred to by the number of rows and columns

What architectural model of health information exchange allows participants to access data in point-to-point exchange? a. Consolidated b. Federated—consistent databases c. Federated—inconsistent databases d. Switch

Answer: C The Federated—inconsistent databases—model for HIE includes multiple enterprises agreeing to connect and share specific information in a point-to-point manner

The Privacy Rule generally requires documentation related to its requirements to be retained: a. 3 years b. 5 years c. 6 years d. 10 years

Answer: C The Privacy Rule uses six years as the period for which Privacy Rule-related documents must be retained. The six-year time frame refers to the latter of the following: the date the document was created or the last effective date of the document. Such documents include policies and procedures, the notice of privacy practices (NPP), complaint dispositions, and other actions, activities, and designations that must be documented per Privacy Rule requirements

A clinic has a contract with the city government to perform all new employee physicals and work injury evaluations. Is it appropriate that a patient's family history of cancer be reported to the employer? a. No, because this information is considered PHI b. No, unless the cancer diagnosis is still active c. Yes, because the employer has the right to access all information on its employees d. Yes, unless the employer has allowed for such exclusion

Answer: D Unless the employer has allowed for such exclusion, it is appropriate that a patient's family history of cancer be reported to the employer. In this case the patient is being treated or examined at the request of the employer so the employer is a business associate of the clinic

By querying the healthcare entity data, you find that patients admitted on a weekend have a mean length of stay that is 1.3 days longer than patients who are admitted Monday through Friday. This method of finding information is called: Data mining or SQL?

Answer: Data mining In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set. Data mining is sometimes referred to as knowledge discovery. In healthcare, data mining may be used to determine if it is cost effective to expand facilities

Data quality measurement functions involve continuous improvement for data quality throughout an organization. Includes 4 key processes

Application Collection Warehousing Analysis

Predictive modeling

Application that uses statistical techniques to determine the likelihood of certain events occurring together

Integrated health record

Arranged in chronological order with documentation from various sources intermingled

Scope Creep

As an EHR implementation project proceeds, additional hospital departments add requirements for the system and the project becomes more complex

Documentation integrity

Automated insertion of clinical data using templates or similar tools with predetermined componets using uncontrolled and uncertain clinical relevance

The Joint Commission requires a varying number of safety functions and plans depending on the license or services provided by an organization. The standards require the assessment of safety features for patients, staff, and visitors. Which of the following lists are required safety standard plans for the environment of care? A. Emergency management, security management, and patient management B. Medical equipment management, life safety management, and emergency management C. Employment management, hazardous materials and waste management, and life safety management D. Utilities management, employment management, and medical equipment management

B

The director of Health Information Services is allowed access to the health record tracking system when providing the proper login and password. Under what kind of access security mechanism is the director allowed access to the system? A. Role-based B. User-based C. Context-based D. Situation-based

B

The distinguishing feature of a results management application is that it: A.Provides diagnostic study information in viewable form B. Enables results of a diagnostic study to be compared and displayed with other data C. Captures charges for diagnostic studies and sends them to a billing system D. Directs the work of the departments that produce results of diagnostic studies

B

Utilization management is the: A. group of activities used to ensure that facilities and resources are used appropriately to meet the healthcare and patient care needs B. group of processes used to measure how efficiently health care is managed C. process of determining whether healthcare services meet predetermined criteria D. mechanism to monitor and ensure customer satisfaction

B

When managing the master patient index (MPI) which of the following would be the biggest concern for the health information technician? A. Physical space to house the server B. Duplicate record numbers C. Maintaining the database D. Number of computers in registration

B

Which RFP component would fit the following description? Describe the EHR product's data architecture, analytical processes supported, necessary interfaces, reliability and security features, system capacity, expansion capabilities, response time, downtime, and other issues associated with system maintenance. A. Functional specifications B. Operational requirements C. Organizational profile D. Vendor information

B

Which individual is most likely to use a tactical decision support system? A. CEO b. Director of HIM c. Coding supervisor d. Physician

B

Which of the following can be used to show the frequency for each interval or category of nominal, ordinal, and discrete data? A. frequency polygon B. bar graph C. scatter diagram D. pareto diagram

B

Which of the following is a retention concern with electronic health records? A. Durability B. Hardware obsolescence C. Storage space D. Statute of limitations

B

Which of the following is a solution to the problem of staff recruitment for coding and transcription? A. Cross-training B. Telecommuting C. Web-based training D. Job rotation

B

Which of the following procedures regarding physician orders is no longer common practice in healthcare facilities? A. Concurrent open review of the record while the patient is hospitalized in order to assure signatures on orders B. Retrospective closed review of the record after the patient's discharge in order to identify all unsigned orders C. Use of standing orders for a physician's commonly performed procedures and services D. Training for physicians in documenting orders

B

A technique for measuring healthcare entity performance across the four perspectives of customer, financial, internal processes, and learning and growth is called:

Balanced scorecard methodology Balanced scorecard methodology is a technique for measuring organization performance across the four perspectives of customer, financial, internal processes, and learning and growth (McClernon 2016, 951).

What type of graph is the best choice to use when comparing lengths of stay across three hospitals?

Bar chart Bar charts are used to display data from one or more variables. The bars may be drawn vertically or horizontally. Bar charts are used for nominal or ordinal variables. In this case, you would be displaying the average length of stay by service and then within each service have a bar for each hospital (Horton 2017, 257-258).

What is the correct sequence (from low to high) of levels of interoperability?

Basic, functional, semantic Interoperability is often described in levels. The NCVHS has identified three levels: basic, functional, and semantic. Basic interoperability relates to the ability to successfully transmit and receive data from one computer to another. Functional interoperability refers to sending messages between computers with a shared understanding of the structure and format of the message. The use of clinical terminologies in EHRs to provide standardized data is essential to achieving semantic interoperability (Palkie 2016a, 153).

The user needs a list of all of the patients that were diagnosed a cerebral infarction or a cerebral hemorrhage. This is an example of a situation in which what type of search should be used?

Boolean search Boolean search capabilities such as "and," "or," and "not" may be used in the QBE database to narrow down the data to specifically what the user needs. In this example the query could retrieve patients who had a diagnosis cerebral infarction or cerebral hemorrhage and find all of them (Sayles and Kavanaugh-Burke 2018, 29).

Internal procedures to reduce the risk of groupthink?

Brainstorming Revisiting important decisions monitoring the degree of consensus and disagreement rotating the devils advocate role actively seeking contradictory information

Tort

Branch of civil law that is concerned with civil wrongs

A subpoena duces tecum compels the recipient

Bring records to a legal proceeding

Western States Medical Center consistently sends their HIM staff to AHIMA's component state association annual conference in an effort to provide continuing education and training for these employees. How does this investment in continuing education by Western States Medical Center support their commitment to quality?

By providing a culture of competence through staff development and learning

A tool used to determine the amount of time workers are spending on a task is called a: A. flow process chart B. movement diagram C. work distribution chart d. PERT Chart

C

If a patient suffers from an acute myocardial infarction (AMI) and has a new AMI within the four-week time frame of the initial AMI, codes from what category or categories are assigned? I21 ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial information I22 Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial information I25 Chronic ischemic heart disease A. I21 B. I22 C. I21, I22 D. I21, I25

C

In data quality management the purpose for which data are collected is: A. Warehousing B. Collection C. Application D. Analysis

C

Introducing a new employee to the organizational structure and illustrating how the person contributes to the objectives of the department is what principle of management? A. Scalar chain B. Unity of direction C. Order D. Unity of command

C

Which of the following technologies would allow a hospital to quickly get as much health record information online as possible? A.Clinical data repository B. Picture archiving system C. Computer output to laser disk D. Speech recognition system

C

The antidumping statue

COBRA

In which metadata architecture model is all of the healthcare entity's patient health information stored in on system?

Centralized A centralized metadata architecture consists of a single repository that holds all of the organization's metadata. A centralized system works well if a single metadata model meets all of the data and user needs (Johns 2015, 164).

Clinical data repository

Centralized database that captures, sorts and processes patient data and sends it back to the user

Community Hospital uses barcoding technology as part of its medication management processes. Barcoding is an example of:

Character and symbol recognition technology Character and symbol recognition technologies include bar coding, optical character recognition, and gesture recognition technologies. The bar code symbol was standardized for the healthcare industry, making it easier to adopt barcoding technology. Barcoding applications have been adopted for labels, patient wristbands, specimen containers, business/employee/patient records, library reference materials, medication packages, dietary items, paper documents, and more (Sandefer 2016a, 351).

The physician's office sent a request for payment to Able Insurance Company. The term used in the healthcare industry for this request for payment is a(n):

Claim A claim lists the fees or charges for each service (Casto 2018, 67).

The physician's office sent a request for payment to Able Insurance Company. The term used in the healthcare industry for this request for payment is:

Claim A claim lists the fees or charges for each service (Casto 2018, 67).

In a typical acute care setting which revenue cycle area uses an internal auditing system(scrubber) to ensure error free claims (clean claims) are submitted to third party payers

Claims processing

In a typical acute-care setting the explanation of benefits, Medicare summary notice and remittance advice documents are monitored in which revenue cycle area?

Claims reconciliation and collections

Most common architecture used in EHRs in hospitals today?

Client or server

A polyp was removed from a patient's colon during a colonoscopy procedure. The physician and pathologist document the polyp as probable adenocarcinoma of the colon. Which of the following actions should the coding professional take to code this encounter?

Code "polyp" In the outpatient setting, do not code a diagnosis documented as "probable." Rather, code the conditions to the highest degree of certainty for the encounter (Schraffenberger and Palkie 2019, 105).

Unique personal identifier

Code or password

Survey research method

Collecting data with a survey instrument such as a questionnaire or interview guide

Database

Collection of data that is organized so its contents can be easily accessed managed and updated

CARF

Commission on accreditation of rehab facilities

Physician index

Compare the Number and quality of treatments for patients who underwent the same operation with different surgeons

It is impossible to have health information interoperability or health information exchange without what?

Complete, publicly available standards Complete, publicly available standards are required to be able to exchange data and information effectively. The market needs to focus on interoperability, the ability of different systems to work seamlessly. In health information, interoperability is expected to include transmitting the meaning of data (Biedermann and Dolezel 2017, 302).

SNOMED-CT

Comprehensive international clinical reference technology. CT=Core technology Offers a consistent language fro capturing, sharing and aggregating health data across specialties and sites of care

Using the staff turnover information in this graph, determine the next action the quality council at this hospital should take. a. Do nothing, as the data is below the external benchmark b. Coordinate a PI team to look into the cause for the high employee turnover rate in year 3 c. Coordinate a PI team to look into the cause for the drop in employee turnover rate in year 4 d. Do nothing, as the data is above the internal benchmark

Correct Answer: B The employee turnover rate is over the internal benchmark for this hospital, so a performance improvement (PI) team should be formed to determine what the causes for this increase were. This increase in the turnover rate represents an opportunity for improvement

Healthcare Integrity & Protection Data Bank

Created to collect information on the legal actions (civil & criminal) taken against licensed health care providers.

Uniform Ambulatory Care Data Set(UACDS)

Data set used to document an elective surgical procedure that does not require an overnight hospital stay(outpatient)

Work products that must be produced as a result of a project are referred to as:

Deliverables Deliverables are a tangible output produced by the completion of project tasks (Olson 2016, 899).

Cross sectional prevalence study

Describes characteristics and health outcomes at one specific point or period of time

Descriptive research study

Describes the frequency and distribution of diseases in populations commonly used when little in known about the health condition

Fixed budget

Does not change or flex when sales or some other activity decreases; preparing a budget for the fiscal year based on past budget & expected capacity for the coming year

When an effective leader provides employees with information, responsibility, authority, and trust, this is called

Empowerment

When an effective leader provides employees with information, responsibility, authority, and trust, this is called:

Empowerment Empowerment is the concept of providing employees with the tools and resources to solve problems themselves. In other words, employees obtain power over their work situation by assuming responsibility. Empowered employees have the freedom to contribute ideas and perform their jobs in the best possible way (Patena 2016, 779).

Strategic information systems planning

Ensure that all IS technology initiatives are integrated and aligned with the healthcare entity's overall strategy

Interval

Equal differences between #'s correspond to equal #'s in the traits Ex: test scores, temperature Distance is meaningful

In order to expedite basic performance improvement team functioning, the team should:

Establish ground rules Ground rules must be agreed upon by the team at the very beginning of the process improvement effort. All members of the team should have input into the ground rules. They should agree to abide by them for the sake of the team's success (Shaw and Carter 2019, 59).

Benefits realization study

Evaluation of the benefits that have accrued from the EHR investment. It may be performed at specific milestones in the life of the project and used to help in future systems planning, designing and implementing

Information

Factual data that have been collected, combines, analyzed, interrupted and converted into a form that can be used for a specific purpose

OCHIT

Federal office of the coordinator of health information technology was formed by the secretary of HHS to work toward the goal of promoting health information technology to lower costs, reduce medical errors, improve quality of care and provide better info for patients and physicians

E discovery rules were created in response to the tremendous volume of evidence maintained in electronic format that is pertinent to lawsuits and amended with legislation?

Federal rules of Civil Procedure

The GAAP and GAAS standards for accounting and auditing are established by the:

Financial Accounting Standards Board (FASB)

According to Medicare Conditions of Participation, how long must health records be retained?

Five years

Heather and Jim are both coders at Medical Center Hospital. The hospital allows them to set their own hours as long as one of them is in the office between 9:00 a.m. and 3:00 p.m. so they are accessible to physicians. This kind of work arrangement is called:

Flextime Flextime generally refers to the employee's ability to work by varying his or her starting and stopping hours around a core of midshift hours, such as 10 a.m. to 1 p.m. Depending on their position and the institution, employees may have a certain degree of freedom in determining their hours (Oachs 2016, 795).

What are alternate work scheduling techniques?

Flextime, telecommuting, and compressed workweek Alternate work schedules are alternatives to the regular 40-hour workweek; the following are examples: compressed workweek, flextime, and job sharing (Oachs 2016, 795).

Control chart

Focuses attention on any variation in a process and helps the team to determine whether that variation is normal or a result of special circumstances

Risk Management

Focuses on reducing risk and subsequent liabilities from patient harm, specifically financial loss or diminished public image

Histogram

Frequency distribution of continuous data

Four major types of Hospitals

General Specialty Rehab and chronic disease psychiatric

Three types of hospital ownership

Government owned Privately owned-not for-profit Privately owned for profit hospitals

A standardized set of performance measures designed to allow purchasers and consumers to compare the performance of managed care plans

HEDIS

Federated-Consistent Databases

HIE model where organization acts much like an ASP or bank vault. Data is stored in separate vaults, but is managed centrally.

Used to transfer data, sometimes translating or reformatting as required

HL7

Occlusion

Has the objective of closure and can involve a natural opening for procedures on the orifices

Application service provider model

In an application service provider (ASP) model, there is much less upfront capital outlay and fewer IT staff required in-house. In fact, the ASP acquisition strategy may be considered essentially a financing model

Resident assessment protocols(RAP)

In long term settings these are problem-oriented frameworks for additional patient assessment based on problem identification items

What must be in place to enhance the retrieval process for scanned documents?

Indexing system To enhance retrieval of scanned documents, some form of indexing needs to take place in order to organize the documents. Ideally, each form that is scanned or otherwise created should have a bar code or some other forms recognition feature, or features, associated with it (Amatayakul 2017, 285).

The process of preventing the spread of communicable diseases in compliance with applicable legal requirements is performed in this quality management function.

Infection control The medical staff and the healthcare organization should work together to provide an environment that reduces the risk of infections in both patients and healthcare providers. The healthcare organization should support activities that look for, prevent, and control infections. An infection review is done with the involvement of the medical staff. Information is collected regularly on endemic and epidemic healthcare-associated infections. As appropriate, the healthcare organization must report significant information to both internal groups and public health agencies (Shaw and Carter 2019, 179).

Dr. Smith, a member of the medical staff, asks to see the medical records of his adult daughter who was hospitalized in your institution for a tonsillectomy at age 16. The daughter is now 25. Dr. Jones was the patient's physician. Of the options listed here, what is the best course of action?

Inform Dr. Smith that he cannot access his daughter's health record without her signed authorization allowing him access to the record Generally, if the patient is a minor at the time of treatment or hospitalization but has reached the age of majority at the time the authorization for access or disclosure of information is signed, the patient's authorization is legally required (Brodnik 2017b, 343-344).

Clinical practice guidelines

Information that provides physicians with pertinent health information beyond the health record itself to determine treatment options

Intranet

Internet that runs within a network and is accessible only to users who can be authenticated

To ensure quality of data, the cancer committee reviews the abstracting done by the cancer registry personnel. This type of reliability check is called:

Interrater Reliability is frequently checked by having more than one person abstract data for the same case. The results are then compared to identify any discrepancies. This is called an interrater reliability method of checking. Several different people may be used to do the checking. In the cancer registry, physician members of the cancer committee are called on to check the reliability of the data (Forrestal 2016, 589).

The Hay method is used to measure the three levels of major compensable factors: the know-how, problem-solving, and accountability requirements of each position. This system is used for:

Job evaluation The Hay Guide Chart-Profile Method of Job Evaluation is widely used as a job evaluation tool (LeBlanc 2016, 740).

What organization developed a set of National Patient Safety Goals (NPSGs) that all institutions participating in accreditation must promote and to which their staffs providing care must be trained to adhere?.

Joint Commission The Joint Commission developed a set of National Patient Safety Goals (NPSGs) that all institutions participating in accreditation are required to promote and to which their staff members who provide care must be trained to adhere. The Joint Commission has continued to revise and fine-tune the original set of NPSGs that went into effect in 2003, moving some of them into the formal accreditation standards (Shaw and Carter 2019, 16).

Which type of identity theft occurs when a patient uses another person's name and insurance information to receive healthcare benefits?

Medical Medical identity theft occurs when a patient uses another person's name and insurance information to receive healthcare benefits. Most often this is done so a person can receive medical care with an insurance benefit and pay less or nothing for the care he or she receives (Rinehart-Thompson 2016, 71).

An analysis of a company's liquidity attempts to measure the company's ability to?

Meet current debt payments

An analysis of a company's liquidity attempts to measure the company's ability to:

Meet current debt payments Liquidity refers to the ease with which assets can be turned into cash. This is important because payroll, loan payments, and other financial obligations are typically paid in cash (Revoir and Davis 2016, 852).

A coder notes that the patient is taking prescribed Haldol. The final diagnoses on the progress notes include diabetes mellitus, acute pharyngitis, and malnutrition. What condition might the coder suspect the patient has that the physician should be queried to confirm?

Mental or behavioral problems Haldol is a drug frequently administered for behavior or mental conditions, so the coder would suspect mental or behavioral problems for this patient. The physician must be queried to confirm the diagnosis. Documentation is needed in the record to support the coding of the mental or behavioral problem (Hunt 2016, 276-277).

The form of coaching in which an individual in the beginning stages of a career is matched with a senior person is known as:

Mentoring Mentoring is a form of coaching. A mentor is a senior employee who works with employees early in their careers, giving them advice on developing skills and career options (Patena 2016, 761).

Protocols that support communication between applications

Messaging standards (interoperability standards) (data exchange standards)

Prospective payment system

Method where by reimbursement amounts are predetermined based on the services rendered

Rob is the project manager for a large PI initiative for a large hospital corporation. As part of his duties, he is consistently reviewing the current status of the project and ensuring that activities are meeting their timeline. If Rob finds that activities are not meeting their timeline, he initiates changes to help the project to get back on track. What phase of project management is Rob performing?

Monitoring and controlling Monitoring and controlling are distinct processes, but in project management they work together as a single activity. The monitoring activity is performed to determine the current status of the project, enabling the project to be controlled. The control activity is performed to assess project status in reference to planned activities and their timeline. If the project is off target, a project manager would take action to bring it back on track (Shaw and Carter 2019, 371).

Degaussing

Most appropriate method for destroying electronic data

Context based access

Most stringent type of access control. It takes into account the person attempting to access the data, the type of data accessed and the context of the transaction in which the access attempt is made

Ground rules

Must be agreed upon by the team at the very beginning of the process improvement effort

Core data elements for MPI

Name Gender Address DOB

What would generally be found in a query to a physician?

Name and contact number of the individual initiating the query and account number It is recommended that the healthcare entity's policy address the query format. A query generally includes the following information: patient name, admission date or date of service, health record number, account number, date query initiated, name and contact information of the individual initiating the query, and statement of the issue in the form of a question along with clinical indicators specified from the chart (for example, history and physical states urosepsis, lab reports WBC of 14,400, emergency department report fever of 102°F) (Hunt 2016, 279).

Conversion factor

National dollar multiplier that sets the allowance for the relative values- a constant

What is included in a healthcare entity's strategic profile?

Nature of its customers or users, nature of its market segments, and nature of its geographic markets The strategic profile identifies the existing key services or products of the department or organization, the nature of its customers and users, the nature of its market segments, and the nature of its geographic markets (McClernon 2016, 934; Robert 2006, 53-542).

Focused Audit

Necessary for deeper understanding of patterns of error or change in high risk areas or other areas of specific concerns

Tool used to determine the most critical areas for training and education for a group of employees

Needs assessment First step in a successful department training plan

Today, Janet Kim had her first appointment with a new dentist. She was not presented with a Notice of Privacy Practices. Is this acceptable?

No, it is a violation of the HIPAA Privacy Rule The Privacy Rule introduced the standard that individuals should be informed of how covered entities use or disclose protected health information (PHI). This notice must be provided to an individual at his or her first contact with the covered entity (Rinehart-Thompson 2017d, 219).

Battery

Nonconsensual, intentional touching of another person in an impermissible manner

Type I error

Null hypothesis was rejected but it was in fact true

The leaders of a healthcare entity are expected to select an entity-wide performance improvement approach and to clearly define how all levels of the entity will monitor and address improvement issues. The Joint Commission requires ongoing data collection that might require possible improvement for what areas?

Operative and other invasive procedures, medication management, and blood and blood product use Appointments to the board of directors is important information, but the Joint Commission requires detailed information on the responsibilities and actions of the board, not necessarily its composition. The Joint Commission requires healthcare organizations to collect data on each of these areas: medication management, blood and blood product use, restraint and seclusion use, behavior management and treatment, operative and other invasive procedures, and resuscitation and its outcomes (Shaw and Carter 2019, 304, 313).

Defamation of character

Oral(slander) or written(libel) communication that damages the persons reputation in the eyes of the community

Product line management scheme

Organizes management around product line categories as opposed to departments like nursing pharmacies etc.

A set of activities designed to familiarize new employees with their jobs, the healthcare entity, and work culture is called:

Orientation After employees have been recruited and selected, the first step is to introduce them to the organization and their immediate work setting and functions. New employee orientation includes a group of activities that introduce the employee to the organization's mission, policies, rules, and culture; the department or workgroup; and the specific job he or she will be performing (Patena 2016, 756).

OASIS

Outcome and Assessment Information set used for measuring adult homecare patient outcomes

This type of performance measure indicates the result of the performance or non performance of a function or process:

Outcome measure

Tool for RSC preparation because they outline the hospitals Medicare payment patterns compared to other hospitals in the state?

PEPPER Program for evaluation payment patterns electronic reports

Allows large, long-term, and complex projects to be shown graphically in order to clarify critical task sequences, potential bottlenecks, and the time required for them

PERT

Health record banking model

PHR model allowing patients and healthcare providers to share information by making deposits of health information into a bank; health record bank would have to protect privacy and security of the health information

3 types of qualitative research

Participant observation focus groups cause studies

Indemnification

Parties to a contract agree to hold each other harmless for each others actions or inactions, this is referred to as?

Which of the following is an example of an M:M relationship? Patients to hospital admissions Patients to consulting physicians Patients to hospital health records Primary care physician to patients

Patients to consulting physicians For each patient, there are many consulting physicians, for each consulting physician, there are many patients

Time required to recoop the cost of an investment

Payback period

What is the first step in a successful departmental training and development plan?

Performing a needs analysis To develop an orientation program, it is helpful to begin with a task analysis to determine the specific skills required for the job. The job description and the job specification are excellent sources for this part of the process. A task analysis is part of the needs assessment (Patena 2016, 753).

In a partnership, all profits are considered: retained earnings reserves operational funds personal income

Personal income

Administrative Information

Personal information about patients such as their names, ages and address

Client/Server

Predominant form of computer architecture used in healthcare associations today. Certain computers(servers) have been configured to preform most of the processing and resource-intensive tasks, while other computers(clients) are generally less-powerful computers, capture, view and preform limited processes on data

The computer abstracting system in a facility has an edit that does not allow coders to assign obstetrical codes to male patients. This edit is called a(n):

Preventative control Preventive controls are front-end processes that guide work in such a way that input and process variations are minimized. Simple things such as standard operating procedures, edits on data entered into computer-based systems, and training processes are ways to reduce the potential for error by using preventive controls (Oachs 2016, 804).

RAID

RAID is a data storage virtualization technology that combines multiple physical disk drive components into one or more logical units for the purposes of data redundancy, performance improvement, or both.

Dimensions of data quality

Relevancy Granularity Timeliness Currency Accuracy Precision Consistency

Continuous data

Represent qualitative variables that have infinite number of possible values -Weight

Covered entities must retain documentation of their security policies for atleast

Six years from the last day it was in effect

IEEE 1073

Standard for communication between bedside medical devices and patient care information systems.

True or false: Peripheral angiopathy is presumed when gangrene is present

True

Nominal

Used to describe data collected where the info is qualitative not quantitative = gender, race

Aggregate Data

Used to develop information about groups of patients. Patterns of events, measured against a predetermined acceptable threshold.

Check sheet

Used when one needs to gather data on a sample observations in order to detect patterns

causal-comparative research

a research design that resembles experimental research but lacks random assignment to a group and manipulation of treatment

Learning management system (LMS)

a software application that assists with managing and tracking learners and learning events, and collating data on learner progress

breach

acquisition, access, use, disclosure of PHI in a manner not permitted under HITECH/HIPAA that compromises security or privacy of PHI

A&C

adults and children (in daily census)

confounding variable

an event or factor that is outside a study but occurs concurrently with the study

project champion

an executive in the organization who believes in the benefits of the project and advocates for the project

Agency for Healthcare Research and Quality (AHRQ)

branch of US Public Health Service that supports general health research and distributes research findings and treatment guidelines with the goal of improving the quality, appropriateness, and effectiveness of healthcare services

A physician was sued for failure to perform services as expressly agreed; he made no mistakes in care of the patient, but did not perform a planned elective procedure. The patient took time off from work, incurred travel expenses in arranging for the agreed-upon surgery. The appropriate liability theory to apply here is:

breach of contract

root operation: fragmentation

breaking apart of solid matter in a body part

operational budget

budget that allocates and controls resources to meet an organization's goals and objectives for the fiscal year

capital budget

budget that focuses on long-term investments

zero-based budget

budgets in which each budget cycle poses the opportunity to continue or discontinue services based on available resources so that every department or activity must be justified and prioritized annually to effectively allocate resources

data definition steward

business role with major responsibilities, including identifying specific data needed to operate business processes, recording metadata, and identifying and enforcing quality standards

A Strategy map

can be useful tool because it provides a better visual framework for integrating strategies

risk management

comprehensive program of activities intended to minimize potential for injuries to occur in a facility and to anticipate and respond to ensuring liabilities for those injuries that do occur; processes in place to identify, evaluate, and control risk, defined as organization's risk of accidental financial liability

continuity of care record

concept designed to help standardize clinical content for sharing between providers

appellate court

courts that hear appeals on final judgments of state trial courts or federal trial courts

TRICARE

covers care for retired veterans, active military members, and dependents of active and retired members of the 7 armed forces

Health Information Technology for Economic and Clinical Health (HITECH) Act

created to promote adoption and meaningful use of health information technology in the US; provides for additional privacy and security requirements that will develop and support electronic health information, facilitate information exchange, and strengthen monetary penalties

display goals for patients and provide the corresponding ideal sequence and timing of staff actions to achieve those goals with optimal efficiency

critical paths

Net income

difference between revenue and expenses

variance

disagreement between two parts; square of standard deviation; measure of variability that gives the average of the squared deviations from the mean; in financial management, the difference between the budgeted amount and the actual amount of a line item; in project management, the difference between the original project plan and current estimates

DNFB

discharged no final bill - patient has been d/c - billing process is not complete (waiting for documentation to be coded)

provider

entity responsible for ensuring quality of health record documentation

Made up of several characters such as name, age, or gender

field

whistleblowers

individuals including patients, employees, and competitors, who bring lawsuits based on their knowledge of fraud

priviledged communication

information held confidential within a protected relationship

clinical practice guidelines

information that provides physicians with pertinent health information beyond the health record itself; used to determine treatment options

spoliation

intentional destruction, mutilation, alteration, or concealment of evidence

believed quality must start at the top of the organization; triangle

joiner

interprets the law

judicial

developed trilogy processes

juran

nonmaleficence

legal principle meaning "first to do no harm"

beneficence

legal term meaning promoting good for others or providing services that benefit others, such as releasing health information that will help a patient receive care or will ensure payment for services rendered

writs

legal written commands

Data Use and Reciprocal Service Agreement (DURSA)

legally binding contract that draws from federal and local laws and defines the requirements for participation in the eHealth Exchange national network

creates new legislation

legislative

Favorable

less than budgeted amount

State decisis

let the decision stand, rely on precedent Lower courts bound to follow decisions of the higher courts in the same court system in order to determine the outcome of a case as long as the fact patterns of higher court case was similar of the current case

Positions that have direct responsibility for accomplishing the objectives of an organization

line

trends over time

line graph

Local area network(LAN)

link systems within a small geographic area such as many connected PCs to a main frame Pc to printer PC to PC in a facility Ethernet

Capitol budget

looks at long term investments. Such as investments are usually related to improvements in the facility infustructure, expansion of services ore replacement of existing assets. Facility plan for allocating resources over and above the operating budget.

data life cycle

made of series of successive stages: data planning, inventory and evaluation, capture, transformation and processing, access and distribution, maintenance, archival, destruction

Point of Service (POS) plan

managed care plan where enrollees are encouraged to select healthcare providers from a network under contract, but are allowed to go out of network and pay a larger share of the cost

continuous quality improvement (CQI)

management philosophy that emphasizes importance of knowing and meeting customer expectations, reducing variation within processes, and relying on data to build knowledge for process improvement; component of total quality management (TQM) that emphasizes ongoing performance assessment and improvement planning

master data management

master data that an enterprise maintains about key business entities such as customers, employees, or patients, and reference data that is used to classify other data or identify allowable values for data such as codes for state abbreviations or products

organizational safeguards

measures like business associate agreements so arrangements are made to protect ePHI between organizations

MAP key

measures specific revenue cycle function and provides the purpose for the measurement, value of the measure, and specific equation (numerator and denominator) to consistently calculate the measure

point method

method of job evaluation that places weight (points) on each of the compensable factors in a job whereby the total points associated with a job establish its relative worth and jobs that fall within a specific range of points fall into a pay grade with an associated wage

hybrid health records

mixture of paper and electronic, or multiple electronic systems that do not communicate or are not logically architected for record management

unstructured data

non-binary, human-readable data; more specific than structured data

asynchronous

not at the same time; web-based courses where learners and instructors interact through emails or discussion forums

Hospital-Issued Notice of Noncoverage (HINN)

notification to beneficiaries prior to admission/at admission/during inpatient stay to explain that their services are not covered; could be because it is not medically necessary, not delivered in the most appropriate setting, or custodial in nature

strict liability

occurs when a person or entity is held for acts or omissions regardless of whether there was fault

RAT-STATS

offered by OIG; statistical package that is free to download and use for both sample size determination and generation of the random numbers required for sampling

Transitions of Care (ToC) initiative

one of the projects of the Standards and Interoperability (S&I) Framework; exchange of clinical summaries is hampered by ambiguous common definitions of what data elements must at a minimum be exchanged, how they must be encoded, and how those common semantic elements map to Meaningful Use specified formats

corporate negligence

organization is reliable for consequences of unauthorized disclosure

medical staff classification

organization of physicians according to clinical assignment

The terms are referred to as nonessential modifiers

parentheses

A&D

patients admitted/discharged on the same day

contributory negligence

plaintiff's conduct contributed in part to injury the plaintiff suffered and, if found to be sufficient, can preclude plaintiff's recovery for injury

comparative negligence

plaintiff's conduct contributed in part to the injury the plaintiff suffered, but plaintiff's recovery is reduced by some amount based on his or her percentage of negligence (plaintiff is somewhat responsible so recovery is reduced depending on how much of the negligence is the patient's fault)

broad guidelines

policies

favorable variance

positive difference between budgeted amount and actual amount of a line item, when actual revenue exceeds budget or actual expenses are less than budget

abuse

practices that, either directly or indirectly, result in unnecessary costs to Medicare; includes any practice that is not consistent with goals of providing patients with services that are medically necessary, meet professionally recognized standards, and are fairly priced

Process to determine specific procedures and services a practitioner is permitted to perform under jurisdiction of institution

privilege delineation

steps designed to accomplish a specific task

procedures

key performance indicator

quantifiable measure used over time to determine whether some structure, process, or outcome in the provision of care to a patient supports high-quality performance measured against best practice criteria

problem-oriented medical record

record in which clinical problems are defined and documented individually

basic interoperability

relates to the ability to successfully transmit and receive data from one computer to another

misfeasance

relating to negligence or improper performance during an otherwise correct act

need-to-know principle

release-of-information principle based on the minimum necessary standard; only release information that is absolutely necessary only to those who are helping care for the patient

The data are meaningful to the performance of the process or application for which they are collected

relevance

hearsay statements made during an incident are admissible as evidence

res gestae

quantitative analysis

review of health record to ensure completeness and accuracy; assure record meets all documentation requirements; all parts are present; generally retrospective

Health Savings Account (HSA)

savings accounts designed to help people save for future medical and retiree health costs on a tax-free basis--part of 2003 Medicare bill--AKA medical savings accounts

project management constraints

schedule, budget, and scope of a project (also known as triple constraint)

morphology

science of structure and form of organisms without regard to function

equity

securities that are shared in the ownership of the organization

waterfall method

sequential method of completing project phases; can't start part B until part A is finished

business plan

should be used as basis for Information Systems Strategic Plan; balance business requirements with technology advancement

overlay

situation in which a patient is issued an MRN that has been previously issued to a different patient

overlap

situation in which a patient is issued more than one MRN from an organization with multiple facilities

electronic data interchange (EDI)

standard transmission format using strings of data for business information communicated among the computer systems of independent organizations

data dictionary

standardize definitions and ensure consistency of use--enhances use across systems

Certified Electronic Health Records Technology (CEHRT)

standards used to inform technology vendors and providers about the functionality required to receive incentive payments for the implementation of EHR technology in the CMS EHR incentive program

Notice of Privacy Practices

statement issued by organization that informs individuals of uses and disclosures of PHI that may be made by organization, as well as individual's rights and legal duties with respect to information

Healthcare fraud statute

statute identifying that it is illegal to defraud any healthcare benefit program or to obtain fraudulent funds or property by any of the healthcare benefit programs

The organization's mission, its vision, and innovative ways of achieving the type of future that will ensure the organization's survival and effectiveness

strategic planning

Balanced Scorecard (BSC) methodology

strategic planning tool that identifies performance measures related to strategic goals

legal hold

suspend normal disposition or processing of records

extranet

system of connections of private internet networks outside an organization's firewall that uses internet technology to enable collaborative applications among enterprises

Operational and budgetary planning designed to accomplish immediate and short-term plans

tactical planning

latency

the amount of time it takes to answer a question, compactness of the display, and user preference

To be successful any information system technology initiative must align with

the healthcare strategic plan process

Zero-based budget

the point of a zero-based budget is to make income minus the outgo equal zero; expenses must be justified, prioritized for each new period

Delegation

the process of assigning managerial authority and responsibility to managers and employees lower in the hierarchy

cluster sampling

the process of selecting subjects for a sample from each cluster within a population (for example, a family, school, or community

Technical safeguards

the technology and policies and procedures for its use that protect ePHI and controls access to it

percentage of occupancy

total service days for a period/total bed count days for the period

Clinical Care Classification (CCC)

two interrelated taxonomies (CCC of Nursing Diagnoses and outcomes, and CCC of Nursing Interventions and Actions) that provide a standardized framework for documenting patient care in hospitals, home health agencies, ambulatory care clinics, and other healthcare settings

Multihospital system

two or more hospitals owned, leased, sponsored, or contract managed by a central organization

double billing

two providers bill for one service provided to a single patient

pay for performance

type of incentive to improve clinical performance using the EHR that could result in additional reimbursement or eligibility for grants or other subsidies to support further HIT efforts; Integrated Healthcare Association initiative in California based on the concept that physician groups would e paid for documented performance

charge code

used to assign cost and charge rates to types of work; cost rate for person doing the work

Gatekeeper

usually the primary care physician who coordinates all care provided to the patient

The plaintiff sued a hospital for negligence in failing to discover and properly treat his disease; injury resulted. The court found the nurse in this case (a hospital employee) to be negligent in failing to fully inform the attending physician of all the patient's symptoms on admission so that prompt action could be taken. The hospital was held liable under the theory of _____. The plaintiff was awarded ____ damages by the court, intended to restore him to his position before the injury occurred.

vicarious liability; actual

coefficient of determination

(r^2); measures how much of variation in one variable is explained by the second variable

Access control

-The first Technical Safeguard Standard of the HIPAA Security Rules -Responsibility for all healthcare providers to allow access only to those users (or software programs) that have been granted access rights

Middle process of revenue cycle

-ensure accurate & complete coding -identify reimbursable services -manage medical malpractice

Sources of law

1. constitution 2. statutes 3. decisions of the court 4. rules of administrative agencies

Manuel receives surgery in 1 day and is discharged to home. Where was he treated? A. Surgicenter B. Satellite clinic C. Ancillary department D. Observation unit

A

The charge description master relieves the HIM department of ________ that does not require documentation analysis. A. Repetitive coding B. Manual coding C. Duplicate coding D. Procedure coding

A

Which of the following is an example of a 1:M relationship? A. Patients to hospital admissions B. Patients to consulting physicians C. Patients to hospital health records D. Primary care physicians to patients

A

n a recent coding audit, the coding manager discovered the following issue: A skin lesion was removed from a patient's cheek in the dermatologist's office. The dermatologist documented skin lesion, probable basal cell carcinoma. Which of the following actions should the coding professional take in order to correctly code this encounter? A. Code skin lesion B. Code benign skin lesion C. Code basal cell carcinoma D. Query the dermatologist

A

Uniform Hospital Discharge Data Set (UHDDS)

A code set of date elements that are collected by hospitals on all discharges and all discharge abstract systems -required for medical reporting

Research on emotional intelligence shows that:

A combination of feelings and rationality make managers more successful

Standard deviation

A measure of variability that describes the deviation from the mean of a frequency distribution in the original units of measurement

Work breakdown structure

A project plan starts with a WBS or task list. The WBS is a hierarchical list of steps needed to complete the project. This structure provides levels that are similar to the concept of a book outline. Each level drills down to more detail. The lowest level is the task level to which resources are assigned and work effort estimates are made.

Use case

A set of scenarios that describes an interaction between a user and a system is called

Is used to bill for outpatient services

APC

Best of fit

All applications are provided by a single vendor. Makes it easier to add new applications from that vendor, but difficult to add products from other vendors.

Which of the following is used to reconcile accounts in the patient accounting department? a. Explanation of benefits b. Medicare code editor c. Preauthorization form d. Fee schedule

Answer: A In the claims reconciliation process, the healthcare facility uses the explanation of benefits, Medicare Summary Notice, and the remittance advice to reconcile accounts

Patient accounting is reporting an increase in national coverage decisions (NCDs), and local coverage determinations (LCDs) failed edits in observation accounts. Which of the following departments will be tasked to resolve this issue? a. Utilization management b. Patient access c. Health information management d. Patient accounts

Answer: C

In this level of interoperability, the receiving computer has some information regarding the nature of the information being exchanged, but does not have complete and shared understanding with the sending system. A. Basic B. Functional C. Semantic D. Process

B

Which of the following would be part of the release of information system? A. A letter asking for additional information on a patient previously treated at the hospital B. A letter notifying an individual that the authorization was invalid C. A letter notifying a physician that he has delinquent medical records D. A letter asking a physician to clarify a primary diagnosis

B

Which data collection program is the basis for the CMS value-based purchasing program? a. Leapfrog b. HEDIS c. Hospital Compare d. HCUP

C

Subacute care

Care provided to a patient after an acute illness before the patient is released to a long term care facility, home heath or home

What is the term for contracts that separate out certain types of healthcare services to decrease MCO's risk?

Carve out

Diversity Jurisdiction

Citizens from different states are engaged in a lawsuit and: -no plaintiff is from the same state as any of the defendants and the amount in controversy is at least 75k

Employees, physicians, and other stakeholders are invited to town hall meetings, receive newsletters and e-mail, and can check social media for the status of the EHR implementation project. This is an example of good:

Communication Effective communication must occur at and between all levels of the organization from top leadership all the way to the front lines as well as with the persons working behind the scenes. Communication can take many forms these days including meetings, newsletters, and even social media (Biedermann and Dolezel 2017, 261).

Continuity of care

Concept designed to help standardize clinical content for sharing between providers

The Workforce Security Standard has all of the following addressable implementation standards except:

Concept supervision The Workforce Security Standard requires the organization to ensure that those with a legitimate need to access information are able to do so while at the same time ensuring that those workforce members who do not have a legitimate need to that information are prevented from gaining access. The three specifications include: authorization and supervision, workforce clearance procedures, and termination procedures. Concept supervision is not one of the three specifications (Biedermann and Dolezel 2017, 384-385).

It is the year 201X. The federal government is determined to lower the overall payments to physicians. To incur the least administrative work, which of the following elements of the physician payment system would the government reduce?

Conversion factor The conversion factor is an across-the-board multiplier that sets the allowance for the relative values—a constant (Casto 2018, 143).

If an analyst is studying the wait times at a clinic and the only list of patients available is on hard copy, which sampling technique is the easiest to use? a. Survey sampling b. Systematic sampling c. Cluster sampling d. Stratified sampling

Correct Answer: B A systematic random sample is a simple random sample that may be generated by selecting every fifth or every tenth member of the sampling frame. In order to ensure that a systematic random sample is truly random, the sample frame should not be sorted in an order that might bias the sample

The Joint Commission and CMS identify core measures that provide an indication of a healthcare facility's performance. Some of the core measure data sets include which of the following? a. Myocardial infarction, pneumonia, and HIV/AIDS b. Pneumonia, congestive heart failure, and gastric ulcers c. Pneumonia, congestive heart failure, and myocardial infarction d. Congestive heart failure, HIV/AIDS, and myocardial infarction

Correct Answer: C

Violation of the AHIMA Code of Ethics triggers: a. Automatic loss of AHIMA credentials b. Disciplinary actions and a fine c. A review by peers with potential disciplinary actions d. Nothing because a violation of ethics is not a big deal

Correct Answer: C A formal code of ethics ensures that professionals understand and agree to uphold an ethical standard that puts the interests of the profession before their personal interests. Violation of the AHIMA Code of Ethics triggers a peer review process

It is impossible to have health information interoperability or health information exchange without the following: a. 100 percent adoption of EHRs b. A federally mandated Data Use and Reciprocal Support Agreement c. Complete, publicly available standards d. ONC and CMS regulations

Correct Answer: C Complete, publicly available standards are required to be able to exchange data and information effectively. The market needs to focus on interoperability, the ability of different systems to work seamlessly. In health information, interoperability is expected to include transmitting the meaning of data

A health information technician wants to obtain a chronological list of all patients admitted to the facility during the third quarter with a diagnosis of appendicitis. Which database should the technician utilize? A. accession register B. MPI C. Disease index D. patient register

D

Cecile, a 78-year-old female, needs intermittent skilled nursing care. Which facility would best meet her needs? A. Skilled nursing facility B. Hospice C. Rehab facility D. Home health care

D

Facility-based cancer registries receive approval as part of the facility cancer program from which of the following agencies? A. American Cancer Society B. National Cancer Registrars Association C. National Cancer Institute D. American College of Surgeons

D

James is the director of HIM and Linda is his manager of the main file room. James sees one of Linda's subordinates give a medical record to a physician without following the proper procedure. James immediately goes to Linda to have her correct the clerk and the situation. To which organizational principle is James adhering? A. organizational function B. Scalar principle C. Span of control D. Unity of command

D

TJC requests to view a patient's health record, which contains a diagnosis of AIDS. The director of health information should: A. call the facility's attorney B. deny access to TJC C. obtain written authorization from the patient or legal representative D. allow access to the record upon request of TJC

D

Which of the following statements is true regarding HIPAA security? A. All institutions must implement the same security measures. B. HIPAA allows flexibility in the way an institution implements the security standards. C. All institutions must implement all HIPAA implementation specifications. D. A security risk assessment must be performed every year.

D

Coded data

Data that have been grouped into meaningful categories according to a classification system

Most facilities begin counting days in accounts receivable at what time?

Date the claim drops

Data governance

Decision making and authority over data related matters

Spoliation

Destroying health record contents which would be damaging to the employee, could not be used in trial

Redundant Systems

Duplication of all data, hardware, cables or other components of the system so if the server crashes the system switching over to the second server and can continue processing

Which of the following best categorizes the group of adopters who comprise the backbone of the organization, are conventional and deliberate in their decisions, and form a bridge with other adopter categories?

Early majority The early majority comprises about 34 percent of the organization. Although usually not leaders, the individuals in this group represent the backbone of the organization, are deliberate in thinking and acceptance of an idea, and serve as a natural bridge between early and late adopters (Swenson 2016, 701).

Data integrity

Ensuring that data have been accessed or modified only by those authorized to do so

The process of integrating healthcare facility systems requires the creation of:

Enterprise master patient indexes (EMPIs) Enterprise master patient indexes (EMPIs) provide access to multiple repositories of information from overlapping patient populations that are maintained in separate systems and databases. This occurs through an indexing scheme to all unique patient identification numbers and information in all the organizations' databases. As such, EMPIs become the cornerstones of healthcare system integration projects (Reynolds and Sharp 2016, 129-131).

What is the name of the notice sent after the provider files a claim that details amounts billed by the provider, amounts approved by the payer, how much the payer paid, and what the patient must pay?

Explanation of benefits

Charges for items that must be reported separately but are used together, such as interventional radiology imaging and injection procedures are called:

Exploding charges The charge description master can provide a method for grouping items that are frequently reported together. Items that must be reported separately but are used together, such as interventional radiology imaging and injection procedures, are called exploding charges (Schraffenberger and Kuehn 2011, 227).

A visitor sign in sheet to a computer area is an example of what type of control?

Facility access

What architectural model of health information exchange allows participants to access data in point-to-point exchange?

Federated - inconsistent databases The Federated—inconsistent databases—model for HIE includes multiple enterprises agreeing to connect and share specific information in a point-to-point manner (Amatayakul 2017, 417-418).

Penalties for violating HIPAA privacy rule with intent to sell, transfer or use PHI for commercial advantage

Fine of not ore then 250,000 not more than 10 years in jail, or both

The leader of the coding performance improvement team wants all team members to clearly understand the coding process. What tool could help accomplish this objective?

Flowchart To help all members understand the process, a team will undertake development of a flowchart. This work allows the team to thoroughly understand every step in the process and the sequence of steps. It provides a picture of each decision point and each event that must be completed. It readily points out places where there is redundancy and complex and problematic areas (Oachs 2016, 814).

The most recent coding audit has revealed a tendency to miss secondary diagnoses that would have increased the reimbursement for the case. What strategy will help to identify and correct these cases in the short term?

Focus reviews on lower-weighted MS-DRGs from triples and pairs The focused review indicated areas of risk related to lower weighted MS-DRGs from triple and pair combinations which may be the result of a coder missing secondary diagnoses. A focused audit based on this specific potential problem area could help to identify these cases. Optimization seeks the most accurate documentation, coded data, and resulting payment in the amount the provider is rightly and legally entitled to receive (Hunt 2016, 286).

Medical record committees

Formed to review the accuracy and timelines of patient records -Develops policies relating to the analysis of patient records for documentation, etc.

Contracting for staffing to handle a complete function within the HIM department, such as the Cancer Registry function, would be considered what type of contracting arrangement?

Full-service When a manager is planning to contract for staffing in a transitional situation in order to meet organizational goals, various types of arrangements can be considered. Full-service contracting would be handing off a complete function to the contracted company (Oachs 2016, 797).

Inferential statistics

Generalizations based on data collected

National Committee on Vital and Health Statistics

Government agency that has led the development of basic data sets for health records and computer databases

ERD

Graphical display of the relationships between tables in a database

Switch

HIE organization that has no access to personal health information

Designated Record Set (DRS)

HIPAA record sets; records maintained by or for a covered entity that A. are medical or billing records; B. enrollment, payment, claims adjudication, and case or medical management record systems; C. used in whole or part by or for covered entity to make decisions about individuals

Which of the following conditions would be the most likely to fall into the category of notifiable diseases as defined by the National Notifiable Diseases Surveillance System?

HIV infection A notifiable disease is one for which regular, frequent, and timely information on individual cases is considered necessary to prevent and control disease. The list of notifiable diseases varies over time and by state; however, HIV/AIDS would be a notifiable disease anywhere (Edgerton 2016, 503-504).

Organization that develops standards related to the interoperability of health information technology

Health level 7

A physician who provides care in a healthcare facility, is not employed by the healthcare entity and therefore not under the direct control or supervision of another, and is personally responsible for his or her negligent acts and carries his or her own professional liability insurance is considered a(n) ________ to the healthcare entity.

Independent contractor Each provider who practices care under the auspices of a healthcare organization must do so in accordance with delineated clinical privileges. One of the requirements for these privileges is for the individual to carry his or her own professional liability insurance and therefore that provider is considered an independent contractor within the healthcare organization (Shaw and Carter 2019, 279).

Successful strategic managers understand that three competencies are common to all successful change and that these competencies can and must be developed. These three competencies are:

Leadership, change management, and strategic development Every aspect of management involves a strategic management component. With organizational learning as a centerpiece, this approach unifies change management, strategy development, and leadership. In all three, people learn by observing and reflecting on the results of experiences (Revoir and Davis 2016, 930).

This type of data display tool is a plotted chart of data that shows the progress of a process over time.

Line graph or plot A line graph or plot may be used to display time trends. The x-axis shows the unit of time from left to right, and the y-axis measures the values of the variable being plotted (Marc 2016, 546).

WAN- Wide area networks

Link a larger span of systems such as linking several buildings that are apart of the same medical facility Connected by phone or satellite Fiber-disturbed data interface, Light pulses through thin glass strands that form fiber optic cables

What are statistical techniques used to create a model to assess the probability that current Medicare claims are fraudulent?

Logistic regression, cluster analysis, and decision trees Statistical techniques are used in predictive modeling to create a model to assess the likelihood or probability of fraudulent claims. These statistical techniques include logistical regression, cluster analysis, or decision trees. A data warehouse is not a statistical technique that would be used for this purpose (White 2016b, 532).

To promote comparability and compatibility of data by using standard data items with uniform definitions

MDS

When a coder fails to assign diagnoses or procedures that should be coded, this can affect a hospital's MS-DRG case mix in what way?

Makes it lower than warranted by the actual service or resource intensity of the facility MS-DRG sets exist where the listings of diagnoses used to drive the grouping are the same. But, the presence or absence of a complication or comorbidity (CC) diagnosis or major complication or comorbidity (MCC) assigns the case to a higher or lower DRG. By missing diagnoses or procedures that should be coded, or failing to assign the most specific coding possible, the coding staff can cause the case-mix index to be lower than it should be (Malmgren and Solberg 2016, 255).

Medicaid coverage is not identical in New Jersey, California, and Idaho. Why is this?

Medicaid allows states to maintain a unique program adapted to state residents' needs and average incomes. Coverage differs among these states because Medicaid allows states to maintain a unique program adapted to state residents' needs and average incomes. Although state programs must meet coverage requirements for groups such as recipients of adoption assistance and foster care, other types of coverage, such as vision and dental services, are determined by the states' Medicaid agencies (Casto 2018, 84).

Sue is updating the data dictionary for her organization. In this data dictionary, the data element name is considered which of the following?

Metadata Metadata are often referred to as "data about data." Metadata are structured information used to increase the effective use of data. One of the most familiar types of metadata is used to describe data in databases. Data element name, data type, and field length are examples of this kind of metadata (Johns 2016, 82-83).

Federated inconsistent databases

Model for HIE includes multiple enterprises agreeing to connect and share specific info in a point to point manner

What analytic technique is being used by CMS to assist in prepayment audits?

Predictive modeling

Ongoing record review

Process where HIM professionals monitor the records of current inpatients as well as closed records after the patients have been discharged or transferred. TJC survey process

Malpractice

Professional negligence Hospitals can be held accountable for negligence on behalf of conduct or actions by individuals in their facilities

SOAP

Progress note format, in POMR chart Subjective-patient perception of problem Objective-Records the practitioner evaluation Assessment- Combines the subjective and objective perspectives into a conclusion Plan-Which approach is going to be taken to resolve the problem

Prevalence

Proportion of people in a population who have a particular disease at a disease at a specific point in time or over a specified period of time

Used to report information about mortality ,morbidity at local, state and national levels?

Proportions, ratios and rates

The best reason for implementing IS technology in healthcare

Provide effective and efficient patient care services

Episode of care:

Providers receive one lump sum for all the services they provide related to a condition or disease

Authentication

Providing proof of the authorship of health record documentation

Discrete data

Quantitative variables that are limited such as the number of children in a family or the number of medications a patient is taking

The process of entity authentication means a computer:

Reads a predetermined set of criteria to determine is a user is who he or she claims to be Entity authentication is the verification of a user's identity. Simply put, this standard seeks to ensure that organizations put methods in place to verify that users are who they claim they are (Biedermann and Dolezel 2017, 395).

Maintenance Plan

Regular review of LHR policies and procedures to ensure a health care entity remains in compliance with legal requirements

Maintenance plan

Regular review of LHR policies and procedures to ensure a healthcare entity remains in compliance with legal requirements

Frequency distribution

Represents the number of times each category or value of a variable is observed within a sample

Project Office

Responsible for defining project management procedures, conducting risk analyses on projects and mentoring project managers

An individual designated as an inpatient coder may have access to an electronic medical record in order to code the record. Under what access security mechanism is the coder allowed access to the system?

Role-based Role-based access control (RBAC) is a control system in which access decisions are based on the roles of individual users as part of an organization (Theodos 2017, 270).

Which key word precedes the listing of variables to be returned from an SQL query?

SELECT

Federated-Consisted database

Same as consolidated model of data being stored in separate data vaults, yet it is still managed centrally

Assumption

Scope limiting parameters. Provide constraints on what is and is not included in the project

Core (performance measures)

Standardized sets of valid, reliable and evidence based measures implemented by TJC

Three types of quality indicators:

Structure Process Outcome

For an EHR to provide clinical decision support it needs(2)

Structured data Clinical data repository

Charge Description Master

Supplies, devices, medications Charge master reviews should be performed at least annually to review validity of CPTs

Required the development of the PPS

TERFA

When an ERD is implemented ad a relational database an entity will become a?

Table

Focused Audit

The HIM department can plan focused reviews based on specific problem areas after the initial baseline review has been completed. This would be called a focused inpatient review

Empowerment

The concept of providing employees with the tools and resources to solve problems themselves. In other words, employees obtain power over their work situation by assuming responsibility. Empowered employees have the freedom to contribute ideas and perform their jobs in the best possible way

The confidentiality of incident reports is generally protected in cases when the report is filed in:

The hospitals risk managers office

Materials Required in a emergency care record

Time and means of patient arrival Treatment rendered Instructions at discharge

How are employee performance standards used?

To communicate performance expectations Standards that are measurable and relevant to an employee's overall performance are helpful in setting clear expectations. They also are useful in providing constructive feedback (LeBlanc 2016, 731).

Indexes

Tool used to sort data in a variety of ways to assist in the study of certain data elements

Medicare Summary Notice (MSN)

Type of remittance advice from Medicare to plan beneficiaries to explain how their benefits were determined. a summary of health care services and items you have received during the previous three months. The MSN is not a bill. The contractor that processes your claims for Medicare will send you the MSN, so it may have the name and address of a private company on it.

Data collection utilized by peer review organizations to determine the quality of patient care

UCDS

What type of information makes it easy for hospitals to compare and combine the contents of multiple patient health records?

Uniform data sets - Clinical information is the basis for uniform data sets.

When should a e-discovery team be formed?

Well in advance of any litigation

remittance advice

a copy of the sales invoice returned with a customer's payment that indicates the invoices, statements, or other items being paid

cohort study

a study, followed over time, in which a group of subjects is identified as having one or more characteristics in common

nonrandom (non probability) sampling

a type of convenience or purposive sampling in which all members of the target population do not have an equal or independent chance of being selected for the study

Interoperability

ability of different systems to communicate and exchange information as related to the health care field 3 levels: Basic Functional Semantic

information governance

accountability framework and decision rights to achieve enterprise information management (EIM); responsibility of executive leadership for developing and driving IG strategy throughout organization; encompasses both DG and IT governance

Flexible budget

adjusts or flexes with changes in volume or activity

hypothesis test

allows the analyst to determine the likelihood that a hypothesis is true given the data present in the sample with a predetermined acceptable level of making an error

external validity

an attribute of a study's design that allows its findings to be applied to other groups

indirect standardization

appropriate to use for risk adjustment when risk variables are categorical and the rate or proportion for the variable of interest is available for the standard or reference group at the level of the risk categories, the expected outcome rate for each risk category is calculated based on the reference group and then weighted by the volume in each risk group at population to be compared to the standard

topography

code that describes the site of origin of the neoplasm and uses the same three- and four-character categories as in the neoplasm section of the second chapter of ICD-10; description of a part of the body

ANOVA test

compares means of X amount of groups on one independent variable

Firewall

controls external access to a network

debt service

current obligations of an organization to repay loans

root operation: detachment

cutting off all or part of the upper or lower extremities; used exclusively in amputations

root operation: excision

cutting out or off, without replacement, a portion of a body part; examples are partial nephrectomy, liver biopsy, breast lumpectomy, excision of cyst, sigmoid polypectomy, or excision of melanoma

root operation: resection

cutting out or off, without replacement, all of a body part; examples are total nephrectomy, total lobectomy of lung, total mastectomy, resection cecum, prostatectomy, or cholecystectomy. removal of entire lymph node chain is resection, removal of single lymph node is excision

liquidity

degree to which assets can be quickly and efficiently turned into cash, for example, marketable securities are generally liquid, the assumption being that they can be sold for their full value in a matter of days, whereas buildings are not liquid because they cannot usually be sold quickly

revenue code

descriptions and dollar amounts charged for hospital services provided to a patient

arbitration

disputes are submitted to a third party or panel of experts outside the judicial trial system

X12N

electronic data interchange standards; both parties (provider and payer) must adhere to these standards in order for transmission of healthcare data

cross-functional

entity or activity that involves more than one department, service area, or discipline

Assesses workspace for comfort and safety, educates staff on how to reduce injuries and discomfort

ergonomic management

egoism

ethical principle that involves only considering oneself in the decision-making process

enforces and administers the law

executive

defamation of character

false communication about someone to a person other than the subject that injures the person's reputation

visual display of data generated through brainstorming

force field analysis

net present value (NPV)

formula used to assess current value of a project when monies used were invested in organization's investment vehicles rather than expended for the project, both of which are adjusted to current time

network

group of hospitals, physicians, providers, or payers collaborating to coordinate and deliver services to their community

asset

human, financial, and physical resources of an organization

Uniform Hospital Discharge Data Set (UHDDS)

inpatient data set incorporated into federal law and required for Medicare reporting

Ancillary services

laboratory and diagnostic imaging

acquittal

lack of proven guilt

ethnography

method of observational research that investigates culture in naturalistic settings using both qualitative and quantitative approaches

case finding

methods used to identify patients who have been seen and treated in the facility for the particular disease or condition of interest to the registry

semantic interoperability

mutual understanding of the meaning of data exchanged between information systems

nonfeasance

negligence of failure to act

t-test (one sample and two-sample)

one-sample: compares whether measured variable is greater/less than a standard, specified value (usually compares whether a mean is greater/less than standard) two-sample: compares whether two means are equal (null hypothesis is always equal)

occurrences on the chart are organized from most frequently occurring to the least frequent

pareto chart

longitudinal health record

permanent, coordinated patient record of significant information listed in chronological order and maintained across time, ideally from birth to death

root operation: destruction

physical eradication/elimination of all or a portion of a body part by the direct use of energy, force, or a destructive agent; common terms used are ablation, fulguration, cryotherapy, and cautery

stakeholder analysis

process that identifies and analyzes attitudes or opinions of stakeholders

Who owns the physical health record?

provider or facility

straight numeric filing system

records are filed in numerical order according to the number assigned

personal characteristics that are appealing to the constituency

referent

incidence

refers to number of new case of a disease

negligence

refers to result of an action by an individual who does not act in the way a reasonably prudent person would act under the same circumstances

Discharged, not final billed (DNFB)

report that includes all patients who have been discharged from the facility but for whom, for one reason or another, the billing process is not complete

balance sheet

report that shows total dollar amounts in accounts, expressed in accounting equation format, at a specific point in time

followers delegate power to the leader

representative

petition for writ of certiorari

request for US Supreme Court to consider a case

Something is self evident

res ipsa loquitor

mixed methods research

research method approach that combines quantitative and qualitative techniques within a single study or across multiple, complementary studies

An intervention in which the focus of care is on giving the caregiver time off while continuing the care of the patient

respite care

data analytics

science of examining raw data with the purpose of drawing conclusions about that information; includes mining, machine language, development of models, and statistical measurements; can be descriptive, predictive, or prescriptive

Covered entities are required to assign a unique name and/or number for identifying and tracking user identity

security rule

A new number is assigned to the patient for each new encounter at the facility

serial numbering

unit work division

simultaneous assembly in which everyone performs a different specialized task at the same time

goals of HIPAA Administrative Simplification

standardize electronic transmission of health data; prevention of healthcare fraud and abuse; medical liability reform; transactions and code set standardization

root operation: extirpation

taking or cutting out solid matter or material from a body part; examples are thrombectomy, removal of foreign body, choledocholithotomy, and removal of calculus

grounded theory

theory about what is actually going on instead of what should go on

longitudinal

time frame for research studies during which data are collected from the same participants at multiple points in time

The patient retains the same number for every encounter at the facility

unit numbering

Derived Data

Data consist of factual details aggregated or summarized from a group of health records that provides no means to identify specific patients

Auditing integrity

Inadequate functions that make it impossible to detect when an entry was modified or borrowed from another source and misrepresented as an original entry by an authorized user is an example of a potential breach or

Capitated rate:

Method of payment for health services in which the third part payer reimburses providers a fixed per capita amount for a period, Per captia means, per head or per person

Six sigma

Principle behind it is based on a normal distribution of events that fall within three standard deviations from the mean. Optimum standard of quality is indicated by 3.4 defects per million opportunities Based on : Define the problem Measure performance Analyze information Develop an improvement solution Sustain improvement

Switch

Service that enables the exchange of information across multiple independent enterprises that have unilateral independent exchange data and in which there is no access to PHI

Migration path

Strategic plan that identifies applications, technology and operational elements needed for the overall information technology program in a healthcare entity

Concept res ispa loquiter

"burden of proof" The thing speaks for itself

days in accounts receivable

(ending accounts receivable balance) / (average day's revenue)

Technical Safeguards

-technology and related polices that protect data from unauthorized access

Given the information provided, the case-mix index would be:

0.8808 The weight of each MS-DRG is multiplied by the number of discharges for that MS-DRG to arrive at the total weight for each MS-DRG. The total weights are summed and divided by the number of total discharges to arrive at the case-mix index for a hospital. Calculation is as follows: (0.9139 × 10) + (0.7241 × 20) + (1.3167 × 10) + (0.9002 × 20) + (0.6868 × 10) = 61.66/70 = 0.8808 (White 2016a, 155-156).

clinical privileges are made for a period of no more than ____ years

2

to earn and maintain accreditation, a facility must undergo an on-site survey by a TJC survey team at least every _____ years

3

How long must health records be retained according to Medicare conditions of participation

5 years

frequency distribution

5-15 classes

A breach occurs when unsecured protected health information is accessed or released. The Secretary of HHS and local media must be notified if this threshold of patient records breached has been met or exceeded.

500

Temporary

A one-time revision that affects the budget in the current fiscal year only

What term is used to represent a difference between the budgeted amount and the actual amount of a line item that is not expected to reverse itself during a subsequent period?

A permanent variance

Characteristic of strategic management?

A plan to improve the healthcare entity's fit with the external world

Deliverables

A tangible output produced by the completion of project tasks

Unique Personal identifier

A type of information that refers to only one individual or organization

Resident Assessment Instrument (RAI)

A uniform assessment instrument developed by CMS to standardize the collection of skilled nursing facility patient data

During the voluntary review process, the performance of a healthcare entity is measured against:

Accreditation standards Accreditation is the act of granting approval to a healthcare organization. The approval is based on whether the organization has met a set of voluntary standards that were developed by the accreditation agency. The Joint Commission is an example of an accreditation agency (Shaw and Carter 2019, 330).

A coding supervisor audits coded records to ensure the codes reflect the actual documentation in the health record. This coding auditing process addresses the data quality element of:

Accuracy The quality of coded clinical data depends on a number of factors, including accuracy. Accuracy is ensuring that the coded data is free from error and a correct representation of the patient's diagnosis and procedures (Sharp and Madlock-Brown 2016, 197).

Component of PERT

Activities Events Goals

Claim management

Administrative and legal procedures initiated when adverse events occur

Elements of a contract

Agreement between two or more persons or entities and the agreement must include: A valid offer Acceptance Exchange of consideration

Regarding life-sustaining treatment and a patient's right of self-determination, courts have generally held that:

An incompetent adult has a right to the withdrawal of medical treatment if that incompetent adult, while competent, expressed his or her wishes and the state now determines that the evidence of those wishes is sufficient Competent adults have a general right to consent to/or refuse medical treatment. If an adult has a sound mind or did when he or she created a living will, this patient has the right to refuse treatment (Klaver 2017c, 154-155).

This federal agency is charged with responsibility for the oversight and enforcement of the HIPAA privacy regulations. a. The Office of the National Coordinator for Health Information Technology b. The Centers for Medicare and Medicaid Services c. The HHS Office of Civil Rights d. The HHS Office of the Inspector General

Answer: C The Office of Civil Rights of the Department of Health and Human Services has been given responsibility for the oversight and enforcement of the HIPAA regulations

Plan-do-check-act(PDCA)

Based on recurring improvement cycles Plan for improvements Do the improvement actions Check the results Act on the evidence

Change management includes

Being able to listen to staff

Private (civil) law

Concerns the rights and duties between private parties businesses, non-criminal law torts, contracts, intellectual property

Coded Data

Data that is translated into standard nomenclature of classification so that it may be aggregated, analyzed and compared.

Proof of malpractice or negligence requires the following elements to be present

Duty Breach Proximate cause Harm or damages

Used when two conditions cannot occur together

Excludes 1

Stark Law

Federal physician self-referral statue

Annual renewal of fire safety and disaster preparedness are topics that may be addressed best through training known as:

In-service education In-service education is a continuous process that builds on the basic skills learned through new employee orientation and on-the-job training. It is concerned with teaching employees specific skills and behaviors required to maintain job performance (Patena 2016, 762).

Financial statement that reflects the extent to which a healthcare entity's revenue exceed its expenses?

Income statement

Capital Budgets

Larger dollar purchases, useful life of one fiscal year

The key to an effective retention and retrieval system of health records in a facility is:

Master patient index The master patient index (MPI) is a permanent database including every patient ever admitted to or treated by the facility. Even though patient health records may be destroyed after legal retention periods have been met, the information contained in the MPI must be kept permanently (Reynolds and Sharp 2016, 129).

record retention

Medicare COP requires record retention of 5 years

Comprehensive assessment for adult home care patient and forms the basis for measuring patient outcomes

OASIS

Utilization management

Oversight/management of healthcare costs, usually required by the payer

Reviews the claim for errors using predetermined criteria

PC grouper or claim scrubber software

1. Learn what information has been collected about them 2. View and have a copy of that information 3. Maintain limited control over the disclosure of that information to other persons or entities

Privacy Act

The statement "Coding of inpatient records must be completed at a 98 percent accuracy rate" is an example of a:

Qualitative standard Qualitative standards specify the level of service quality expected from a function, such as accuracy rate. For example, assignment of diagnostic and procedure codes for inpatient records is at least 98 percent accurate (Revoir and Davis 2016, 799-800).

Line graph

Shows process over time

Who is responsible for charge capture?

Staff

A measure of variability that describes the deviation from the mean of a frequency distribution in the original units of measurement is called the:

Standard deviation The standard deviation (SD) is the square root of the variance. As such, it can be more easily interpreted as a measure of variation. If the SD is small, there is less dispersion around the mean. If the SD is large, there is greater dispersion around the mean (Horton 2017, 231).

Identified serious problems and inconsistencies in medical education

The Flexner Report

For a contract to be valid, it must include three elements.

The elements of a contract must be stated clearly and specifically. A contract cannot exist unless all the following elements exist: there must be an agreement between two or more persons or entities and the agreement must include a valid offer, acceptance, and exchange of consideration (Rinehart-Thompson 2016, 56).

To be successful, any information system tactical plan must align with:

The healthcare entity's strategic plan It is critical that the organization's information system (IS) plans be well aligned and integrated with its overall organizational strategic plans. To develop a tactical plan for IS technology, the healthcare organization should engage in strategic IS planning (Amatayakul 2016, 389).

Systems thinking focuses on an understanding of which of the following?

The relationships among parts and processes of the healthcare entity and how they work together A critical element of systems thinking is viewing an organization as an open system of interdependencies and connectedness rather than a collection of individual parts and professional enclaves. This approach sees interrelatedness as a whole and looks for patterns rather than snapshots of organizational activities and processes (Shaw and Carter 2019, 30).

Assault

Threat coupled with the ability to do physical harm

Interrater

To ensure quality of data, the cancer committee reviews the abstracting done by the cancer registry personnel.

What is the debt ratio?

Total liabilities/total assets

True or false: Individuals do not have the right to access to psychotherapy notes

True

The administrative simplification portion of Title II of HIPAA addresses which of the following?

Uniform standards for transactions and code sets

An EKG tracing is an example of ________ data.

Vector Graphic Physiological signal processing systems, such as ECG, EEG, and FHR tracing systems, store data based on the body's signals and create output based on the lines plotted between the signals' points. The data type used by these systems is referred to as signal tracing or vector graphic data (Sandefer 2016a, 358).

Data dictionary

When characteristics of each data element are defined

cross-sectional study

a biomedical research study in which both the exposure and the disease outcome are determined at the same time in each subject

malfeasance

a wrong or improper act

tort

action brought when one party believes that another party caused harm through wrongful conduct and seeks compensation for that harm

data content standards

allow data to be shared in a uniform way--clear guidelines for the acceptable values for specified data fields--allows users to interpret data in the same way

data steward

an individual appointed with responsibility and accountability for data, usually in a specific domain

e-health

application of e-commerce in healthcare

components of quality

appropriateness, technical excellence, accessibility, acceptability

The diagnosis is coded as confirmed, unless the classification provides a specific entry

borderline

Net present value

considers time value of money

primary purpose for documenting and maintaining health records

effective communication among caregivers for continuity of care

Business Intelligence (BI)

end product or goal of knowledge management

improper performance of an act

misfeasance

Strategic management

pg.122

Data values should be just large enough to support the application or process

precision

EMR

record for use within one single organization

one sample t-test

used to compare a population to a standard value

Qui Tam relators

whistleblower provisions of False Claims Act which provides that private persons (relators) may enforce the Act by filing a complaint, under seal, alleging fraud committed against the government

Process of studying the amount of work accomplished and the amount of time it takes to accomplish it

work measurement

fee schedule

A list of charges or established allowances for specific medical services and procedures

mapping

process of associating concepts from one coding system with concepts from another coding system and defining their equivalence in accordance with a documented rationale and a given purpose

data modeling

process of determining the users' information needs and identifying relationships among the data

False Claims Act

prohibits contractors from making a false claim to a governmental program; used to reinforce prevention of healthcare fraud and abuse

Federal anti-kickback statute

prohibits payment in exchange for referrals of federally payable services Knowingly, willingly offering to: - Pay, solicit, receive remuneration in exchange for referrals, other deals, in cash or in kind

Business Record Exception

rule under which a record is determined to NOT be hearsay if it was made at or near the time, by or from information transmitted by, a person with knowledge; it was kept in the course of a regularly conducted business activity; it was the regular practice of that business activity to make the record (ex. health records fall into this category because it's regular practice for hospitals to keep them)

database

tool used to collect, retrieve, report, and analyze data. cannot function without management system to manipulate and control data it stores--stored in one place and accessed by many systems

average length of stay

total los/total discharges

Respondent superior

Let the master answer

LOINC codes

Logical Observation Identifiers, Names, and Codes. used for identifying lab test results

Which type of architecture has one powerful central computer that performs all processing and storage functions while sending and receiving data to or from various terminals and printers?

Mainframe

contingency plan

documentation of the process for responding to a system emergency, including performance of backups, line-up of critical alternative facilities to facilitate continuity of operations, and the process of recovering from a disaster; recovery plan in the event of power failure, disaster, or other emergency that limits or eliminates access to facilities and ePHI; details how to handle a situation that may or may not happen

Consultation report

documented findings or recommendation for further treatment by a physician and specialist

compliance projects

include self-imposed initiatives organizations place on themselves, industry imposed compliance where organizations must meet a minimum level of stakeholder expectations, and government or regulatory compliance that organizations must meet in order to remain in business

Immunization records, birth, death and surgical registries and the MPI should be retained ________.

indefinitely

relative risk (RR)

ratio that compares risk of disease between two groups

data

raw facts generally stored as characters, words, symbols, measurements, or statistics

Made up of a series of fields about one person or thing

record

disaster recovery plan

document that defines the resources, actions, tasks, and data required to manage the business recovery process in the event of a business interruption; concerned with restoring information systems and operations to the state they were in prior to the disaster

Res judicata

"Matter already judged"; a legal doctrine that bars litigation between the same parties on matters already determined in a former lawsuit In the case of res judicata, the matter cannot be raised again, either in the same court or in a different court. A court will use res judicata to deny reconsideration of a matter.

external audit

An evaluation conducted by one organization, such as a CPA firm, on another.

Identifying user information needs is part of the ______analysis phase of systems development life cycle

Analysis

What type of data display tool is used to display discrete categories?

Bar graph Discrete data are whole numbers that may or may not be related, so a bar graph is the best data display tool to use (Shaw and Carter 2019, 76).

The natural balance of which one of the following accounts is a credit? A. Accounts receivable B. Expenses C. Fund balance D. Equipment

C

An application that contains rules to support and advise care providers about treatment alternatives

CDS

Changes and updates to ICD-10-CM are managed by the ICD-10-CM Coordination and Maintenance Committee, a federal committee cochaired by representatives from the NCHS and:

CMS

What is a characteristic of commercial healthcare insurances?

For-profit in the private sector

Uniform Electronic Transaction Act (UETA)

Makes electronic transactions as enforceable as paper transactions

Term used to describe breaking data elements into the level of detail needed to retrieve the data?

Normalization

In the data warehouse, the patient's last name and first name are entered into separate fields. This is an example of what?

Normalization Normalization is a formal process applied to database design to determine which variables should be grouped in a table to reduce data redundancy. In this example, entering the patient's last name and first name into separate fields is normalization (Johns 2015, 132).

This Health Information Exchange (HIE) consent model requires the patient to give their consent for the inclusion of their data in the HIE. What type of consent model is this an example of:

Opt-in The opt-in model requires patients to specifically affirm their desire to have their data made available for exchange within an HIE. This option provides up-front control for patients since their data cannot be included unless they have agreed (Biedermann and Dolezel 2017, 306).

1:1 relationship

Patients to hospital beds

Ratio data

Property of equal differences between numbers but also distinguished by the fact that the value of 0 indicates absence of the trait being measured.

Document imaging is preformed in which stage?

Record creation, capture or receipt

X12N

Referring to standards adopted for electronic data interchange

Type 1 error

Rejection of a true null hypothesis

Regulation

Rule established by an administrative agency of government

Plan that addresses long term needs and sets comprehensive plans of actions:

Strategic plan

Which statement is made by one party to induce another party to enter into a contract?

Warranty

capitation

a specified amount of money paid to a health plan or doctor, used to cover the cost of a health plan member's healthcare services for a certain length of time

facility charge

allows the capture of an E/M charge that represents those resources not included with the CPT code for the clinic environment

original documents must be produced in a legal proceeding

best evidence rule

A system of assigning code numbers to diseases and operations

classification

structured plans of care

clinical pathways

Fiscal Intermediary

contractor that manages the health care claims

punitive damages

damages awarded to punish or deter wrongful conduct over and above compensation for injury

big data

data sets so large and complex that new tools for analysis are required

developed 14 principles and 7 deadly diseases

deming

implied warranty

exists when law implies warranty exists "as matter of public policy" to protect public from harm

Has ultimate legal authority and responsibility for the operation of the hospital, including the quality and cost of care

governing board

persuasive content of the message

information

private communication

one-to-one communication that involves just a few individuals about work matters

slander

spoken defamation

Respondeat Superior

"let the master answer"--puts responsibility on the employer for negligent actions of employees. AKA vicarious liability

subpoena duces tecum

"production of evidence"; instructs recipient to bring documents and other records to a deposition or court

Based on the financial data listed, what was Triad's total net assets before posting net income for the year? Cash - $500,000 A/R - $250,000 Building - $1,000,000 Land - $700,000 A/P - $350,000 Mortgage - $600,000 Revenue - $2,500,000 Expenses - $2,250,000

$1,500,000 In a not-for-profit environment, the difference between assets and liabilities is referred to as net assets. These relationships can be expressed in the following equation: Assets − Liabilities = Net assets (equity) In this example, add the assets (cash $500,000 + A/R $250,000 + building $1,000,000 + land $700,000 = $2,450,000) and then subtract the liabilities (A/P $350,000 + mortgage $600,000 = $950,000) or $2,450,000 − $950,000 = $1,500,000 (Revoir and Davis 2016, 842-843).

Using the information provided, this participating physician, who accepts assignment, can expect how much reimbursement from Medicare? Physician's normal charge = $340 Medicare fee schedule = $300 Patient has met his deductible

$240 Nonparticipating providers (nonPARs) do not sign a participation agreement with Medicare but may or may not accept assignment. If the nonPAR physician elects to accept assignment, he or she is paid 95 percent (5 percent less than participating physicians). For example, if the MFS amount is $200, the PAR provider receives $160 (80 percent of $200), but the nonPAR provider receives only $152 (95 percent of $160). In this case, the physician is participating so he or she will receive 80 percent of the MFS or $240 (80 percent of $300) (Casto 2018, 144, 320-321).

Based on the financial data listed above, what was Triad's net income? Cash - $500,000 A/R - $250,000 Building - $1,000,000 Land - $700,000 A/P - $350,000 Mortgage - $600,000 Revenue - $2,500,000 Expenses - $2,250,000

$250,000 The net income is based only on the arithmetic difference between total revenue and total expenses of the current fiscal year. The difference between the total revenue of $2,500,000 and the total expenses of $2,250,000 is $250,000 (Revoir and Davis 2016, 849).

current ratio

(total current assets) / (total current liabilities)

The three levels of communication important to successful EHR implementation among internal stakeholders include:

- Between executive leadership, stakeholders, and vendors - From stakeholder to stakeholder - Between executive leadership and internal stakeholders Through the system implementation, stakeholders should be kept apprised of the project status. This is important to ensure the various users begin to understand the project and do not get the feeling that it is happening in a vacuum. Communication can be accomplished through formal and informal methods. Communication between stakeholders and standards setting organizations would not occur during system implementation (Biedermann and Dolezel 2017, 261).

What is included on the charge description master (CDM).

- The CDM maintenance committee should review new technology items for FDA approval. - The CDM maintenance committee should review new technology items for OPPS pass-through assignment. - The CDM maintenance committee should have a professional coder review code assignments even if codes are suggested by the manufacturer. The process for adding a new technology into the charge description master (CDM) includes reviewing new technology for FDA approval, for OPPS pass-through assignment, and also to have a coding professional check the codes from the manufacturer for accuracy (Schraffenberger and Kuehn, 2011, 234).

Physical Safeguards

-make sure data is physically protected =security systems and video surveillance, door and window locks, locations of servers and computers -polices about mobile devices and removing hardware and software from certain locations

Device and media controls

-physical safeguards -requires covered entities to develop policies and procedures that will guard the electronic protected health information (EPHI) on both hardware and movable media

Administrative Safeguards

-polices and procedures that help protect against a breach -determine documentation processes, roles, and responsibilities, training requirements, data maintenance policies and more -ensure that physical and technical protections are implemented properly and consistently -document retention

4 general rules of security

1.) Ensure the confidentiality, integrity and availability of all electronic PHI 2.) Protect against reasonably anticipated threats or hazards 3.) Protect against reasonably anticipated non-permitted uses or disclosures 4.) Ensure compliance of regulations by workforce

3 part PHI test

1.) identify person or provide reasonable basis to believe person could be identified from given information 2.) relate to one's past, present, or future: physical/mental health condition, provision of care, or payment for provision of care 3.) held or transmitted by covered entity or business associate

What would be an indicator of process problems in a health information department?

18% error rate on abstracting data Performance measurement is the process of comparing the outcomes of an organization, work unit, or employee to pre-established performance standards. The results of performance measurement are usually expressed as percentages, rates, ratios, averages, or other quantitative assessment. It is used to assess quality and productivity in clinical and administrative services. An 18 percent error rate on abstracting data is an indicator of a process problem in the health information management (HIM) department because it is an HIM function. The other items are not under the control of the HIM department and would not indicate a process problem in HIM (Oachs 2016, 803).

At a cost of $12,000, Community Hospital is refinancing the mortgage on the building that houses its clinic. The hospital will save $500 a month in interest. What is the payback period on the refinancing?

2 years The payback period is the time required to recoup the cost of an investment. Mortgage refinancing analysis frequently uses the concept of payback period. Mortgage refinancing is considered when interest rates have dropped. Refinancing may require up-front interest payments, called points, as well as a variety of administrative costs. In this example, the payback period is the time it takes for the savings in interest to equal the cost of the refinancing. For this problem, it is asking how long it will take to pay back the money spent to refinance. The hospital is spending $12,000 to refinance and will save $500 a month once they do. The payback period, or time to recoup their costs, is $12,000/$500 = 24 months or two years (Revoir and Davis 2016, 866-867).

There were 25 inpatient deaths, including newborns, at Community Memorial Hospital during the month of June. The hospital performed five autopsies during the same period. The gross autopsy rate for the hospital for June was:

20% A gross autopsy rate is the proportion or percentage of deaths that are followed by the performance of autopsy. Using this data, five patients had autopsies performed out of the 25 deaths; therefore, 5/25 = 0.2 × 100 = 20% (Edgerton 2016, 498).

Suppose that you are purchasing shelving units. The department has planned for units that are 5 shelves high, and each shelf is to be 36 inches wide and have 33 inches of actual filing space. From a sampling of records in the current files, you have determined that the average thickness of each record is 2 inches. You are planning to store 10 years' worth of records, and the average discharge rate is 2,000 per year. How many shelving units do you need to purchase?

243 The estimated number of file shelves needed is based on several factors. One consideration is the average size of individual records. The volume of patients and the number of repeat visits or readmissions affect the potential expansion of each individual patient record. The type of facility also affects the size of individual records. For this equation, multiply anticipated discharges by projected number of years (2,000 × 10 years = 20,000). Because records average a 2-inch thickness, 40,000 filing inches are needed (20,000 × 2 = 40,000). Because each 5-shelf unit will have 165 linear filing inches available (33 × 5 = 165), the number of inches needed, 40,000, must be divided by 165 to determine the number of filing units that must be purchased, which will be 243 (242.4) (Reynolds and Sharp 2016, 133).

The HIM director is performing a staffing analysis to determine the number of employees needed to prep, scan, index, and carry out quality control on scanned medical records. Given a turnaround time of 24 hours and an average number of 48,000 images to be captured and considering the benchmarks listed here, what is the least number of employees the department needs, with each employee working an eight-hour shift?

25 employees The staffing level is determined by dividing the number of images by the expected productivity. An FTE is the total number of workers, including part-time, in an area as the equivalent of full-time positions. Divide 48,000 by maximum standard work per hour for each function then add up the calculated hours for each function and divide by 8 (Horton 2017, 186-187).

What is the standard increment in days that most healthcare entities use for the aging of accounts?

30 day increments

According to the records kept on filing unit performance over the past year, the filing unit has filed an average of 1,000 records per day. There are three full-time equivalent (FTE) record filers in the department who are productive 88 percent of each workday (that is, 12 percent unproductive or 12 percent PFD). Based on this information, the average number of records filed per productive hour per FTE is:

48 records per hour First calculate the number of productive hours in a day: 88% × 8 hours = 7.04 hours/day. Then determine the number of records filed per record filer: 1,000/3 = 333.3. Then divide 333 records/7 hours = 47.5 or 48 charts/hour per productive FTE (Oachs 2016, 805-806).

A coding service had 400 discharged records to code in March. The service coded 200 within 3 days, 100 within 5 days, 50 within 8 days, and 50 within 10 days. The average turnaround time (TAT) for coding in March was:

5 days The average turnaround time was calculated by dividing the total response days attributed to the volume of routine requests that were responded to within the reporting period by the volume of routine requests responded to. The calculation is: (200 × 3) + (100 × 5) + (50 × 8) + (50 × 10)/400 = 5 days (Oachs 2016, 805).

Community Memorial Hospital had 25 inpatient deaths, including newborns, during the month of June. The hospital had a total of 500 discharges for the same period, including deaths of adults, children, and newborns. The hospital's gross death rate for the month of June was:

5% The gross death rate is the proportion of all hospital discharges that ended in death. It is the basic indicator of mortality in a healthcare facility. The gross death rate is calculated by dividing the total number of deaths occurring in a given time period by the total number of discharges, including deaths, for the same time period: 25/500 = 0.05 × 100 = 5% (Palkie 2016b, 296).

Community Memorial Hospital discharged nine patients on April 1. The length of stay for each patient is shown in the following table. The average length of stay for these nine patients was: Patient - Number of days A - 1 B - 5 C - 3 D - 3 E - 8 F - 8 G - 8 H - 9 I - 9

6 days The average length of stay (ALOS) is calculated from the total LOS. The total LOS divided by the number of patients discharged is the ALOS. Using the data provided, the ALOS for the 9 patients discharged on April 1 is 6 days (54/9) (Glewwe-Edgarton 2016, 493).

In January, Community Hospital had 57 discharges from its medicine unit. Four patients developed urinary tract infections while in the hospital. What is the hospital-acquired infection rate for the medicine unit for January?

7% The hospital-acquired infection rate is (4 × 100)/57 = 400/57 = 7.0%. Hospital-acquired (nosocomial) infection rates may be calculated for the entire hospital. They also may be calculated for the specific types of infections. Ideally, the hospital should strive for an infection rate of 0.0 percent (McCann 2016, 499).

Community Memorial Hospital discharged nine patients on April 1st. The length of stay for each patient is shown in the following table. What is the mode length of stay for this group of patients? Patient - Number of Days A - 1 B - 5 C - 3 D - 3 E - 8 F - 8 G - 8 H - 9 I - 9

8 days The mode is used to indicate the most frequent observation in a frequency distribution. In this data set there are three occurrences of the value 8 and only two or less occurrences of any other value, so 8 is the mode (Edgerton 2016, 486).

A Gantt chart is useful in which of the following management activities? A. Scheduling B. Recruitment C. Purchasing D. Workflow

A

A database rule that states "patient gender must be recorded as M=male, F=female, and U= unknown" is referred to as: A. Integrity constraint B. Authorization management C. Knowledge management D. Data map

A

A hospital is reviewing the quantity and type of resources being used in the provision of chemotherapy treatments. This is an example of: A. FOCUS-PDCA review B. Accreditation review C. Medication reconciliation D. Utilization management review

A

A transcription manager is assigned to a project team that is implementing a voice-recognition system. He reports to the director of health information services for regular job functions and to the project manager for tasks related to the project. This is an example of which type of project management structure? A. Matrixed B. Projectized C. Functional D. Hybrid

A

As the corporate director of HIM Services and enterprise privacy officer, you are asked to review a patient's health record in preparation for a legal proceeding for a malpractice case. The lawsuit was brought by the patient 72 days after the procedure. Health information contains a summary of two procedures that were dictated 95 days after the procedure. The physician in question has a longstanding history of being lackadaisical with record completion practices. Previous concerns regarding this physician's record maintenance practices had been reported to the facility's Credentialing Committee. Are the summaries of the two procedures admissible in court? A. This information could be rejected since the physician dictated the procedure note after the malpractice suit was filed. B. This information will be admissible in court because it is part of the patient's health record. C. This information could be rejected because it is not relevant to the malpractice case. D. This information will be rejected because the patient did not authorize its release.

A

At the end of March, the HIM department has a YTD payroll budget of $100,000. The actual YTD amount paid is $95,000 because a coder resigned in February. For the past two months, the position has been filled through outsourcing. Therefore, the actual YTD amount for consulting services is $5,000, although no money was budgeted for consulting services. The reporting threshold for variances is 4%. The fiscal year-end is December. What is the best description of the payroll variance for this year? A. Favorable, permanent B. Unfavorable, permanent C. Favorable, temporary D. Unfavorable, temporary

A

Barbette, director of HIM, writes a proposal for an electronic chart tracking system. She states that the purchase of the $30,000 system will save approximately $9000 per year in personnel time. She has conducted a: A. cost-benefit analysis B. break-even analysis C. cost-effectiveness analysis D. payback period

A

Nurse Bob wants a multidisciplinary approach to outline individualized patient goals and an appropriate time frame for expected optimal efficiency patient care. Which should he use? A. Critical pathways B. Clinical protocols C. Critical guidelines D. Clinical pathways

A

Of the following disclosures of PHI, which one allows an individual the option to agree or disagree with the disclosure of the information? A. Facility directory B. Treatment, payment, and operations C. Workers' compensation D. Information regarding decedents

A

The HIM Manager at Anywhere Hospital has contracted with an outside vendor to handle the complete cancer registry function for the facility. This type of contract for services would be considered: A. full service B. project based C. temporary D. specialty function

A

The HIM manager is conducting a study that compares the ICD-9-CM and ICD-10-CM diabetes mellitus codes and documents variations in order to assess the impact on the organization. This process creates a: A. Data map B. Data dictionary C. Data chargemaster report D. Database management system

A

The MPI is necessary to physically locate health records within the paper-based storage system for all types of filing systems except which of the following? A. Alphabetical B. Middle-digit C. Terminal-digit D. Straight numerical

A

The designated record set: A. Must be maintained outside a covered entity B. Includes incident reports C. Includes medical and billing records D. Is not used to make decisions about an individual

A

The members of which group are responsible for recommending clinical privileges to the governing body? A. executive committee B. medical staff C. credentialing coordinator D. credentialing staff

A

The performance standard to"Deliver the record to the requester of a STAT request within 10 minutes of receiving the request" is an example of a: A. Quality standard B. Quantity standard C. Joint Commission standard D. Compliance standard

A

The primary purpose of a Minimum Data Set in healthcare is to: A. Recommend common data elements to be collected in health records B. Mandate all data that must be contained in a health record C. Define reportable data for federally funded programs D. Standardize medical vocabulary

A

Using the information provided, if a participating physician accepts the assignment then what is the patient's liability to the physician? Physician's normal charge = $340 Medicare Fee Schedule = $300 Patient has met his deductible. A. $60 B. $100 C. $160 D. The patient has no further financial liability.

A

What information might be displayed on a histogram? A. Discharges by age B. Discharges by sex C. Discharges by third-party payer D. Discharges by service

A

Which of the following ensures that procedures are in place to handle an emergency response in the event of an untoward event such as a power outage?

A contingency plan The contingency plan standard is central to being able to ensure availability of data. The standard requires covered entities to establish and implement as-needed policies and procedures for responding to an emergency or other occurrence. These policies and procedures include a data back up plan, disaster recovery plan, and emergency mode operation plan. An environmental risk plan is not part of the implementation specification (Biedermann and Dolezel 2017, 387).

An HIM professional violates privacy protection under the HIPAA Privacy Rule when he or she releases ________ without specific authorization from the patient(s) or patient representative(s).

A list of newborns to the local newspaper for publication in the birth announcements section The Privacy Rule provides patients an opportunity to agree or object to specific types of disclosure. These do not require a written authorization; verbal authorization is acceptable. However, communication with the patient regarding these types of disclosures and the patient's decision should be documented in the health record or other appropriate manner of documentation (Brinda and Watters 2016, 317).

What is a characteristic of strategic management?

A plan to improve the healthcare entity's fit with the external world Strategic management is a process a leader uses for assessing a changing environment to create a vision of the future, determining how the organization fits into the anticipated environment based on its mission, vision, and knowledge of its strengths, weaknesses, opportunities, and threats, and then setting in motion a plan of action to position the organization accordingly (Gordon and Gordon 2016, 928).

Violation of the AHIMA Code of Ethics triggers:

A review by peers with potential disciplinary actions A formal code of ethics ensures that professionals understand and agree to uphold an ethical standard that puts the interests of the profession before their personal interests. Violation of the AHIMA Code of Ethics triggers a peer review process (Gordon and Gordon 2016, 915).

HIPAA mandated that healthcare business partners and covered entities implement a common standard for data and information transfer

ASC X12N

Reviewing claims to ensure appropriate coding for deserved payments is one method of:

Achieving legitimate optimization When coders "optimize" the coding process, they attempt to make coding for reimbursement as accurate as possible. In this way, the healthcare facility can obtain the highest dollar amount justified within the terms of the government program or the insurance policy involved (Hunt 2016, 286).

Damages awarded in a malpractice negligence case intended to restore the person to her position before the injury occurred is known as:

Actual damages

ADT Interface

Admission Discharge Transfer (ADT) Interface Used to maintain MPI Covers a lot of use cases such as admissions, cancellation of admits, merging of patient data, etc.

Staff Model

All providers work in the same facility. HMOs use this model to employ a comprehensive set of service providers all who work in the same location

A comprehensive retrospective review should be conducted at least once a year of what aspect of the CDI program?

All query opportunities During a clinical documentation improvement quality review, an organization should track and monitor the following elements: validity of queries generated, validity of working DRG assignment, validity of CDI specialist's assignment, and missed query opportunities (Hess 2015, 210).

Community Hospital is evaluating the following three investments. Which one has the highest profitability index?

All three are equally profitable In this case, a profitability index helps the organization prioritize investment opportunities. For each investment, divide the present value of the cash inflows by the present value of the cash outflows. The profitability index for each investment is calculated in the figure below. Each investment is equally profitable, as all three have the same profitability index of 4 (Revoir and Davis 2016, 868).

City Hospital's HIPAA committee is considering a change in policy to allow hospital employees who are also hospital patients to access their own patient information in the hospital's EHR system. A committee member notes that HIPAA provides rights to patients to view their own health information. However, another member wonders if this action might present other problems. In this situation, what suggestion should the HIM director provide?

Allowing employees to access their own records using their job-based access rights appears to violate HIPAA's minimum necessary requirement; therefore, allow employees to access their records through normal procedures. Allowing employees of a covered entity to access their own protected health information electronically results in a situation in which the covered entity may be in compliance with parts of the HIPAA Privacy Rule, but in violation of other sections of the Privacy Rule. An ideal situation would be to establish a patient portal through which all patients may view their own records in a secure manner, and for which an employee has neither more or less rights than any other patient (Thomason 2013, 109).

As part of a large PI initiative that is occurring in a hospital, the PI team is tasked with presenting their findings to hospital administration. The PI team presents data on the number of urinary tract infections (UTIs) that were documented and coded at the facility. Hospital administration finds this information interesting but are unclear as to what the data means to the organization. Why is the hospital administration unclear about this data?

Although the data provides important information regarding infections, the context of the data was missing from the presentation Data are only meaningful in context. They must be formatted, filtered, and manipulated to be transformed into information and knowledge that can be acted on for decision-making in PI programs. In this scenario, the PI team did not provide the context regarding the data to administration in their presentation. These UTIs could have been HAIs, or patients could have been admitted to the facility with the UTI, so administration does not know why they should be concerned (Shaw and Carter 2019, 348).

Conversion factor

An across-the-board multiplier that sets the allowance for the relative values - a constant

Vulnerability

An inherent weakness or absence of a safeguard that could be exploited by threat

Identifying user information needs is part of which phase of the systems development life cycle?

Analysis

Which of the following are phases of the systems development life cycle (SDLC)?

Analysis, design, and implementation Although there are many different models of the SDLC, all generally include a variation of the following four phases: analysis, design, implementation, and maintenance and evaluation. Alignment and improvement are not included in the four phases of the SDLC (Amatayakul 2017, 46).

University Medical Center contracts with the XYZ Corporation for a clinical information system. The hospital pays a fixed monthly fee. XYZ owns the hardware and hosts the application software using the Internet. The Medical Center accesses the system through onsite workstations. In this situation, XYZ Corporation is a(n): a. Application service provider b. Neural network c. Health information system database d. Clinician portal

Answer: A

Community Hospital wants to provide transcription services for transcription of office notes of the private patients of physicians. All of these physicians have medical staff privileges at the hospital. This will provide an essential service to the physicians as well as provide additional revenue for the hospital. In preparing to launch this service, the HIM director is asked whether a business associate agreement is necessary. Which of the following should the hospital HIM director advise to comply with HIPAA regulations? a. Each physician practice should obtain a business associate agreement with the hospital. b. The hospital should obtain a business associate agreement with each physician practice. c. Because the physicians all have medical staff privileges, no business associate agreement is necessary. d. Because the physicians are part of an Organized Health Care Arrangement (OHCA) with the hospital, no business associate agreement is necessary.

Answer: A If physicians were to dictate information on patients they are treating in the facility, the disclosure of protected health information to the transcriptionists would be considered healthcare operations and, therefore, permitted under the HIPAA Privacy Rule. If physicians, who are separate covered entities, are dictating information on their private patients, however, it would be necessary for physicians to obtain a business associate agreement with the facility. It is permitted by the Privacy Rule for one covered entity to be a business associate of another covered entity

The Security Rule leaves the methods for conducting the security risk analysis to the discretion of the healthcare entity. The first consideration for a healthcare facility should be: a. Its own characteristics and environment b. The potential threats and vulnerabilities c. The level of risk d. An assessment of current security measures

Answer: A Before an organization can decide on the methods for conducting the security risk analysis, they must consider their own characteristics and environment and implement reasonable and appropriate measures to protect against reasonably anticipated threats and hazards to the security of PHI. The security risk analysis process provides covered entities and business associates with the structural framework upon which to build their security plan

One strategy for acquiring EHR components from various vendors and interfacing them is: a. Best-of-breed b. Best-of-fit c. Dual core d. Integration

Answer: A Best-of-breed is when an organization has acquired the "best" products from various vendors. The result is that each individual organizational unit may be happy with its chosen product, but as the organization moves toward adding clinical components that rely on the various other systems as a source of data or to which data must be sent, the challenge to exchange such data can be overwhelming

A hospital currently includes the patient's social security number on the face sheet of the paper medical record and in the electronic version of the record. The hospital risk manager has identified this as a potential identity breach risk and wants the information removed. The physicians and others in the hospital are not cooperating, saying they need the information for identification and other purposes. Given this situation, what should the HIM director suggest? a. Avoid displaying the number on any document, screen, or data collection field b. Allow the information in both electronic and paper forms since a variety of people need this data c. Require employees to sign confidentiality agreements if they have access to social security numbers d. Contact legal counsel for advice

Answer: A It is generally agreed that Social Security numbers (SSNs) should not be used as patient identifiers. The Social Security Administration is adamant in its opposition to using the SSN for purposes other than those identified by law. AHIMA is in agreement on this issue due to privacy, confidentiality, and security issues related to the use of the SSN

Working with the healthcare entity's integration team to ensure that ADT interfaces are properly built and tested is the responsibility of the: a. MPI manager b. EHR analyst c. IT manager d. Electronic forms manager

Answer: A Monitoring and managing a master patient index (MPI) also requires constant vigilance from the organization, including oversight, evaluation, and correction of errors. The overall responsibility of maintaining the MPI should be centralized and given to an individual who is detail oriented, is properly trained, has access to adequate tools, and is well versed in the organization's policies and procedures for MPI maintenance. Working with the organization's integration team to ensure ADT interfaces are properly built and tested is a key responsibility of the MPI manager

An HIM professional violates privacy protection under the HIPAA Privacy Rule when he or she releases ________ without specific authorization from the patient(s) or patient representative(s). a. A list of newborns to the local newspaper for publication in the birth announcements section b. Data about cancer patients to the state health department cancer surveillance program c. Birth information to the country registrar d. Information about patients with sexually transmitted infections to the county health department

Answer: A The Privacy Rule provides patients an opportunity to agree or object to specific types of disclosure. These do not require a written authorization; verbal authorization is acceptable. However, communication with the patient regarding these types of disclosures and the patient's decision should be documented in the health record or other appropriate manner of documentation

An audit trail is a good tool for which one of the following? a. Holding an individual patient accountable for actions b. Reconstructing electronic events c. Defending the corporation against an IRS audit d. Stopping attacks from the intranet to the Internet

Answer: B An audit trail is a record that shows who accessed a computer system, when it was accessed, and what operations were performed. These can be categorized as follows: individual accountability, reconstructing electronic events, problem monitoring, and intrusion detection

A dietary department donated its old microcomputer to a school. Some old patient data were still on the microcomputer. What controls would have minimized this security breach? a. Access controls b. Device and media controls c. Facility access controls d. Workstation controls

Answer: B HIPAA requires the implementation of policies and procedures for the removal of hardware and electronic media that contain ePHI into and out of a facility. There are four implementation specifications within this standard: disposal, media reuse, accountability, and data backup and storage. In this case the organization did not follow policies for the removal of hardware and electronic media

A possible justification for building an information system in-house rather than purchasing one from a vendor is that: a. It is cheaper to buy than to build b. The facility has development teams they do not want to give up c. Integration of systems will be easier d. Vendor products are not comprehensive enough

Answer: B Most organizations recognize that commercial products can meet their needs and that most of these products will far surpass the functionality that could be self-developed. Still, some organizations want to at least consider the build option. Some physicians are intrigued with developing their own perfect system, and some hospitals have development teams they do not want to give up. An organization's decision to build or buy should be based on a careful review of the marketplace. Currently, it is more expensive to undertake self-development. Unless self-development is coupled with a vendor partnership that leads to commercialization, a selfdeveloped system can be a drawback when attempting to integrate with commercial products as the organization grows, merges, or acquires affiliates

Under the HIPAA Security Rule, these types of safeguards have to do with protecting the environment: a. Administrative b. Physical c. Security d. Technical

Answer: B Physical safeguards have to do with protecting the environment, including ensuring applicable doors have locks that are changed when needed and that fire, flood, and other natural disaster preparedness is in place (for example, fire alarms, sprinklers, smoke detectors, raised cabinets). Other physical controls include badging and escorting visitors and other typical security functions such as patrolling the premises, logging equipment in and out, and camera-monitoring key areas. HIPAA does not provide many specifics on physical facility controls but does require a facility security plan with the expectation that these matters will be addressed

Which of the following represents data flow for a hospital inpatient admission? a. Registration > diagnostic and procedure codes assigned > services performed > charges recorded b. Registration > services performed > charges recorded > diagnostic and procedure codes assigned c. Services performed > charges recorded > registration > diagnostic and procedure codes assigned d. Diagnostic and procedure codes assigned > registration > services performed > charges recorded

Answer: B The data flow for a hospital inpatient can begin in several ways. Data collection starts in the registration department if patients are a direct admission for their physician's office or hospital outpatient department. Data collection begins in the emergency room if the patients arrive at the hospital, are assessed in the emergency room, and are admitted as an inpatient. No matter where the data collection begins, the same patient demographic information is collected. During the course of the inpatient stay, patient care is delivered and data is captured. As care is delivered and procedures are performed, charges are entered either by nursing staff or the personnel performing the procedure. After the patient is discharged, diagnosis and procedure codes are assigned.

A hospital health information department receives a subpoena duces tecum for records of a former patient. When the health record professional goes to retrieve the patient's medical records, it is discovered that the records being subpoenaed have been purged in accordance with the state retention laws. In this situation, how should the HIM department respond to the subpoena? a. Inform defense and plaintiff lawyers that the records no longer exist b. Submit a certification of destruction in response to the subpoena c. Refuse the subpoena since no records exist d. Contact the clerk of the court and explain the situation

Answer: B Those who choose to destroy the original health record may do so within weeks, months, or years of scanning. If the record was destroyed according to guidelines for destruction and no scanned record exists, the certificate of destruction should be presented in lieu of the record

Employees, volunteers, trainees, and other persons performing functions on behalf of covered entities and business associates, whether paid or not, are considered to be: a. Consultants b. Workforce c. Immune from prosecution under HIPAA d. Vendors

Answer: B When applying HIPAA, covered entities must also consider members of their workforce who may not be limited only to employees. The Privacy Rules defines workforce as employees, volunteers, trainees, and other persons whose conduct in the performance of work for a covered entity (CE) or business associate is under the direct control of such CE or business associate whether or not they are paid by the CE or business associate

Jack Mitchell, a patient in Ross Hospital, is being treated for gallstones. He has not opted out of the facility directory. Callers who request information about him may be given: a. No information due to the highly sensitive nature of his illness b. Admission date and location in the facility c. General condition and acknowledgment of admission d. Location in the facility and diagnosis

Answer: C A facility may maintain a facility directory of patients being treated. HIPAA's Privacy Rule permits the facility to maintain in its directory the following information about an individual if the individual has not objected: name, location in the facility, and condition described in general terms. This information may be disclosed to persons who ask for the individual by name

Which of the following statements describes a critical skill for a strategic manager? a. Ability to change direction quickly b. Ability to deliver results on budget c. Ability to envision relationships between trends and opportunities d. Ability to design jobs and match peoples' skills to them

Answer: C Strategic managers develop skills reflecting the implications and opportunities afforded by trends. Whether reading a journal or discussing new ideas with others, strategic managers are always testing new ideas, identifying those that have merit, and discarding those that do not. They are creating links between the trends and the value-adding actions they can take

Sometimes federal and state health information privacy laws and regulations are in conflict. When this is the case one law must take precedence. For health information privacy this is determined as follows: a. The federal law always takes precedence b. The state law always takes precedence c. The law that gives the consumer greater rights with respect to their PHI takes precedence d. The facility can choose to follow either the state or federal law

Answer: C The Privacy Rule does not pre-empt or take precedence over the stricter or more stringent state statutes if the statutes provide individuals with greater privacy protections and give individuals greater rights with respect to their PHI

Placing locks on computer room doors is considered what type of security control? a. Electronic access control b. Workstation control c. Physical access control d. Security breach

Answer: C The facility security plan should document the use of physical access controls. To meet the implementation specification, organizations should consider methods such as lock and key controls, security tagging equipment, using video cameras for surveillance, monitoring identification badges, and the use of human workforce to perform facilities security checks

Linda Wallace is being admitted to the hospital. She is presented with a Notice of Privacy Practices. In the Notice, it is explained that her PHI will be used and disclosed for treatment, payment, and operations (TPO) purposes. Linda states that she does not want her PHI used for those purposes. Of the options listed here, what is the best course of action? a. The hospital must honor her wishes and not use her PHI for TPO. b. The hospital may decline to treat Linda because of her refusal. c. The hospital is not required to honor her wishes in this situation, as the Notice of Privacy Practices is informational only. d. The hospital is not required to honor her wishes for treatment purposes but must honor them for payment and operations purposes.

Answer: C Treatment, payment, and healthcare operations (45 CFR 164.501)—collectively referred to as TPO—are functions of a covered entity (CE) that are necessary for the CE to successfully conduct business. It is not the intent of the Privacy Rule to impose onerous rules that hinder a CE's functions. Therefore, many of the Privacy Rule's requirements are relaxed or removed where PHI is needed for purposes of TPO

The HIPAA methods titled Expert Determination and Safe Harbor are ways in which the following can be achieved legally. a. Data analysis b. Reidentification c. Deidentification d. Public health reporting

Answer: C Expert Determination and Safe Harbor are Office of Civil Rights sanctioned HIPAA Privacy Rule deidentification methods. Deidentified information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to deidentify information. (1) A formal determination is made by a qualified statistician. (2) The removal of specified identifiers of the individual and of the individual's relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual

Physicians use the ________ to access multiple sources of patient information within the healthcare organization's network. a. Data repository b. Clinical information system c. Data warehouse d. Clinician portal

Answer: D

This analytic technique is being used by CMS to assist in prepayment audits? a. Descriptive statistics b. Graphical analysis c. Exploratory data analysis d. Predictive modeling

Answer: D Predictive modeling applies statistical techniques to determine the likelihood of certain events occurring together. Statistical methods are applied to historical data to learn the patterns in the data. These patterns are used to create models of what is most likely to occur

Which request for proposal (RFP) component would fit the following description: Describe how your product supports the ability to register a patient in the clinic, admit the patient using the same health record number and demographic information, and share the medication list for medication reconciliation with the nursing home to which the patient is discharged. a. Application support b. Operational requirements c. Technical specifications d. Use case

Answer: D The use case is based on the organization's redesigned processes and ask the vendor how its products would perform the inherent functions. The approach is useful for avoiding yes and no responses.

Which legal doctrine was established by the Darling v. Charleston Community Hospital case of 1965? a. Hospital-physician negligence b. Clinical negligence c. Physician-patient negligence d. Corporate negligence

Answer: D Corporate negligence is a legal doctrine that was established by a judicial decision handed down in the 1965 court case Darling v. Charleston Community Hospital. The court in this case ruled specifically that hospital governing boards have a duty to institute a means to evaluate and council medical staff who personally perform services on a patient that results in harm due to unreasonable risk. Hospitals may be held liable when a member of the medical staff fails to meet established standards of patient care

University Medical Center contracts with the XYZ Corporation for a clinical information system. The hospital pays a fixed monthly fee. XYZ owns the hardware and hosts the application software using the Internet. The Medical Center accesses the system through onsite workstations. In this situation, XYZ Corporation is a(n):

Application service provider Application service providers (ASPs) are service firms that deliver, manage, and remotely host ("remote hosting" being a common term associated with ASPs) standardized (prepackaged) applications software through centralized servers via a network that are not exclusively but more commonly the Internet (Amatayakul 2016, 402).

Chi-square test

Assesses the degree of relationship or association between two qualitative or nominative variables to determine if there are differences between two or more groups with respect to the variable

Pearson correlation coefficient

Assesses the directions and degree of relationship between two continuous variables Positive- When one variable goes up so does the other Negative- When on variable goes up the other goes down

A clinical documentation improvement (CDI) program facilitates accurate coding and helps coders avoid:

Assumption coding A CDI program provides a mechanism for the coding staff to communicate with the physician regarding nonspecific diagnostic statements or when additional diagnoses are suspected but not clearly stated in the record, which helps to avoid assumption coding (Hess 2015, 42).

Non-repudation

Authentication of EHR - document cannot later be denied by originator or receiver

A hospital has experienced an increase in third-party payer denials for lack of pre-authorization for certain services. Which of the following departments should hospital administration scrutinize to ensure that proper procedures are in place? A. Utilization Management B. Patient Access C. Health Information Management D. Patient Accounts

B

According to TJC standards, a hospital is required to: A. provide charitable care to the indigent B. promote performance improvement C. employ an RHIA or RHIT D. review and update policies yearly

B

Allowing patterns of retrospective documentation, hiding or ignoring negative quality review outcomes, and hiding incomplete health records from accreditation surveyors are unethical behaviors for which of the following Code of Ethics principle? A. Advocate and uphold the right to privacy B. Put service before self-interest C. Represent the profession accurately to the public D. Respect the inherent dignity and worth of every person

B

Medicare requires that a history and physical examination be completed within what time frame after a patient's admission to a hospital? A. 12 hours B. 24 hours C. 48 hours D. 72 hours

B

The IT department of an academic medical center has created a project management office (PMO) in order to help manage the many projects relating to implementing an EHR that have been underway for a few years already. After a few months, the chief information officer is concerned that many tasks the PMO was expected to perform have not been accomplished. In addition, the chairs of the domain teams continue to work independently and directly with the vendor. The project management mistake illustrated in this scenario is: A. Lack of sponsorship B. Lack of ownership C. Lack of project manager D. Lack of project management software

B

Which one of the following facility types is required to release information under the Freedom of Information Act? A. Proprietary B. Military C. Private D. State

B

The financial statement that communicates the financial position of an organization at a certain point in time is called the:

Balance sheet A balance sheet is a snapshot of the accounting equation at a point in time (Revoir and Davis 2016, 849).

The following information was abstracted from Community Hospital's balance sheet. Total assets - $25,000,000 Current assets - $4,000,000 Total liabilities - $10,000,000 Current liabilities - $5,000,000 A vendor selling a large dollar amount of goods to this hospital on credit would:

Be somewhat concerned because the current ratio is less than one The current ratio compares total current assets with total current liabilities: 4,000,000/5,000,000=4/5=0.8 Total current assets/Total current liabilities From this information, one can take the current assets (cash + accounts receivable + inventory) divided by current liabilities (accounts payable) to arrive at current ratio. The current ratio indicates that for every dollar of current liability, $0.80 of current assets could be used to discharge the liability, which is not enough because it is not at least $1 (Revoir and Davis 2016, 852).

Change management includes:

Being available to listen to staff Communication is key to engaging others in the vision and change process. The communication plan must offer groups the opportunity to talk back. Listening to staff concerns through the process is an important element (McClernon 2016, 948-949).

External change agents have the advantage over internal agents regarding:

Benchmarking the healthcare entity against other entities The external change agent has the advantage of providing a fresh, outside view as well as having the knowledge base to compare performance across organizations. Not having direct connections to the organization, he or she usually feels more comfortable challenging norms and culture, questioning unusual or unfair practices, and generally noting events that others may be reluctant to comment on. Being from the outside, he or she may be seen as having new skills and being more objective, or at least less biased, than an internal agent (Swenson 2016, 705).

What would likely be recorded on an information systems issues log?

Betty reported receiving 25 erroneous email messages Because of the number of tasks and their complexity and dependencies in EHR implementation, it is important to have an issues management program. An issues management program serves to receive and document issues and track them to their resolution (Amatayakul 2017, 258).

In this EHR implementation strategy, virtually every nursing unit, department, clinic, or other organizational unit goes live at the same time with a given component of the EHR.

Big bang roll-out Big bang roll out is the implementation of all aspects of the EHR component (or entire EHR in an ambulatory setting) in all organizational units virtually simultaneously (Amatayakul 2017, 253).

What are the most common reasons for claim denials

Billing for non-covered services Lack of medical necessity Beneficiary not covered Coverage not in effect for date of service is not a most common reason for claims denials as effective dates of coverage are usually resolved in the front end of the revenue cycle or prior to submission of the bill to payers (Malmgren and Solberg 2016, 243).

Use of a variety of content delivery methods to accommodate different types of learners is called:

Blended learning Blended learning uses several delivery methods thereby gaining the advantages and reducing the disadvantages of each method alone (Patena 2016, 772).

Authorship Integrity

Borrowing record entries from another source as well as representing or displaying past documentation as current

Which one of the variances in the following scenario will the HIM director be required to explain? At the end of March, the HIM department has a YTD payroll budget of $100,000. The actual YTD amount paid is $95,000 because a coder resigned in February. For the past two months, the position has been filled through outsourcing. Therefore, the actual YTD amount for consulting services is $5,000, although no money was budgeted for consulting services. The reporting threshold for variances is 4 percent. The fiscal year-end is December.

Both the payroll and consulting services variances When the operating budget has been developed and approved, it is the responsibility of the department manager to ensure the budget goals are met and to explain all variances (Revoir and Davis 2016, 861).

Western States Medical Center consistently sends its HIM staff to AHIMA's component state association annual conference in an effort to provide continuing education and training for these employees. How does this investment in continuing education by Western States Medical Center support their commitment to quality?

By providing a culture of competence through staff development and learning Organizations that embrace ongoing performance improvement do so because their leaders foster a culture of competence through staff self-development and lifelong learning. The competitive advantage for healthcare organizations today lies in their intellectual capital and organizational effectiveness (Shaw and Carter 2019, 273).

A medical staff committee wants to compare long-term survival rates for breast cancer by comparing outcomes for the mastectomy versus lumpectomy approaches. The best source of this information is the: A. Disease index B. Operative index C. Cancer registry D. Master patient index

C

A visitor to the hospital looks at the screen of the admitting clerk's computer workstation when the clerk leaves her desk to copy some documents. What security mechanism would best have minimized this security breach? A. Access controls B. Audit controls C. Automatic logoff controls D. Device and media controls

C

An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." How should the coder proceed to code this case? A. Code sepsis as the principal diagnosis with urinary tract infection due to E. coli as secondary diagnosis. B. Code urinary tract infection with sepsis as the principal diagnosis. C. Query the physician to ask if the patient has septicemia because of the symptomatology. D. Query the physician to ask if the patient had septic shock so that this may be used as the principal diagnosis.

C

An adult patient's daughter who identifies herself as the patient's representative requests to access her father's health information. The patient has not been treated in this health care organization for the last three years. How should you respond to this request? A. Release the information to the patient's daughter because she said she is his representative. B. Deny the request because you need the patient's authorization even if the daughter is the legal representative. C. Determine whether the daughter has documentation that identifies her as the patient's representative. D. Wait until the patient comes in for treatment again, and then you can release the information

C

Electronic prescribing is used in: A. Computerized provider order entry B. Hospital order entry systems C. Physician's office prescription writing D. Pharmacy systems

C

The CEO needs a system to assist with strategic planning and making "what if" decisions. What is the information system that will best meet her needs? A. Executive information system B. expert system C. decision support system D. data warehouse

C

The first and most fundamental strategy for minimizing security threats is to: A. Establish access controls B. Implement an employee security awareness program C. Establish a security organization D. Conduct a risk analysis

C

The standard that requires covered entities and business associates to have an agreement regarding use, disclosure, and security of protected health information is the: A. Business Associate Agreement Standard B. Covered Entity Contracts and Other Arrangements Standard C. Business Associate Contracts and Other Arrangements Standard D. Covered Entity and Business Associate Agreement Standard

C

The technology that allows a healthcare organization to logically (or conceptually) link multiple physical data repositories is: A. MPI B. OLAP C. OLTP D. EMPI

C

When the Medicare Recovery Audit Contractor has determined that incorrect payment has been made to an organization what document is sent to the provider notifying them of this determination? A. Appeal request B. Claims denial C. Demand letter D. Medicare Summary Notice

C

Which of the following statements about compiling a directory of patients being treated in the hospital is true? A. A written authorization from the patient is required before any information about him or her is placed in a hospital directory of patients. B. Only the patient's last and first name may be placed in a directory without his or her consent or authorization. C. The covered entity must inform the individual what information is maintained in a directory and to whom this information may be disclosed. D. Because this is considered a normal hospital operation, an individual may not restrict or prohibit any uses of the directory.

C

Which of the following would be most beneficial in locating a charged-out medical record? A. outguide B. transfer notice C. requisition slip D. MPI

C

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. prospectively B. concurrently C. retrospectively D. ongoing

C

Provides healthcare services for dependents and survivors of disabled veterans, survivors of veterans who die from service-connected conditions, and survivors of military personnel who died in the line of duty

CHAMPVA

A powerful tool to support implementation of standard care plans, reduce errors, and guide clinicians to utilize best practices in their care planning sessions

CPOE

The term "hard-coding" refers to:

CPT codes that appear in the hospital's chargemaster During order-entry a unique identifier for each service is entered. This unique identifier triggers a charge from the chargemaster to be posted on the patient's account. This process is known as hard coding (Casto 2018, 236).

A director of health information services in a hospital wants to implement a computer-based patient record system over the next 2 years. She gets support from the CIO, who advocates for the project with the administrative team. The CIO has become the project's ________.

Champion The project champion is an executive in the organization who believes in the benefits of the project and advocates for the project. Depending on the overall impact the project has on the healthcare organization, this individual may be the manager of the HIM department or the director over the business unit where the HIM department resides, or it could be the chief operations officer (COO) (Olson 2016, 882).

If an analyst wishes to determine the root cause of claim denials during June via a random sample, what is the sampling unit?

Claim Sampling is used when examining the entire population is either too time consuming or too expensive. A sample is the subset of the population or universe. The universe is the set of all units that are eligible to be sampled. A listing of all of the subjects in the universe is called the sampling frame. The universe in a sampling plan may be patients, physicians, health records, or any other unit of analysis that is studied. In this case, the sample unit is the claim (White 2016a, 135).

Dr. Smith orders 500 mg of penicillin by mouth three times a day for Jane Doe, who is being seen in the hospital emergency department. The computer sends an alert to Dr. Smith to tell her the patient, Jane Doe, is allergic to penicillin. What type of computer system is Dr. Smith using?

Clinical decision support Clinical decision support systems refer to software that processes information to help users make a clinical decision. Clinical decision support systems can identify a potential problem (for example, a drug interaction or drug allergy) and issue an alert or a reminder that includes a recommendation for specific corrected action (Amatayakul 2017, 22-23).

What term refers to information that provides physicians with pertinent health information beyond the health record itself used to determine treatment options?

Clinical practice guidelines Clinicians use health record information to develop clinical pathways and other clinical practice guidelines, which help clinicians make knowledge- and experience-based decisions on medical treatment. These guidelines make it easier to coordinate multidisciplinary care and services (Fahrenholz 2017b, 77).

What is one way in which healthcare organizations can combat the resistance to change commonly experienced by employees during a transition?

Communicate openly with employees about all aspects of the change Left to their own thoughts and feelings and without sufficient information during this phase of organizational change, individuals may decide to escape their discomfort and confusion by leaving the organization. Resistance to change is a common threat to change. When the change process is understood, however, the transitional period can be a time of renewal and creativity (Shaw and Carter 2019, 381).

Community Hospital is reviewing its job descriptions and notices that some job descriptions for clinical positions include a reference to the potential risks of exposure to blood-borne pathogens while others do not. The human resource manager insists that all job descriptions should include this language. Why is this important to include?

Community Hospital needs to define the level of risk for infection from blood-borne pathogens for its employees Blood-borne pathogens, such as HIV and hepatitis B and C, are transported through contact with infected body fluids such as blood, semen, and vomitus. Each facility should define the employee level of risk for infection associated with their job classification and define the proper precautions needed to prevent exposure. Most healthcare facilities require employee job descriptions to carry a definition of blood-borne pathogen risk associated with the job task (Shaw and Carter 2019, 179).

Cost-effectiveness analysis

Compares non economic benefits such as fewer medication errors with the cost of a new system

Cost-benefit analysis

Compares the operating costs of the old system with the new system Break-even analysis payback period discounted payback period

Technology that electronically stores, manages, and distributes documents that are generated in a digital format and whose output data are report-formatted and print-stream originated is called:

Computer output laser disk (COLD) technology Computer output laser disk/enterprise report management (COLD/ERM) technology electronically stores, manages, and distributes documents that are generated in a digital format and whose output data are report-formatted and print-stream originated. COLD/ERM technology not only electronically stores the report-formatted documents but also distributes them with fax, e-mail, web, and traditional hard copy print processes (Sandefer 2016a, 350).

Computer output laser disk/enterprise report management (COLD/ERM) technology

Computer output laser disk/enterprise report management (COLD/ERM) technology electronically stores, manages, and distributes documents that are generated in a digital format and whose output data are report-formatted and print-stream originated. COLD/ERM technology not only electronically stores the report-formatted documents but also distributes them with fax, e-mail, web, and traditional hard copy print processes

Decision support system

Computerized system that gathers info from various sources and uses analytical models to assist providers in critical decision making

What is the most accurate statement regarding the relationship between levels of management and managerial skills?

Conceptual skills are greatest at the top level of management Conceptual skills, especially at the higher levels of the organization, include such competencies as visioning the organization, planning, decision making, problem solving, creativity, and conceptualizing the connections among parts of a complex organizational system or "systems thinking" (Swenson 2016, 681).

As a preliminary step in designing an IS strategy, it is important for the steering committee to conduct a scan of the external environment and to:

Conduct an internal environment assessment Challenges are those inevitable elements that pose barriers to achieving success with a health information system. Without recognizing them as early in the planning process as possible, it becomes very difficult to overcome them. An environmental scan is a process to formally identify challenges that considers both internal and external factors (Amatayakul 2016, 394-395).

Negligence

Conduct that is considered unreasonably dangerous, particularly if the danger was foreseen and the degree of harm was sufficient to require acting in a safe manner

Qualitative research

Conducted when little is known about the subject area and often provides the base for more focused quantitative studies. - Often used to assess perceptions, attitudes and relationships

A ________ is a range of values, such that the probability of that range covering the true value of a parameter is a set probability or confidence.

Confidence interval Basic healthcare operations questions may often be analyzed using confidence intervals or hypothesis tests. A confidence interval is a range of values, such that the probability of that range covering the true value of a parameter is a set probability or confidence (White 2016b, 513).

Serial work division

Consecutive handling of tasks or products by individuals who perform a specific function in sequence. Referred to as a production line work division, leads to task specialists

Derived data

Consists of factual details aggregated or summarized from a group of health records that provides no means to identify specific problems

Accession Number

Consists of the first digit of the year the patient was first seen at the facility with the remaining digits assigned sequentially throughout the year

What is a conflict management method in which both parties meet with an objective third party to explore their perceptions and feelings?

Constructive confrontation Conflict management focuses on working with the individuals involved to find a mutually acceptable solution. There are three ways to address conflict: compromise, control, and constructive confrontation. Constructive confrontation is a method in which both parties meet with an objective third party to explore their perceptions and feelings. The desired outcome is to produce a mutual understanding of the issues and to create a win-win situation (LeBlanc 2016, 744).

A core data set developed by the American Society for Testing and Materials (ASTM) to communicate a patient's past and current health information as the patient transitions from one care setting to another is:

Continuity of Care Record (CCR) Continuity of care record (CCR) is documentation of care delivery from one healthcare experience to another (Palkie 2016a, 162).

The Information Access Management Standard specifically requires that healthcare entities include specifications around:

Controlling access to a workstation, transaction, program, or process The information access management standard is focused on policies and procedures that, based upon the entity's access authorization policies, establish, document, review, and modify a user's right of access to a workstation, transaction, program, or process (Biedermann and Dolezel 2017, 386).

The director of the health information department wanted to determine the level of physicians' satisfaction with the department's services. The director surveyed the physicians who came to the department. What type of sample is this?

Convenience Researchers use convenience samples when they "conveniently" use any unit that is at hand. For example, HIM professionals investigating physician satisfaction with departmental services could interview physicians who came to the department (Forrestal 2016, 593).

Using the staff turnover information in this graph, determine the next action the quality council at this hospital should take.

Coordinate a PI team to look into the cause for the high employee turnover rate in year 3 The employee turnover rate is over the internal benchmark for this hospital, so a performance improvement (PI) team should be formed to determine what the causes for this increase were. This increase in the turnover rate represents an opportunity for improvement (Shaw and Carter 2019, 27-28).

Darling Vs. Charleston community hospital

Corporate Negligence. When a member of the medical staff fails to meet established standards of patient care.

Which legal doctrine was established by the Darling v. Charleston Community Hospital case of 1965?

Corporate negligence Corporate negligence is a legal doctrine that was established by a judicial decision handed down in the 1965 court case Darling v. Charleston Community Hospital. The court in this case ruled specifically that hospital governing boards have a duty to institute a means to evaluate and council medical staff who personally perform services on a patient that results in harm due to unreasonable risk. Hospitals may be held liable when a member of the medical staff fails to meet established standards of patient care (Pozgar 2012; Fahrenholz 2017b, 86).

In assessing the quality of care given to patients with diabetes mellitus, the quality team collects data regarding blood sugar levels on admission and on discharge. This data is called a(n): a. Indicator b. Measurement c. Assessment d. Outcome

Correct Answer: A An indicator is a performance measure that enables healthcare organizations to monitor a process to determine whether it is meeting process requirements. Monitoring blood sugars on admission and discharge is an indicator of the quality of care delivered to the diabetes patient during the stay

In the APC system, a high-cost outlier payment is paid when which of the following occurs? a. The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount. b. The LOS is greater than expected. c. The charges for the services provided are greater than the expected payment. d. The total cost of all the services is greater than the sum of APC payments by a fixed ratio and exceeds the sum of APC payments plus a threshold amount.

Correct Answer: A An outlier payment is paid when the cost of the service is greater than the ambulatory payment classification (APC) payment by a fixed ratio and exceeds the APC payment plus a threshold amount

The concept of legal hold requires: a. Special, tracked handling of patient records involved in litigation to ensure no changes can be made b. Attorneys for healthcare entities to stop all activity with records involved in litigation c. All records involved in litigation to be printed and held in a locked cabinet d. To not allow further documentation to occur in any record involved in litigation

Correct Answer: A The legal hold requires special, tracked handling of patient records to ensure no changes can be made in a record involved in litigation. This is common in the paper record environments to substantiate the integrity of the record and less common in the electronic environment where audit logs are the standard. Record managers need to address the use of legal hold for patient records in any information mode or medium

Data-mining efforts of recovery audit contractors (RAC) allow them to deny payments without ever reviewing a health record based on the information they gather without having access to the record. Which of the following would be an example of a potential denial based on information the RAC contractor would have without the health record? a. A coder assigning the wrong DRG for a patient b. Billing for two colonoscopies on the same day for the same Medicare beneficiary c. An inaccurate principal diagnosis d. A principal procedure code

Correct Answer: B As healthcare organizations throughout the country have become more computer savvy, so too has the federal government. The data-mining efforts of the recovery audit contractors (RACs) allow them to deny payments without ever reviewing a health record. For example, duplicate billing, such as billing for two colonoscopies on the same day for the same Medicare beneficiary, is easy to identify as a potential improper payment. Through the use of the RACs' proprietary software, RACs are able to detect improper payments. Underpayment and overpayment amounts can be subject to an automated review

In healthcare, a data warehouse may be use for: a. Accounts receivable management b. Materials or inventory management c. Best practice guideline development d. Utilization review

Correct Answer: C Data warehouses are often hierarchical or multidimensional and are designed to receive very large volumes of data (often as an extraction of data from a repository) and perform complex, analytical processes on the data. Data can be mined and processed in many ways. For example, a data warehouse may be used for clinical quality improvement and best practice guideline development (Sandefer 2016, 376).

The patient has a biopsy of the colon followed by a hemicolectomy. In the ICD-10-PCS coding system, which procedure(s) are coded? a. The hemicolectomy only b. The biopsy only c. Both the biopsy and the hemicolectomy d. It depends on the results of the biopsy

Correct Answer: C ICD-10-PCS coding guideline B3.4b states that if a diagnostic Excision, Extraction, or Drainage procedure (biopsy) is followed by a more definitive procedure, such as Destruction, Excision, or Resection at the same procedure site, both the biopsy and the more definitive treatment are coded

Which of the following requires financial institutions to develop written medical identity theft programs? a. HIPAA Security Rule b. HITECH Act c. Fair and Accurate Credit Transactions Act d. HIPAA Privacy and Security Rule

Correct Answer: C In 2007, Identity Theft Red Flags and Address Discrepancy Rules were enacted as part of the Federal Fair and Accurate Credit Transactions Act (FATCA) of 2003. The FATCA requires financial institutions and creditors to develop and implement written identity theft programs that identify, detect, and respond to red flags that may signal the presence of identity theft

Which of the following do HIE participants use to search for health records on other healthcare organization systems using patient indexing and identification software? a. Admit, discharge, transfer b. Advance patient identifier c. Continuity of care document d. Record locator service

Correct Answer: D

A request for proposal (RFP) serves two important purposes: it solidifies the planning information and healthcare entity requirements into a single document, and it: a. Allows one vendor an advantage over the other potential vendors b. Delineates the entity's system requirements in such a way that a vendor is selected without review of the entire RFP pool c. Enables the healthcare entity to make decisions quickly d. Provides valuable insights into the vendors operations and products and levels the playing field in terms of asking all the vendors the same questions

Correct Answer: D A well-constructed RFP serves two important purposes. One is to solidify the planning information and organizational requirements into a single document, and the other is to provide valuable insights into the vendor's operations and products and to level the playing field in terms of asking all the vendors the same questions. This process requires skill and time

The federal physician self-referral statute is also known as the: a. Sherman Anti-Trust Act b. Deficit Reduction Act c. False Claims Act d. Stark Law

Correct Answer: D The Stark Law or Federal Physician Self-Referral Statute prohibits physicians from referring Medicare or Medicaid patients for certain designated health services to an entity in which the physician or a member of his immediate family has an ownership or investment interest, or with which he or she has a compensation arrangement, unless an exception applies

At the end of March, the HIM department has a YTD payroll budget of $100,000. The actual YTD amount paid is $95,000 because a coder resigned in February. For the past two months, the position has been filled through outsourcing. Therefore, the actual YTD amount for consulting services is $5,000, although no money was budgeted for consulting services. The reporting threshold for variances is 4 percent. The fiscal year-end is December. a. Favorable, permanent b. Unfavorable, permanent c. Favorable, temporary d. Unfavorable, temporary

Correct answer: B It is unfavorable and permanent because money that was not in the budget was spent on consulting services.

Determining costs associated with EHR hardware and software acquisition, implementation, and ongoing maintenance represents which type of analysis?

Cost-benefit feasibility study Cost-benefit feasibility is used to determine if an EHR initiative is appropriate for the organization at this time; it measures the costs associated with acquisition of hardware and software, installation, implementation, and ongoing maintenance (Amatayakul 2016, 104-105).

A coding audit shows that an inpatient coder is using multiple codes that describe the individual components of a procedure rather than using a single code that describes all the steps of the procedure performed. What should be done in this case?

Counsel the coder to stop the practice immediately Unbundling is the practice of using multiple codes that describe individual components of a procedure rather than using an appropriate single code that describes all steps of the procedure performed. Unbundling is a component of the NCCI and is what the coder in this example was doing. The use of audits or other evaluation techniques to monitor compliance and assist in the reduction of identified problem areas and corporate compliance is necessary to become aware of coding issues and stop them. The coder would need to be educated regarding unbundling and would be advised to stop the practice immediately (Kuehn 2019, 405).

In the case of behavioral healthcare information a healthcare provider may disclose health information on a patient without the patients authorization in which of the following situations?

Court order Duty to warn Involuntary commitment proceedings

In the case of behavioral healthcare information, a healthcare provider may disclose health information on a patient without the patient's authorization in what situation:

Court order, duty to warn, and involuntary commitment proceedings The mental health professional can disclose information without an authorization from the patient in the following situations: - The patient brings up the issue of the mental or emotional condition - The health professional performs an examination under a court order - Involuntary commitment proceedings - A legal "duty to warn" an intended victim when a patient threatens to harm an identifiable victim(s) - The mental health professional believes that the patient is likely to actually harm the individual(s) (Brodnik 2017b, 347-348).

Differentiate civil and criminal law

Criminal law regulates crimes, and wrongs committed against the government. The plaintiff is always the state/federal government Civil law regulates disputes between private parties

Joe is hired as a floater in a health information department to fill in wherever help is needed. He learns the jobs of several employees. This is an example of:

Cross-training In cross-training, the employee learns to perform the jobs of many team members. This method is most useful when work teams are involved (Patena 2016, 761).

If a patient is readmitted to a facility after a recent admission, Joint Commission allows the facility to use the existing history and physical from the first admission if it is for a related condition and was completed within _____ of the second admission and if an interval note updating any changes to the patient's condition has been documented. A. 48 hours B. 72 hours C. 7 days D. 30 days

D

The CPT codes for Emergency Department visits are: 99281 - Level 1 Emergency Department Visit 99282 - Level 2 Emergency Department Visit 99283 - Level 3 Emergency Department Visit 99284 - Level 4 Emergency Department Visit 99285 - Level 5 Emergency Department Visit This set of CPT codes is an example of: A. Nominal data B. Interval data C. Ratio data D. Ordinal data

D

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. preadmission review B. continued stay review C. retrospective review D. discharge review

D

What information does not have to be included in a covered entity's notice of privacy practice? A. A description with one example of disclosures made for treatment, payment, and healthcare operations B. A description of all the other purposes for which a covered entity is permitted or required to disclose PHI without consent or authorization C. A statement of individual's rights with respect to PHI and how the individual can exercise these rights D. The signature of the patient and date the notice was given to the patient

D

This landmark case established that hospitals owe a duty to patients to provide quality care. The court said this includes proper accommodations, examination by skilled medical staff and review of the treatment received. This was the _____case, first applying the doctrine of _______.

Darling v. Charleston Community Memorial Hospital, corporate liability

DEEDS

Data elements for emergency department systems

data governance

Data governance is an emerging practice in the healthcare industry. Decision making and authority over data-related matters is data governance. It is clear that any industry as reliant on data as healthcare needs a plan for managing this asset

The computer-based processes of extracting, quantifying, and filtering data that reside in a database is called:

Data mining In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set (White 2016b, 531).

Linkage analysis

Data mining technique discovers relationships between attributes within data sets and displays them in a linked network graph to enable the user to better visualize the patterns

Online or real-time transaction processing (OLTP) is a functional requirement for a:

Data repository Data repositories in healthcare organizations require tools designed to perform intricate data searches and retrievals using online or real-time transaction processing (OLTP) (Amatayakul 2017, 306-307).

Granularity

Data values defined at correct level of detail

What term is used to refer to an organized collection of data that has been stored electronically to facilitate easy access?

Database A database is a term used to refer to an organized collection of data that have been stored electronically to facilitate easy access (Fahrenholz 2017c, 126, 442).

What is a common outcome of conflict in the workplace?

Decreased productivity Sometimes problems arise because of conflicts among employees. It is common for people to disagree, and sometimes a difference of opinion can increase creativity. However, too much conflict can also waste time, reduce productivity, and decrease morale. When taken to the extreme, it can threaten the safety of employees and cause damage to property (LeBlanc 2016, 744).

Distributing work duties to others along with the right to make decisions and take action is called:

Delegation Delegation is the process of distributing work duties and decision making to others. To be effective, delegation should be commensurate with authority and responsibility. A manager must assign responsibility, which is an expectation that another person will perform tasks. At the same time, authority, or the right to act in ways necessary to carry out assigned tasks, must be granted (LeBlanc 2016, 738).

Records that are not completed by the physician within the time frame specified in the healthcare organization policies are called:

Delinquent records Delinquent health records are those records that are not completed within the specified time frame, for example, within 14 days of discharge. A delinquent record is similar to an overdue library book. The definition of a delinquent chart varies according to the facility, but most facilities require that records be completed within 30 days of discharge as mandated by CMS regulations and Joint Commission standards. Some facilities require a shorter time frame for completing records because of concerns about timely billing (Reynolds and Sharp 2016, 126).

What would be considered a discriminatory practice in the employment setting?

Denial of employment based on religion There are several laws that affect discrimination in employment on the basis of race, color, religion, age, sex, national origin, citizenship status, and veterans status. Most organizations would like to hire someone whose vision for the organization is in line with their own vision (Reynolds and Brodnik 2017c, 490).

Information life cycle phases

Design- Birth phase, analysis of the requirements and design Implementation-relates to the development phase, testing and implementation operation and maintenance-growth and maturity Obsolescence-Decline phase, impacted by many variables

Medicare summary notices(MSN)

Details amounts billed by the provider, amounts approved by Medicare, how much Medicare reimbursed the provider and hat the patient must pay the provider by way of a deductible and co payments

Correct sequence of steps when evaluating an ethical problem?

Determine the facts Consider the values and obligations of others consider the choices that are both justified and not justified identify prevention options

The correct sequence of steps when evaluating an ethical problem is:

Determine the facts, who are the stakeholders, what are the options, what is the decision, what justifies the choice, and identify prevention options HIM professionals must factor several criteria into their decision making. Ethicists provide assistance in this process. When faced with an ethical issue, the HIM professional should evaluate the ethical problem following these steps: what are the facts; who are the stakeholders; what are the options; what is the decision; what justifies the choice, and what is the prevention. When a decision must be made about an issue and not identified following the steps, the decision most likely will be based on an individual's narrow moral perspective of right or wrong (Gordon and Gordon 2016, 919).

The most recent coding audit has revealed a tendency to miss secondary diagnoses that would have increased the reimbursement for the case. What would be most likely to correct this problem in the long term?

Development and implementation of a CDI program Facilities may design a clinical documentation improvement (CDI) program based on several different models. Improvement work can be done with retrospective record review and queries, with concurrent record review and queries, or with concurrent coding. Although much of the CDI process is often done while the patient is in-house, it does not eliminate the need for post-discharge queries (Hunt 2016, 266).

Which standard in the security rule provides guidance for covered entities to secure laptops, PDAs and other small portable mobile technologies used within the healthcare facility?

Device and media control standards

DRGS

Diagnosis related groups are used to categorize patients on the basis of principle and secondary diagnosis/procedures, age, sex complications, discharge status Designed to group services and estimate costs for Medicare

Electronic Data Management EDM

Different than electronic health record in that it converts images to electronic or pixilated information and stores them in a manner that can be archived and accessed as needed Key component is Scanner

What technology creates images of paper documents that can be incorporated into an electronic health record?

Document scanner Many hospitals incorporate documents into their EHR systems using image-processing technology. A document scanner creates images of paper documents that are then stored in health record databases as electronic files. Using scanned images solves many of the problems associated with traditional paper-based health records (Rossiter 2017, 294-295).

Using the following data, what conclusions can you draw about Dr. Jones's outcomes compared to the OB/GYN practice group? Category - Dr. Jones - OB/GYN Cesarean section rate - 15.2% - 11.5% Hospital-acquired infection - 1.7% - 1.5% Surgical wound infection rate - 3.8% - 0.36% Mortality rate - 0.57% - 0.07%

Dr Jones performed poorer than the OB/GYN group in all four categories The data shows that Dr. Jones' outcomes are all higher than the OB/GYN group. This data indicates that Dr. Jones should be monitored for continued poor performance compared to his peer group (Shaw and Carter 2019, 89-90).

Dr. Hansen saw a patient in his office with measles. He directed his office staff to call the local department of health to report this case of measles. The office manager called right away and completed the report as instructed. Which of the following provides the correct analysis of the actions taken by Dr. Hansen's office?

Dr. Hansen's office followed protocol and reported this case of measles correctly All states have a health department with a division that is required to track and record communicable diseases. When a patient is diagnosed with one of the diseases from the health department's communicable disease list, the healthcare provider must notify the public health department. Measles is a condition that should be reported within 24 hours to the health department (Shaw and Carter 2019, 177).

John Smith, who was treated as a patient at a multi-hospital system, has three health record numbers. The term used to describe multiple health record numbers is:

Duplicates Duplicate health record numbers are when there is more than one unique identifier (for example, medical record number or person identifier) for the same person in the MPI. This causes one patient to have two or more different medical records within the same facility (Reynolds and Sharp 2016, 130-131).

A joint commission accredited organization must review their formulary annually to ensure a medications continue?

Efficacy and Safety

One of the four general requirements a covered entity must adhere to in order to be in compliance with HIPAA Security Rule is to:

Ensure the confidentiality, integrity and avaliabilty of ePHI

The process of conducting a thorough review of the internal and external conditions in which a healthcare entity operates is called:

Environmental assessment Knowledge of the internal and external environment is essential to vision and strategy formulation. An environmental assessment is defined as a thorough review of the internal and external conditions in which an organization operates. This data-intensive process is the continuous process of gathering and analyzing intelligence about trends that are—or may be—affecting an organization and industry. IBM did not see the market demands and change in the personal home computing environment quickly enough, so their competitors were out to market ahead of them (McClernon 2016, 933).

The financial manager of the physician group practice explained that the healthcare insurance company would be reimbursing the practice for its treatment of the exacerbation of congestive heart failure that Mrs. Zale experienced. The exacerbation, treatment, and resolution covered approximately five weeks. The payment covered all the services that Mrs. Zale incurred during the period. What method of reimbursement was the physician group practice receiving?

Episode-of-care Episode-of-care reimbursement is a healthcare payment method in which providers receive one lump sum for all the services they provide related to a condition or disease (Casto 2018, 9).

What discipline defines the natural laws of work and focuses on employee comfort and safety?

Ergonomics The discipline of ergonomics has helped redefine the employee workspace with consideration for comfort and safety (Oachs 2016, 790).

What activity is likely to occur in the analysis phase of the systems development life cycle?

Examine the current system and identify opportunities for improvement In the analysis phase of the systems development life cycle (SDLC), it is important to examine the current system and identify opportunities for improvement or enhancement. Even though an initial assessment would be completed as part of the strategic information planning process, the analysis phase of the SDLC involves a more extensive evaluation (Amatayakul 2017, 46).

One of the most common issues that healthcare organizations fail to do well in the strategic process is:

Execute the implementation plan The strategic goals and objectives need to be clearly outlined, with assignments for who will be accountable, timelines, allocation of resources, and measurements that will be used to ensure success of implementation. When a detailed implementation includes the elements laid out clearly—with timeframes and regular updates provided within the organization—the likelihood of strategic success increases significantly (McClernon 2016, 945)

A staghorn calculus of the left renal pelvis was treated earlier in the week by lithotripsy. The patient returns now for removal of the calculus via a percutaneous nephrostomy tube. What is the root operation?

Extirpation The correct root operation is extirpation—taking or cutting out solid matter from a body part. The earlier lithotripsy would have been fragmentation but was not successful in removing the calculus (Kuehn and Jorwic 2019, 85-86).

All variances (as related to accounting) should be labeled as either:

Favorable of unfavorable Variances are often calculated on the monthly budget report. The organization's policies and procedures manual defines unacceptable variances or variances that must be explained. In identifying variances, it is important to recognize whether the variance is favorable or unfavorable and whether it is temporary or permanent (Revoir and Davis 2016, 862).

The insured party's member identification number is an example of this type of data:

Financial data Financial data includes details about the patient's occupation, employer, and insurance coverage and is collected at the time of treatment. Healthcare providers use this data to complete claims forms that will be submitted to third-party payers (Fahrenholz 2017b, 74-76).

The security devices situated between the routers of a private network and a public network to protect the private network from unauthorized users are called:

Firewalls Firewalls are hardware and software security devices situated between the routers of a private and public network. They are designed to protect computer networks from unauthorized outsiders. However, they also can be used to protect entities within a single network, for example, to block laboratory technicians from getting into payroll records. Without firewalls, IT departments would have to deploy multiple-enterprise security programs that would soon become difficult to manage and maintain (Sandefer 2016a, 366).

The facility's Medicare case-mix index has dropped, although other statistical measures appear constant. The CFO suspects coding errors. What type of coding audit review should be performed?

Focused audit Focused selections of coded accounts are necessary for deeper understanding of patterns of error or change in high-risk areas or other areas of specific concern. Optimization seeks the most accurate documentation, coded data, and resulting payment in the amount the provider is rightly and legally entitled to receive (Hunt 2016, 286).

HIPAA - fundraising activities

For fundraising activities that benefit the covered entity (CE) 45 CFR 164.514 [f] permits the covered entity (CE) to use or disclose to a business associate or an institutionally related foundation, without authorization, demographic information and dates of healthcare provided to an individual. The CE must inform individuals on its notice of privacy practices (NPP) that PHI may be used for this purpose. If a fundraising activity targets individuals based on their diagnosis, prior authorization is required.

What is a characteristic of an organized medical staff as recognized by the Joint Commission?

Fully licensed physicians are permitted by law to provide patient care services Like any organization, the medical staff, as a self-governing entity, needs to have structure. The medical staff bylaws provide an organizational structure to ensure communication with the governing body and high-quality patient care. Committees are used to help most medical staffs function. This committee structure is used to make credentialing and clinical privilege decisions (Reynolds and Brodnik 2017b, 476-478).

project management tool used to schedule important activities

Gantt chart

breach notification

HITECH requires, following the discovery of a breach of unsecured PHI, the notification of each individual whose unsecured PHI has been or is reasonably believed to have been accessed, acquired, used, or disclosed as a result of the breach

Patient accounting is reporting an increase in national coverage decisions (NCDs), and local coverage determinations (LCDs) failed edits in observation accounts. Which of the following departments will be tasked to resolve this issue?

Health Information Management (HIM) Resolving failed edits is one of many duties of the health information management (HIM) department. Various medical departments depend on the coding expertise of HIM professionals to avoid incorrect coding and potential compliance issues (Schraffenberger and Kuehn 2011, 237-238).

When defining the legal health record in a healthcare entity, it is best practice to establish a policy statement of the legal health record as well as a:

Health record matrix The documentation that comprises the legal health record (LHR) may physically exist in separate and multiple paper-based or electronic systems. This complicates the process of pulling the entire legal record together in response to authorized requests to produce the complete patient record. Once the LHR is defined, it is best practice to create a health record matrix that identifies and tracks the physical location of each paper document and the source of each electronic document that constitutes the LHR. In addition to defining the content of the LHR, it is best practice to establish a policy statement on the maintenance of it (Rinehart-Thompson 2016, 61).

HCPCS

Healthcare common procedure coding systems Used to report healthcare services, medical supplies and devices

In project management, what is a work breakdown structure?

Hierarchical list of the project tasks A project plan starts with a work breakdown structure (WBS), or task list. The WBS is a hierarchical list of steps needed to complete the project. This structure provides levels that are similar to the concept of a book outline. Each level drills down to more detail. The lowest level is the task level, which is the level to which resources are assigned and work effort estimates are made (Olson 2016, 899; Oachs and Watters 2016, 1040).

Vertical organization scheme

Hierarchical, governing board has ultimate authority followed by the CEO, general managers ,staff, departments etc. Vertical communication

Which data collection program is the basis for the CMS value-based purchasing program?

Hospital Compare

Hospital Compare

Hospital Compare reports on 139 measures of hospital quality of care for heart attack, heart failure, pneumonia, and the prevention of surgical infections. The data available at Hospital Compare is reported by hospitals to meet the requirements of the Medicare Value Based Purchasing program. Hospitals that report all measures receive full payment updates from Medicare

Which data collection program is the basis for the CMS value-based purchasing program

Hospital compare

What is the most constant threat to health information integrity?

Humans

What is the most common threat to health information technology?

Humans Humans are the most constant threat to health information integrity. Whether intentional or unintentional, incidents resulting from internal human threats are more common than incidents resulting from external human threats because individuals within an organization often have constant access to large amounts of information. Because intentional breaches are often committed by disgruntled employees, organizations should avoid offering employment with access to patient information to individuals who often change jobs (Rinehart-Thompson 2018, 152-153).

Which of the following is the goal of quantitative analysis performed by health information management (HIM) professionals?

Identifying deficiencies early so they can be corrected Quantitative analysis is a review of the health record to identify deficiencies to ensure completeness and accuracy. It is generally conducted retrospectively, that is, after the patient's discharge from the facility or at the conclusion of treatment (Reynolds and Sharp 2016, 123).

Strategic profile

Identities the existing key services or products of the department or organization, the nature of its customers and users and the nature of its market segments and the nature of its geographic markets

What example shows the gender of the patient constituting information rather than a data element?

In a study comparing the incidence of myocardial infarctions in black males as compared to white females Data are the raw elements that make up our communications. Humans have the innate ability to combine data they collect and, through all their senses, produce information (which is data that have been combined to produce value) and enhance that information with experience and trial-and-errors that produce knowledge. In this example, the gender is tied to race in the data collection that constitutes information and not a data element (Amatayakul 2017, 284).

Every year, a director of health information services sponsors a series of presentations about the confidentiality of patient information. All facility employees are required to attend a session. This method of educational delivery is called:

In-service education In-service education is a continuous process that builds on the basic skills learned through new employee orientation and on-the-job training. In-service education is concerned with teaching employees specific skills and behaviors required to maintain job performance or to retrain workers whose jobs have changed (Patena 2016, 762).

During an influenza outbreak, a nursing home reports 25 new cases of influenza in a given month. These 25 cases represent 30 percent of the nursing home's population. This rate represents the:

Incidence The incidence rate is a computation that compares the number of new cases of a specific disease for a given time period to the population at risk for the disease during the same time period (Oachs and Watters 2016, 1009).

Community Hospital implemented a clinical document improvement (CDI) program six months ago. The goal of the program was to improve clinical documentation to support quality of care, data quality, and HIM coding accuracy. Which of the following would be best to ensure that everyone understands the importance of this program?

Include ancillary clinical staff and medical staff in the process Because clinical documentation improvement (CDI) involves the medical and clinical staffs, it is more likely that the CDI project will be successful if these staff are included in developing the process for documentation improvement. Because all hospital staff do not document in the health record, a memorandum from the CEO to all staff would not be efficient or necessarily effective. The chairperson of the CDI project does not have line authority for employee evaluation. The Joint Commission performs oversight activities but would not be involved in direct operational tasks such as this (Schraffenberger and Kuehn 2011, 360).

Which financial statement reflects the extent to which a healthcare entity's revenues exceed its expenses and presents a record of operations by showing revenue and expenses over a period of time is called the?

Income statement An income statement summarizes the organization's revenue and expense transactions during the fiscal year. The income statement can be prepared at any point in time and reflects results up to that point. The income statement contains only income and expense accounts and reflects only the activity for the current fiscal year (Revoir and Davis 2016, 849).

If parties to a contract agree to hold each other harmless for each other's actions or inactions, this is referred to as a(n):

Indemnification The purpose of hold harmless or indemnification clauses is to either transfer or assume liability. For example, the indemnitor (party assuming liability) may agree to hold the other party harmless against claims arising from the indemnitor's own actions or failures to act. This means if actions (or inactions) result in harm to the other party, the indemnitor will seek to make that party whole, often through some sort of compensation (Klaver 2017b, 129-130).

In assessing the quality of care given to patients with diabetes mellitus, the quality team collects data regarding blood sugar levels on admission and on discharge. This data is called a(n):

Indicator An indicator is a performance measure that enables healthcare organizations to monitor a process to determine whether it is meeting process requirements. Monitoring blood sugars on admission and discharge is an indicator of the quality of care delivered to the diabetes patient during the stay (Shaw and Carter 2019, 143).

Allowing different health information systems to work together within and across organizational boundaries is referred to as:

Interoperability Health informatics must consider the development of standards for software to be used in the EHR and the exchange of data. Compatibility and interoperability, allowing different health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities, are a key focus in health informatics (Biedermann and Dolezel 2017, 22).

Capital budgeting differs from operational budgeting in what manner?

It involves high-dollar purchases and multiple-year projects The capital budget looks at long-term investments. Such investments are usually related to improvements in the facility infrastructure, expansion of services, or replacement of existing assets. Capital investments focus on either the appropriateness of an investment (given the facility's investment guidelines) or choosing among different opportunities to invest. The capital budget is the facility's plan for allocating resources over and above the operating budget (Revoir and Davis 2016, 864).

What is the biggest problem with using mean length of stay as a facility statistic?

It is influenced by outlier values The mean is sensitive to extreme measures. That is, it is strongly influenced by outliers (Horton 2017, 221-222).

Which of the following is a true statement about business process reengineering?

It seeks to reevaluate and redesign organizational processes to make dramatic performance improvements. In reengineering, the entire manner and purpose of a work process is questioned. The goal is to achieve the desired process outcome in the most effective and efficient manner possible. The results expected from reengineering efforts include increased productivity, decreased costs, improved quality, maximized revenue, and more satisfied customers. However, it should be clearly understood that the main focus is on reducing costs (Oachs 2016, 819).

The hospital's public relations department in conjunction with the local high school is holding a job shadowing day. The purpose of this event is to allow high school seniors an opportunity to observe the various jobs in the hospital and to help the students with career planning. The public relations department asks for input on this event from the standpoint of HIPAA compliance. In this case, what should the HIM department advise?

Job shadowing should be limited to areas in which the likelihood of exposure to PHI is very limited, such as administrative areas. Job shadowing should be limited to areas where the likelihood of exposure to PHI is very limited, such as in administrative areas. There is a provision in the Privacy Rule that permits students and trainees to practice and improve their skills in the healthcare environment; however, the context of this provision appears to imply that the students are already enrolled in a healthcare field of study and that they are under the supervision of the covered entity. Most covered entities require students to be trained on confidentiality and other requirements of the Privacy Rule, and job shadowing activities do not appear to apply in this exception (Thomason 2013, 41).

The MPI manager has identified a pattern of duplicate health record numbers from the specimen processing area of the hospital. After spending time merging the patient information and correcting the duplicates in the patient information system, the MPI manager needs to notify which department to correct the source system data?

Laboratory As the HIM department merges two duplicate records together, the source system (laboratory) also must be corrected. This creates new challenges for organizations because merge functionality could be different in each system or module, which in turn creates data redundancy. Addressing ongoing errors within the MPI means an established quality measurement and maintenance program is crucial to the future of healthcare (Glondys and Kadlec 2016, 488).

A large hospital is planning for an EHR but wants to ensure it has adequate source systems in place to support it. Each of the ancillary departments has a separate information system, and each has claimed that the product is the best on the market and that the vendor has promised the system will interface with any EHR on the market. Identify the project management mistake in this situation.

Lack of sponsorship An EHR steering committee or project sponsorship may go by different names. Virtually every organization that undertakes an EHR project forms a steering committee of some type to initiate the project and gain representation from all stakeholders in product selection and implementation (Amatayakul 2017, 222).

When a computer-assisted coding product was installed at Community Memorial Hospital, coders initially found the new system overwhelming and were frustrated because their productivity decreased significantly. This experience represents the first stages of a(n):

Learning curve Adults like feedback on their performance. It is important to understand the concept of the learning curve. When a new task is learned, productivity may decrease while a great deal of material is actually being learned. Later, there is little new learning, but productivity may increase greatly. Either situation can be frustrating, so guidance and feedback are important to help employees understand what they have accomplished (Patena 2016, 769).

Before Central Hospital is permitted to open and provide medical services in a particular state, the healthcare entity must first go through which of the following processes?

Licensure Licensure is the state's act of granting a healthcare organization or individual practitioner the right to provide healthcare services of a defined scope in a limited geographic area. State governments establish licensure requirements, which vary from state to state. Unlike accreditation, which is a voluntary process, licensure is mandatory. Licensure is required prior to a hospital's opening and providing medical services (Fahrenholz 2017b, 82).

Reliability

Measure of consistency of data items based on their reproducibility and an estimation of their error in measurement

Structure indicator

Measure the attributes of the setting, such as number and qualifications of the staff adequacy of equipment and facilities, adequacy of organizational policies and procedures

Work sampling

Measurement tool that uses random sample observations to obtain information about the performance of an entire department

Which of the following lists contains only entities that have roles in the various Medicare Improper Payment Review processes?

Medicare Audit Contractor (MAC), Medicare Recovery Audit Contractors (RAC), and Quality Improvement Organization (QIO) The Medicare Audit Contractor (MAC) reviews prepayment and postpayment, automated, and complex types of reviews to prevent future improper payment. The Medicare Recovery Audit Contractors (RACs) review post-payment, automated, and complex reviews to detect and correct past improper payments. The Quality Improvement Organization (QIO) reviews inpatient hospital claims to prevent improper payment through DRG upcoding (Casto 2018, 38).

components of Resident Assessment Instrument (RAI)

Minimum Data Set (MDS--SNF and LTC), Care Area Assessments (CAA), RAI utilization guidelines. RAIs used to collect necessary information from and about the facility resident

Employees in the hospital business office may have legitimate access to patient health information without patient authorization based on what HIPAA standard or principle?

Minimum necessary

Monitoring risks during the project management process is important because:

Minor changes to the scope of the project can turn into more significant changes to the original work or cost estimates. If one thing can be accurately predicted about a project, it is that it will not progress as scheduled. To account for the inevitable changes, the project manager should be aware of the potential risks of the project and may need to adjust the project schedule, work effort, or cost projections to manage any anticipated risk (Olson 2016, 905-907).

Which of the following statements is most accurate regarding effective communication?

Monitor others' nonverbal behaviors for cues that they are following or confused To communicate effectively, managers must pay just as much attention to how their message is received and interpreted as they do to its content. In order to enhance the accuracy and acceptance of communication, the communicator needs to monitor others' nonverbal behaviors for cues that they are following or confused. Passive listening and distracted parties would not enhance effective communication (Kelly and Greenstone 2016, 36).

Which document is used in the long term care setting that is not used ton the acute-care setting?

Monthly Summary

Medical Subject Headings database (MeSH)

National Library of Medicine's controlled vocabulary thesaurus; consists of terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity

Which tool is used to determine the most critical areas for training and education for a group of employees?

Needs analysis The needs analysis is critical to the design of the training plan. This approach typically focuses on three levels: the organization, the specific job tasks, and the individual employee (Patena 2016, 753).

Employees covered by the provisions of the Fair Labor Standards Act (FLSA) are called ________ employees.

Nonexempt Provisions of the FLSA, for example, cover minimum wage, overtime pay, child labor restrictions, and equal pay for equal work regardless of sex. Covered groups are referred to as nonexempt employees (LeBlanc 2016, 725-726).

The Breach Notification Rule requires covered entities to establish a process for investigating whether a breach has occurred and which of the following?

Notify affected individuals when a breach occurs The Breach Notification Rule requires covered entities and business associates to establish policies and procedures to investigate an authorized use or disclosure of PHI to determine if a breach occurred, conclude the investigation, and to notify affected individuals and the Secretary of HHS within 60 days of date of discovery of the breach (Brinda and Watters 2016, 310-311).

Type II error

Null hypothesis was accepted but in which the null hypothesis was false

The generic formula for calculating rate of occurrence is used to calculate hospital-acquired infections in an intensive care unit in a given month. If the number of hospital-acquired infections is the numerator, the denominator would be the:

Number of discharges (including deaths) of ICU patients Hospital-acquired (nosocomial) infection rates may be calculated for the entire hospital or for a specific unit in the hospital. They also may be calculated for the specific types of infections. Ideally, the hospital should strive for an infection rate of 0.0 percent. The formula for calculating the hospital-acquired, or nosocomial, infection rate is: Total number of hospital-acquired infections for a given period/Total number of discharges, including deaths, for the same period × 100 (Edgerton 2016, 499).

Many states have mandatory reporting requirements for suspected abuse or mistreatment of the following categories of individuals:

Nursing home residents, the elderly and residents of state and mental health facilities

Expert determination & Safe Harbor

OCR sanctioned HIPAA Privacy Rule DE-identification methods

Unfavorable variances

Occur when the actual results are worse than what was budgeted

Phil White had coronary artery bypass graft surgery. Unfortunately, during the surgery, Phil suffered a severe stroke. Phil's recovery included several settings in the continuum of care: acute-care hospital, physician office, rehabilitation center, and home health agency. This initial service and subsequent recovery lasted 10 months. As a member of a managed care organization in an integrated delivery system, how should Phil expect that his healthcare billing will be handled?

One fixed amount for the entire episode that is divided among all the physicians, facilities, and other healthcare providers Integrated delivery system (IDS) is a term referring to the collaboration integration of healthcare providers. The goal of the IDS is a seamless delivery of care along the continuum of care, so one bill would be generated (2018, 106-108).

What is considered a two factor authentication system?

Password and swipe card

What is the most common method for implementing entity authentication?

Password systems

The clinical statement "microscopic sections of the gallbladder reveal a surface lined by tall columnar cells of uniform size and shape" would be documented on which health record form?

Pathology report A pathology report is a document that contains the diagnosis determined by examining cells and tissues under a microscope. The report may also contain information about the size, shape, and appearance of a specimen as it looks to the naked eye (Reynolds and Sharp 2016, 114).

Universal chart order system

Patient health record is kept in the same format or order while the patient is in the facility and after discharge

Which of the following would be included in an accounting of disclosures?

Patient information faxed to the bank Maintaining a procedure to track PHI disclosures has been a common practice in departments that manage health information. However, HIPAA provides for an accounting of disclosures that gives an individual the right to receive a list of certain disclosures that a covered entity has made. Some of the disclosures for which an accounting is not required include: to the individual to whom the information pertains, incidental to an otherwise permitted or required use or disclosure, and pursuant to an authorization. A disclosure would be required for patient information faxes to an erroneous fax number (Rinehart-Thompson 2018, 93).

The universal protocol requires a "time-out" prior to the start of any surgical or invasive procedure to conduct a verification of:

Patient, procedure, and site Universal protocol incorporates the principles of eliminating wrong-site, wrong-procedure, and wrong-person surgery. The steps involved in this protocol include preoperative verification process, marking of the operative site, and a "time-out" before starting any procedure (Shaw and Carter 2019, 164).

The time required to recoup the cost of an investment is called the:

Payback period The payback period is the time required to recoup the cost of an investment. Mortgage refinancing analysis frequently uses the concept of payback period. Mortgage refinancing is considered when interest rates have dropped. Refinancing may require up-front interest payments and called points as well as a variety of administrative costs. In this example, the payback period is the time it takes for the savings in interest to equal the cost of the refinancing (Revoir and Davis 2016, 866).

What term is used to represent a difference between the budgeted amount and the actual amount of a line item that is not expected to reverse itself during a subsequent period?

Permanent variance A permanent variance is a financial term that refers to the difference between the budgeted amount and the actual amount of a line item that is not expected to reverse itself during a subsequent period (Revoir and Davis 2016, 861-862).

Psychological risk

Pg. 75- Shaw

Testing

Phase of system selection and implementation where you run a mock query to asses the functionality of a database

Lean thinking

Philosophy of optimizing processes across an organization. Focus on those activities and processes that provide value to patient care. Asses if each step adds value Link the value-added steps to the process flow and eliminate unnecessary steps

A ___________ assists in educating medical staff members on documentation needed for accurate billing.

Physician advisor The health information manager must continuously promote complete, accurate, and timely documentation to ensure appropriate coding, billing, and reimbursement. This requires a close working relationship with the medical staff, perhaps through the use of a physician advisor. Physician advisors assist in educating medical staff members on documentation needed for accurate billing. The medical staff is more likely to listen to a peer than to a facility employee, especially when the topic is documentation needed to ensure appropriate reimbursement (Hunt 2016, 275).

It is important for a healthcare entity to have ________ addressing how to deal with corrections made to erroneous entries in health records.

Policies and procedures When erroneous entries are made in health records, policies and procedures should have provisions for how corrections are made. Educating clinicians who are authorized to document in the health record on the appropriate way to make corrections will promote consistency and standardization and maintain the integrity of the health record (Jenkins 2017, 161).

What application uses statistical techniques to determine the likelihood of certain events occurring together?

Predictive modeling Predictive modeling applies statistical techniques to determine the likelihood of certain events occurring together (White 2016a, 7-8).

Principle procedure

Procedure that was preformed for the definitive treatment (rather than diagnosis) of the main condition or complication of the condition

The percent of antibiotics administered immediately prior to open reduction and internal fixation (ORIF) surgeries or the percent of deliveries accomplished by cesarean section are examples of what type of performance measure?

Process measure A process measure has a scientific basis for it. In this example, the percentage of antibiotics administered before surgery has been proven through evidence-based medicine, so it is scientifically based (Shaw and Carter 2019, 40-41).

Utilization review

Process of evaluation of health care cost/ service efficiency

The lead coder in a health information department has been the acknowledged coding expert for a number of years. As implementation of a computer-assisted coding (CAC) system moves forward, it becomes evident this coder has an aversion to technology, is resistant to the CAC system, and is losing confidence in her coding skills. In project management terms, this creates a:

Project risk As much as individuals differ in their responses to change, it should not be surprising that various departments, units, and professions as well as other stakeholders also can vary in their responses. The level of perceived impact on organizational and unit culture as well as effect on work styles and turf can dramatically affect responses. For example, in some departments where there is little direct impact, staff may experience minor disruption of daily work and status quo. On the other hand, those who are more affected may show a decline in productivity, have lower morale, and express more complaints. To account for the inevitable changes, the project manager should be aware of the potential risks of the project and may need to make adjustments (Swenson and Olson 2016, 713, 905-906).

The lead coder in a health information department has been the acknowledged coding expert for a number of years. As implementation of an computer-assisted coding (CAC) system moves forward, it becomes evident this coder has an aversion to technology, is resistant to the CAC system, and is losing confidence in her coding skills. In project management terms, this creates a:

Project risk As much as individuals differ in their responses to change, it should not be surprising that various departments, units, and professions as well as other stakeholders also can vary in their responses. The level of perceived impact on organizational and unit culture as well as effect on work styles and turf can dramatically affect responses. For example, in some departments where there is little direct impact, staff may experience minor disruption of daily work and status quo. On the other hand, those who are more affected may show a decline in productivity, have lower morale, and express more complaints. To account for the inevitable changes, the project manager should be aware of the potential risks of the project and may need to make adjustments (Swenson and Olson 2016, 713, 905-906).

DICOM (Digital Imaging and Communications in Medicine)

Protocol for transmission between imaging devices

The advantage of using internal change agents over external change agents is that the former can usually:

Provide a more detailed understanding of healthcare entity's history and issues Internal change agents have the clear advantage of being familiar with the organization, its history, subtle dynamics, secrets, and resources. Such people are often well respected, securely positioned, and have the strong interpersonal relationships to foster change. There is an advantage to recognizing the internal expertise of employees, maintaining confidentiality of the process, and using people who are invested in the success of the outcome (Swenson 2016, 705).

A strategy map can be a useful tool because it:

Provides a visual framework for integrating strategies A strategy map is a tool that provides a visual representation of an organization's critical objectives and the relationships among them that drive organizational performance. Depicting change as a road map is a useful way to help others understand the goals and the course of change (McClernon 2016, 951).

A request for proposal (RFP) serves two important purposes: it solidifies the planning information and healthcare entity requirements into a single document, and it:

Provides valuable insights into the vendors operations and products and levels the playing field in terms of asking all the vendors the same questions A well-constructed RFP serves two important purposes. One is to solidify the planning information and organizational requirements into a single document, and the other is to provide valuable insights into the vendor's operations and products and to level the playing field in terms of asking all the vendors the same questions. This process requires skill and time (Amatayakul 2017, 198).

An HIM professional who accurately reports HIV status and the true results of an audit that indicates health problems meets the ethical standards for:

Public Health Releasing accurate information for public health purposes for patients with communicable diseases, such as AIDS or a venereal disease, and assisting with the complexities of information management in the context of bioterrorism and the threat or reality of global diseases, such as smallpox or Avian flu, are ethical responsibilities of the HIM professional (Gordon and Gordon 2016, 922-923).

LCD

Published by MAC to describe when and under what circumstances Medicare will cover a service (state level)

The performance standard to "respond to release of information requests for continuing care in one working day 95 percent of the time" is an example of a:

Qualitative Standard Qualitative standards specify the level of service from a function such as accuracy rate, error rate, turnaround time, and response time In this case, timely response to release of information requests can indirectly impact patient care. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the health information systems (HIS) functions (Oachs 2016, 799-800).

The performance standard to "respond to release of information requests for continuing care in one working day 95 percent of the time" is an example of a:

Qualitative standard Qualitative standards specify the level of service from a function such as accuracy rate, error rate, turnaround time, and response time In this case, timely response to release of information requests can indirectly impact patient care. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the health information systems (HIS) functions (Oachs 2016, 799-800).

The following data have been collected by the hospital quality council. What conclusions can be made from the data on the hospital's quality of care between the first and second quarters? Measure - 1st Qtr - 2nd Qtr Medication errors - 3.2% - 10.4% Patient falls - 4.2% - 8.6% Hospital-acquired infections - 1.8% - 4.9% Transfusion reactions - 1.4% - 2.5%

Quality of care is declining between the first and second quarters This type of data would be found on a dashboard report provided to the hospital's board of directors. The measures show a dramatic change in patient safety issues at this organization. The board would now need to investigate to determine why these changes occurred (Shaw and Carter 2019, 322-323).

The performance standard to "assign the correct health record number to a returning patient with 99 percent accuracy" is an example of a:

Quality standard Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions (Oachs 2016, 800).

The performance standard "Complete five birth certificates per hour" is an example of a:

Quantity standard Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions. In the scenario, completing five birth certificates per hour is identifying the quantity of work rather than how well the work is being performed so it is a quantity standard (Revoir and Davis 2016, 800).

The performance standard "File 50 to 60 records per hour" is an example of a:

Quantity standard Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions. In the scenario, filing 50-60 records per hour is identifying the quantity of work rather than how well the work is being performed so it is a quantity standard (Oachs 2016, 800).

The performance standard "Transcribe 1,500 lines per day" is an example of a:

Quantity standard Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions. In the scenario, transcribing 1,500 lines per day is identifying the quantity of work rather than how well the work is being performed so it is a quantity standard (Oachs 2016, 800).

The process In which a healthcare entity addresses the provider documentation issues of legibility, completeness, clarity, consistency and precision

Query process

When the physician does not specify the method used to remove a lesion during an endoscopy, what action should the coder take?

Query the physician as to the method used It is not appropriate for the coder to assume that the removal was done by either snare, ablation, or hot biopsy forceps. The coding professional must query the physician to assign the appropriate code (Hunt 2016, 276-277).

In conducting a qualitative review, the clinical documentation specialist sees that the nursing staff has documented the patient's skin integrity on admission to support the presence of a stage I pressure ulcer. However, the physician's documentation is unclear as to whether this condition was present on admission. How should the clinical documentation specialist proceed?

Query the physician to determine if the condition was present on admission As a result of the disparity in documentation practices by providers, querying has become a common communication and educational method to advocate proper documentation practices. Queries can be made in situations when there is clinical evidence for a higher degree of specificity or severity (Hunt 2016, 276-277).

Which of the following would be used to determine what the users need in an information system?

Questionnaire Questionnaires allow for a large number of users to provide input about the needs of the system (Sayles and Kavanaugh-Burke 2018, 53).

A hospital allows the use of the copy functionality in its EHR system for documentation purposes. The hospital has established explicit policies that define when the copy function may be used. What would be the best approach for conducting a retrospective analysis to determine if hospital copy policies are being followed?

Randomly audit EHR documentation for patients readmitted within 30 days Auditing a random selection of EHR documentation would be the best approach for avoiding selection bias and in determining how the copy function is being used (Forrestal 2016, 593).

In order for RHIO and HIE participants to search for health records on each of the other systems using patient indexing and identification software, the systems must be linked by an?

Record locator service (RLS)

In order for health information exchange (HIE) participants to search for health records on each of the other systems using patient indexing and identification software, the systems must be linked by a:

Record locator service (RLS) The HIE's record locator service (RLS) manages the pointers to the information on the servers of the HIE participants. The pointers in a RLS can include a person identification number (person ID) and metadata. The RLS does not provide information about the record, it merely points to where it might be found. Data are not stored in a centralized database and records are only provided when queried (McCann 2016, 454).

Project charter

Records the project objectives, scope, deliverables, expected time line and anticipated cost in a written document. This document is known by various names Project charter Statement of work Project definition document Business plan

What is the process of finding, soliciting, and attracting new employees called?

Recruitment Recruitment is the process of finding, soliciting, and attracting new employees. However, the manager should be sure to understand the organization's recruitment and hiring policies and to seek the assistance of the HR department before the vacancy is publicized (LeBlanc 2016, 732).

Secondary care

Refers to a specialist to which the primary care provider may refer the patient

Benchmarking

Refers to comparing a facilities performance with that of organizations that have been deemed excellent in performance. Internal-between departments in facility Competitive-Other similar facilities Comparative-Comparing with another industry

Informal organization

Refers to interpersonal relationships within the organization that do not appear on the Org. chart

Relational database model

Refers to tables or groups of information that share a common element called the primary key, such as a patient identifier - Uses standard query language (SQL) 1:M M:M 1:1

Which of the following basic services provided by an HIE entity identifies participating users and systems?

Registry and directory

Systems thinking

Relationship among parts and processes of the healthcare entity and how they work together

Part of the coding supervisor's responsibility is to review accounts that have not been final billed due to errors. One of the accounts on the list is a same-day procedure. Upon review, the coding supervisor notices that the charge code on the bill was hard-coded. The ambulatory procedure coder added the same CPT code to the abstract. How should this error be corrected?

Remove the code from the abstract and counsel the coder regarding CDM hard codes in this service If a service is hard-coded into the charge description master (CDM), it is important that this decision is communicated to the coding staff. If the decision is not effectively communicated, the result could be duplicate billing that in turn could result in overpayment to the facility (Casto 2018, 236-237).

Stacy is the nursing manager for the cardiology services at a local hospital. The hospital has recently emphasized a policy requiring all managers to track and report their employees' absences from work. Stacy feels that this requirement is time-consuming and unnecessary. Why would the hospital require their managers to complete this process?

Reports of absences are tabulated and examined for a possible HAI connection An aspect of infection surveillance involves employee health and illness tracking. Employees are a critical vector for bringing community-acquired infections into healthcare settings. Policies related to the tracking of employee absences exist for the specific purpose of preventing infection via healthcare workers. Reports of employee absences are tabulated and examined for any possible connection to cases of HAI (Shaw and Carter 2019, 181).

Stacy is the nursing manager for the cardiology services at a local hospital. The hospital has recently emphasized a policy requiring all managers to track and report their employees' absences from work. Stacy feels that this requirement is time-consuming and unnecessary. Why would the hospital require their managers to complete this process?

Reports of absences are tabulated and examined for a possible hospital acquired infection (HAI) connection An aspect of infection surveillance involves employee health and illness tracking. Employees are a critical vector for bringing community-acquired infections into healthcare settings. Policies related to the tracking of employee absences exist for the specific purpose of preventing infection via healthcare workers. Reports of employee absences are tabulated and examined for any possible connection to cases of HAI (Shaw and Carter 2019, 181).

In carrying out the strategic plan for health IT, the step that describes what is needed to achieve the plan's goals is:

Requirements analysis Requirements analysis is the step that identifies, in detail, the precise requirements needed for both health information technology (that is, hardware and software) and operational components (people, policy, and process) of the health information system to meet the goals specified in the strategic plan (Amatayakul 2016, 400).

What type of health record policies dictate how long individual health records must remain available for authorized use?

Retention policies Hospitals and other healthcare facilities develop health record retention polices to ensure that health records comply with all applicable state and federal regulations and accreditation standards and meet future patient-care needs. Retention policies dictate how long individual health records must remain available for authorized use (Fahrenholz 2017b, 106).

Conducting an inventory of the facility's records, determining the format and location of record storage, assigning each record a time period for preservation, and destroying records that are no longer needed are all components of a:

Retention program The steps in developing a record retention program include: conducting an inventory of the facility's records, determining the format and location of record storage, assigning each record a retention period, and destroying records that are no longer needed (Reynolds and Sharp 2016, 133-135).

In which type of reimbursement methodology, do healthcare insurance companies reimburse providers after the costs have been incurred?

Retrospective payment

Case finding

Review of disease indexes, pathology reports and radiation reports is part of which function in the cancer registry

Quality improvement organization(QIO)

Reviews inpatient hospital claims to prevent improper payment through DRG up coding

RAC

Reviews post payment, automated and complex reviews to detect and correct pat improper payments

Medicare Audit Contractor (MAC)

Reviews prepayment and post payment, automated and complex types of reviews to prevent future improper payment

What are attributes of both projects and daily operations?

Roles and responsibilities A project differs from the day-to-day operations of an organization. Operations are concerned with the everyday jobs needed to run the business. The personnel involved in the operational aspects of the business perform the same functions on a routine basis. This work does not end. In contrast, a project has a precise, expected result produced by defined resources within a specific time frame (Olson 2016, 875).

General Hospital is performing peer reviews of its medical providers for quality outcomes of care. The hospital has over 500 providers on its medical staff. The peer review process is quite extensive to review even 10 cases for each provider. The quality department has concluded that, to accomplish this review process, it will review 20 percent of each provider's inpatient admissions to the hospital on an every-other-year rotation. In this situation, the quality department has applied what technique to its review process?

Sampling Sometimes, the organizational characteristic or parameter about which data are being collected occurs too frequently to measure every occurrence. In this case, those collecting the data might want to use sampling techniques. Sampling is the recording of a smaller subset of observations of the characteristic or parameter, making certain, however, that a sufficient number of observations have been made to predict the overall configuration of the data (Shaw and Carter 2019, 72).

As an EHR implementation project proceeds, additional hospital departments add requirements for the system, and the project becomes more complex. This is known as:

Scope creep One of the most significant changes during a project is a change to the project scope. Various stakeholders frequently wish to add new or enhanced project requirements after the initial requirements were gathered, and the schedule and budget were established based on these requirements. Over time, these small changes in scope create significant changes and require more resources and time than originally planned. These incremental changes are commonly referred to as scope creep (Olson 2016, 905).

Once all data has been posted to patient's account, the claim can be reviewed for accuracy and completeness. Many facilities have an internal auditing system that runs each claim through a set of edits. This internal auditing system is known as a:

Scrubber A claim scrubber is used by facilities as an internal auditing system to limit the number of denied claims (Casto 2018, 237-238).

Which of the following basic services provided by an HIE ensures that information can be retrieved as needed?

Secure data transport

What is a basic services provided by an HIE entity ensures that information can be retrieved as needed?

Secure data transport A basic service provided by an HIE organization must be the actual transmission of the data, which is the technical networking service that provides appropriate bandwidth, latency, availability, ubiquity, and security (Amatayakul 2017, 420).

What is a mechanism that records and examines activity in information systems (IS)

Security audits Security audits are the mechanisms that record and examine activity in information systems. HIPAA does not specify what form of security audits must be used, how or how often they must be examined, or how long they must be retained (Brinda and Watters 2016, 322).

Coders at Medical Center Hospital are expected to do a high volume of coding. Their department also includes a clerical support person who handles phone calls, pulls and files records to be coded, and maintains productivity logs. An abstract clerk enters coded data into the health information system. This is an example of ________ work division.

Serial Serial work division is the consecutive handling of tasks or products by individuals who perform a specific function in sequence. Often referred to as a production line work division, serial work division tends to create task specialists (Oachs 2016, 791).

Work performance/ productivity

Serial-each person has a sequential step in the final product Parallel-each person performs several tasks which might be performed by others Unit Assembly-each person has a separate task but it is not necessarily sequential

Application Service Providers(ASPs)

Service firms that deliver, manage and remotely host standardized( prepackaged) applications software through centralized servers via a network

The slightly higher wage paid to an employee who works a less desirable shift is called a:

Shift differential Many employers pay a slightly higher hourly wage to employees who work less desirable shifts (evening, night, weekend). This is referred to as shift differential (Oachs 2016, 794).

Systemic Sampling

Simple random sample that may be generated by selecting every fifth or every tenth member of the samplings frame.

Care plan

Snapshot of a patients status and includes everything from social issues to disease processes as well as critical paths and clinical pathways that focus on a specific disease

Care Plan

Snapshot of a patients status and includes everything from social issues to disease processes as well as critical paths and clinical pathways that focus on a specific disease process or pathway on LTC.

Data mapping is used to harmonize data sets or code sets. The code or data set from which the map originates is the:

Source For the purposes of mapping, the term coding system is used very broadly to include classification, terminology, and other data representation systems. Mapping is necessary as health information systems and their use evolves in order to link disparate systems and data sets. Any data map will include a source and a target. The source is the code or data set from which the map originates (Biedermann and Dolezel 2017, 155).

A director of health information services in a hospital wants to implement a computer-based patient record system over the next two years. She gets support from the CIO, who champions the project with the administrative team. The CIO has become the project's:

Sponsor Every project has an identified sponsor. The sponsor is the facility employee with the most vested interest in the project's success. It is a good practice to select someone who has responsibility for the organization's departments, divisions, and personnel that will be affected by the project (Olson 2016, 881).

Legally, what is most important in determining the length of time a hospital must retain health records?

Statute of Limitations Applicable statutes of limitations, the time period in which a lawsuit may be filed, must be considered in establishing a retention schedule (Rinehart-Thompson 2017c, 195).

What kind of planning addresses long-term needs and sets comprehensive plans of action?

Strategic Strategic management is a process a leader uses for assessing a changing environment to create a vision of the future, determining how the organization fits into the anticipated environment based on its mission, vision, and knowledge of its strengths, weaknesses, opportunities, and threats, and then setting in motion a plan of action to position the organization accordingly (Oachs 2016, 928).

Migration Path

Strategic plan that identifies applications, technology and operational elements needed for the overall information technology program in a healthcare entity

Identifying future health information needs for a healthcare entity and projecting specific initiatives required to meet those needs is part of:

Strategic planning Strategic planning is a formalized roadmap that describes how the company executes the chosen strategy. A strategic plan spells out where an organization is going over the next three to five years and how it is going to get there. HIM professionals can use strategy to shape and influence change in their department and organization (McClernon 2016, 928).

A transcription manager is assigned to a project team that is implementing a voice recognition system. He reports to the director of health information services for regular job functions and to the project manager for tasks related to the project. This is an example of which type of project management structure?

Strong matrixed The strong matrix organization is very similar to the balanced matrix but includes a department of project managers. In these organizations, project managers are not functional staff members assuming the role of project manager but rather project manager specialists reporting to a manager of project management. The strong matrix organizations provide the project manager a moderate to high level of authority over the project and project resources (Olson 2016, 885).

The data elements in a patient's automated laboratory result are examples of:

Structured data Structured data commonly refer to data that are organized and easy to retrieve and to interpret by traditional databases and data models. The data elements in a patient's automated laboratory order, or result, are coded and alphanumeric. Their fields are predefined and limited. In other words, the type of data is discrete, and the format of this data is structured (Johns 2016, 83).

cultural audit

Study and examination of an organization's cultural characteristics to determine whether they hinder or support its vision and mission

After a claim has been filed with Medicare, a healthcare entity had late charges posted to a patient's outpatient account that changed the calculation of the ambulatory payment classification (APC). What is the best practice for this entity to receive the correct reimbursement from Medicare?

Submit an adjusted claim to Medicare Late charges are any charges that have not been posted to the account number within the healthcare facility's established bill hold time period. By incorporating this predicted billing delay into normal operations, the facility creates a preventive control to avoid under billing or having to submit late charges to the payer. For the provider to be paid for these charges, an adjusted claim must be sent to Medicare (Malmgren and Solberg 2016, 248).

What is an example of an internal medical identity theft?

Sue in her role as a patient registration clerk uses a patient's insurance information to see a specialist for cosmetic surgery Medical identity theft can be the result of either internal or external forces. Electronic health records have improved the ability to share information, but this has also increased exposure to data making it more vulnerable. Internal medical identity theft is committed by organization insiders, such as clinical or administrative staff with access to patient information. External threats are causing a greater risk for healthcare organizations due to increased threats of ransomware, malware, and denial-of-service (DOS) attacks (Olenik and Reynolds 2017, 290).

Fifty percent of an HIM department's staff have a nationally recognized credential. This is an example of what type of performance measurement:

System The foundations of care giving, which include buildings (environmental services), equipment (technical services), professional staff (human resources), and appropriate policies (administrative systems) are examples of system performance measurements. Fifty percent of an HIM department's staff having a nationally recognized credential would be an example of a performance measure in the system (Shaw and Carter 2019, 40).

Qualitative analysis

Systemic review of sample health records to determine whether documentation standards are being met

When an entity relational diagram is implemented as a relational database, an entity will become a:

Table An entity becomes a table in your relational database because it is the person, place, or thing about which you are collecting the data in your database. You would need to be able to query data on each entity from the database (White 2016a, 46).

The coding supervisor has compiled a report on the number of coding errors made each day by the coding staff. The report data show that Tim makes an average of six errors per day, Jane makes an average of five errors per day, and Bob and Susan each make an average of two errors per day. Given this information, what action should the coding supervisor take?

Take no action since not enough information is given to make a judgement The error rates are not comparable since there is no data about the number of records coded during the period by each coder. Work measurement is the process of studying the amount of work accomplished and the amount of work it takes to accomplish it. It involves the collection of data relevant to the work (Oachs 2016, 802).

In the following figure, identify the component of the project plan labeled as B.

Task completed A Gantt chart is used to illustrate project tasks, phases, and milestones and their start, end, and completion dates. It helps to illustrate where more than one task must be performed simultaneously. The column labeled as B shows a check mark indicating the task "Load test data" is completed (Amatayakul 2017, 243).

In the following figure, identify the component of the project plan labeled as D.

Task progress A Gantt chart is used to illustrate project tasks, phases, and milestones and their start, end, and completion dates. It helps to show where more than one task must be performed simultaneously. The column labeled D is showing the progress of the task "1.1 Write test scenario" (Malmgren and Solberg 2016, 243).

Balanced Scorecard Methodology

Technique for measuring healthcare entity performance across the 4 perspectives of customer, financial, internal process and learning and growth

Which of the following is considered a viable solution to a staff recruitment problem for coding and transcription shortages?

Telecommuting Alternative staffing structures offer flexibility in hours, location, and job responsibilities as a method to attract and retain employees and eliminate staffing shortages. Some examples are job sharing, outsourcing, flextime, and telecommuting (Oachs 2016, 795).

LOINC

Terms and codes used for electronic exchange of lab results and clinical observations.

What are SOAP notes?

The Subjective, Objective, Assessment, Plan (SOAP) notes are part of the problem-oriented medical records (POMR) approach most commonly used by physicians and other healthcare professionals. SOAP notes are intended to improve the quality and continuity of client services by enhancing communication among healthcare professionals

An analyst wishes to test the hypothesis that the wait time in the emergency department is longer on weekends than weekdays. What is the alternative hypothesis?

The average wait time is longer on weekends The alternative hypothesis is the compliment of the null hypothesis and typically requires some action to be taken. In this scenario, the analyst is comparing emergency department wait times between weekends and weekdays. The alternative hypothesis would be that the average wait time is longer on weekends (White 2016a, 65).

How is the case-mix index calculated?

The case-mix index can be figured by multiplying the relative weight of each MS-DRG by the number of discharges within that MS-DRG. This provides the total weight for each MS-DRG. The sum of all total weights divided by the sum of total patient discharges equals the case-mix index. Calculation is as follows: (0.9321 × 10) + (0.7313 × 20) + (1.4261 × 10) + (0.9695 × 20) + (0.7111 × 10) = 64.709 / 70 = 0.9244 (weight x discharges) + (weight x discharges) = (weight x discharges) + (weight x discharges) + (Weight x discharges) = x / TOTAL DISCHARGES

What is the definition of revenue cycle management?

The coordination of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue Revenue cycle management is the supervision of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue (Casto 2018, 233-234).

The legal health record for disclosure consist of:

The data Documents Reports Information that comprise the formal business records of any healthcare entity that are to be utilized during legal proceedings.

The legal health record for disclosure consists of:

The data, documents, reports, and information that comprise the formal business records of any healthcare entity that are to be utilized during legal proceedings The concept of legal health records was created to describe the data, documents, reports, and information that comprise the formal business record(s) of any healthcare organization that are to be utilized during legal proceedings. Understanding legal health records requires knowledge of not only what comprises business records used as legal health records, but also the processes as well as the physical and electronic systems used to manage these records (Biedermann and Dolezel 2017, 424).

Net income is defined as the:

The difference between total revenue and total expenses The arithmetic difference between total revenue and total expenses is net income (Revoir and Davis 2016, 849).

A possible justification for building an information system in-house rather than purchasing one from a vendor is that:

The facility has development teams they do not want to give up Most organizations recognize that commercial products can meet their needs and that most of these products will far surpass the functionality that could be self-developed. Still, some organizations want to at least consider the build option. Some physicians are intrigued with developing their own perfect system, and some hospitals have development teams they do not want to give up. An organization's decision to build or buy should be based on a careful review of the marketplace. Currently, it is more expensive to undertake self-development. Unless self-development is coupled with a vendor partnership that leads to commercialization, a self-developed system can be a drawback when attempting to integrate with commercial products as the organization grows, merges, or acquires affiliates (Amatayakul 2017, 191).

When implementing health information management training, determining who needs to be trained, who should do the training, how much training is required, and how the training will be accomplished is the responsibility of:

The implementation team Training is essential to the successful implementation of each new system. The implementation team must define who needs to be trained, who should do the training, how much training is required, and how the training will be accomplished (Biedermann and Dolezel 2017, 260).

Incidence rate

The incidence rate is a computation that compares the number of new cases of a specific disease for a given time period to the population at risk for the disease during the same time period

Using the admission criteria provided, determine if the following patient meets the severity of illness and intensity of service criteria for admission.

The patient meets severity of illness criteria but not intensity of service The patient meets the severity of illness with the vaginal bleeding but does not meet intensity of service because the surgery is not being performed as an inpatient. She would not meet the admission criteria provided (Shaw and Carter 2019, 143).

Sue presents with vaginal bleeding. An ultrasound showed a missed abortion so she is being admitted to the outpatient surgery suite for a D&C.

The patient meets the severity of illness with the vaginal bleeding but does not meet intensity of service because the surgery is not being performed as an inpatient. She would not meet the admission criteria provided.

If a health plan analyst wanted to determine is the readmission rates for two hospitals were statistically different, what is the null hypothesis?

The readmission rates are equal The first step in statistical hypothesis testing is defining the null and alternative hypotheses. The null hypothesis is the status quo. In this example the readmission rates are equal would be the null hypothesis showing no relationship between the two hospitals (White 2016a, 65).

Bob Smith was admitted to Mercy Hospital on June 21. The physical was completed on June 23. According to CMS Conditions of Participation, was this record compliant?

The record is not in compliance as the physical exam must be completed within 24 hours of admission Hospitals must have a policy that establishes a time frame for completing the history and physical. Most facilities set the time frame as within the first 24 hours following admission and require that the history and physical be completed by the provider who is admitting the patient. CMS requires that the history and physical examination must be completed no more than 30 days before or 24 hours after admission and the report must be placed in the record within 24 hours after admission (Reynolds and Sharp 2016, 107-108).

Systems thinking focuses on an understanding of:

The relationship among parts and processes of the healthcare entity and how they work together A critical element of systems thinking is viewing an organization as an open system of interdependencies and connectedness rather than a collection of individual parts and professional enclaves. This approach sees interrelatedness as a whole and looks for patterns rather than snapshots of organizational activities and processes (Shaw and Carter 2019, 30).

A patient has a malunion of an intertrochanteric fracture of the right hip that is treated with a proximal femoral osteotomy by incision. What is the correct ICD-10-PCS root operation?

The root operation performed was division—cutting into a body part without drawing fluids or gases from the body part in order to separate or transect a body part. The intent of the operation was to separate the femur

For the following excerpt from a patient satisfaction survey, determine if in the development of this survey the designer is adhering to good survey design principles.

The survey design principles were not applied in the development of this survey Surveys should be written at the reading level of the respondents, consistent formats should be used, all possible responses should be mutually exclusive, and terminology that the respondents understand should be incorporated. This survey used inconsistent formatting and did not have mutually exclusive responses in the age question (Shaw and Carter 2019, 118).

The following graph of data security breaches shows a range of breaches from year one (YR-1) to year seven (YR-7). In year four (YR-4), a law came into effect for the mandatory reporting of security breaches. Given this information, which of the following is the best interpretation of the graph?

The volume of security breaches cannot be adequately estimated prior to YR-4 Because mandatory reporting of breaches was not required until YR-4, the number of breaches cannot be adequately estimated before that time, therefore, comparisons cannot be made between data before YR-4 and data after YR-4. Practitioners and other health professionals are faced with almost insurmountable amounts of data. This information is ultimately utilized for decision making. However, given the volume, variety, and complexity of the data, there is the potential for errors in decision making. Charts and graphs can help supplement human information processes to maximize the efficiency of interpreting data while minimizing interpretation errors (Marc 2016, 539-540).

Assumes work is as natural as play, motivation could be both internally and externally driven, under the right conditions people will seek responsibility and be creative

Theory Y

Consumer empowerment

This standards defines specific standards needed to enable the exchange of such data between patients and their caregivers via network. Defines standards needed to assist patients in making decisions regarding care and healthy lifestyles

Materials required in a emergency care record:

Time & Means of the patients arrival Treatment Rendered Instructions @ discharge

What are required elements in an emergency care record?

Time and means of the patient's arrival, treatment rendered, and instructions at discharge

How are employee performance standards used?

To communicate performance expectations

What is the best reason for team building?

To help employees develop a common purpose One thing that binds team members together is having a common purpose. The purpose for an ongoing work team, for example, might be to ensure cross-training, improve procedures, and monitor quality and productivity. A common purpose is necessary in order to achieve team building (LeBlanc 2016, 738).

Generally, substantial performance by one party to a contract will obligate the other party:

To perform their contractual obligations A contract action arises when one party claims that the other party has failed to meet an obligation set forth in a valid contract. Another way to state this is that the other party has breached the contract. The resolution available is either compensation or performance of the obligation (Rinehart-Thompson 2016, 56).

Which joint commission survey methodology involves an evaluation that follows the hospital experiences of current patients?

Tracer methodology

Source-oriented

Traditional paper format for a hospital patient care record

Leadership of productivity and functions(Task)

Transactional leadership. Relies on leadership trait separate from the interaction of personalities

Transfer/referral form

Transfer form or agreement serves to facilitate the exchange of information between facilities and practitioners it should be signed by representatives of both instructions and should include Reason for admission Diagnosis Current Medical info Rehab potential

Leadership of personal situations (relational)

Transformational, dynamic change agent. Flexability according to the situation. Pg. 111

Incident report

True: purposes include education of healthcare personnel to help prevent future incidents False: it is always discoverable in the litigation process

HOPPS

Under the Medicare out patient prospective payment system, outpatient services include Recovery Room Supplies Anesthesia

Case Mix group

Under the inpatient, rehab facility PPS (IRF-PPS) system, each patient is assigned a case-mix group (CMG). The CMG assignment is based on the primary condition for which the patient was admitted to the IRF or inpatient unit on the patient's functional and cognitive abilities at the time of the admission. The tier assignment is based on the presence of one or more specified secondary diagnoses, or commodities, that affect the resources needed to treat the patient. Each CMG and tier is assigned a relative weight (RW) that serves as the basis for the payment rate. The payment rate is adjusted at the facility level for teaching status, the applicable geographic wage index, and the percentage of low income patients served by the facility. Cases with extraordinarily high costs compare to the prospectively set payment may qualify for an outlier payment

The HIM department records copy fees as revenue. For the year the budgeted fees were $25,000 and the actual fees received are $23,000. The director may be asked to explain a(n):

Unfavorable variance of $2,000 The difference between the budgeted fees and actual fees is an unfavorable variance of $2,000. Unfavorable variances occur when the actual results are worse than what was budgeted (Revoir and Davis 2016, 862).

The inpatient data set incorporated into federal law and required for Medicare reporting is the:

Uniform Hospital Discharge Data Set (UHDDS) Medicare requires that all inpatient hospitals collect a minimum set of patient-specific data elements, which are in databases formulated from hospital discharge abstract systems. The patient-specific data elements are referred to as the Uniform Hospital Discharge Data Set (UHDDS) (Schraffenberger and Palkie 2019, 91-92).

In which record numbering system is the patient assigned a health record number on the first visit that is kept for all subsequent visits?

Unit numbering Unit numbering storage is a health record identification system in which the patient receives a unique medical record number at the time of the first encounter that is used for all subsequent encounters (Reynolds and Sharp 2016, 128).

False imprisonment

Unlawful restraint of a persons liberty, such as keeping a patient from being discharged until a bill is paid

Per the HIPAA Privacy Rule, which of the following requires authorization for research purposes?

Use of Mary's individually identifiable information related to her asthma The Privacy Rule's general requirement is that authorization must be obtained for uses and disclosure of protected health information (PHI) created for research that includes treatment of the individual (Rinehart-Thompson 2017d, 225).

Per the Privacy Rule, which of the following requires authorization for research purposes?

Use of Mary's individually identifiable information related to her asthma treatments The Privacy Rule's general requirement is that authorization must be obtained for uses and disclosures of PHI created for research that includes treatment of the individual. Public information, de-identified data, or data that is recorded by the investigation so that the subject cannot be directly identified or identified through links are not subject to the Common Rule (Rinehart-Thompson 2017e, 251-252).

Minimum data set(MDS)

Used by a long term facility to gather information about specific health status factors and includes information about specific risk factors in the residents care

Cost-benefit feasibility

Used to determine if an EHR initiative is appropriate for the organization at this time: It measures the costs associated with acquisition of hardware and software, installation, implementation and ongoing maintenance.

Ordinal data

Used to express rankings such as no risk to high risk or strongly agree to strongly disagree - In this format distances between ranks do not necessarily relate to equal distances between the underlying criteria

Virtual Private Network (VPN)

Uses a secure tunnel through a public network usually the internet to connect remote sites or users

Formal organization

Usually represented on an organizational chart which clearly identifies lines of authority, responsibilities and span of control

A distance learning method in which groups of employees in multiple classroom locations may listen to and see the material presented at the same time via satellite or telephone is called:

Videoconferencing Videoconferencing permits additional flexibility in delivering courses that may be enhanced through visual as well as audio presentation, such as those that include demonstrations or simulation exercises. Videoconferencing is useful for training employees in organizations with multiple sites, such as integrated delivery networks with inpatient and outpatient facilities. The expense is justified for large organizations that do extensive training (Patena 2016, 775).

Successful strategic thinkers understand that three competencies can and must be developed. The three are:

Visioning , strategy development and change management

What is a statement made by one party to induce another party to enter into a contract?

Warranty All contracts include representations or warranties of some sort, which are statements of facts existing at the time the contract is made. These statements are made by one party to induce the other party to enter the contract. Typically, these statements relate to the quality of goods or services purchased or leased (Klaver 2017b, 129-130).

Best of breed

When an organization has acquired the "best" products from various vendors. The result is that each individual organizational unit may be happy with its chosen product, but as the organization moves toward clinical components that rely on the various other systems as a source of data, must be sent, the challenge to exchange such data can be overwhelming

Medical identity thefts are situations in which what occurs:

When demographic and financial information is used to acquire medical services Medical identity theft occurs when a patient uses another person's name and insurance information to receive healthcare benefits. Most often this is done so a person can receive medical care with an insurance benefit and pay less or nothing for the care he or she receives (Rinehart-Thompson 2016, 71).

WPA

Wifi protected access is the most popular methods of securing wireless networks -WAN

Under the Americans with Disabilities Act, employees receive protection with respect to their job duties if they are able to perform the necessary functions of a job:

With reasonable accommodations The Americans with Disabilities Act of 1990 protects individuals with disabilities. Employees must be able to perform the necessary functions of a job with "reasonable accommodations," which include modifications to the workplace or conditions of employment so that a disabled worker can perform the job (Reynolds and Brodnik 2017c, 492).

The Health Information Services department at Medical Center Hospital has identified problems with its work processes. Too much time is spent on unimportant tasks, there is duplication of effort, and task assignment is uneven in quality and volume among employees. The manager has each employee complete a form identifying the amount of time he or she spends each day on various tasks. What is this tool called?

Work distribution chart Basic work distribution data can be collected in a work distribution chart, which is initially filled out by each employee and includes all responsible task content. Task content should come directly from the employee's current job description. In addition to task content, each employee tracks each task's start time, end time, and volume or productivity within a typical workweek. The results of a work distribution analysis can lead a department to redefine the job descriptions of some employees, redesign the office layout, or establish new or revised procedures for some department functions in order to gain improvements in staff productivity or service quality (Oachs 2016, 792).

Which work measurement tool uses random sample observations to obtain information about the performance of an entire department?

Work sampling Work sampling is a technique of work measurement that involves using statistical probability (determined through random sample observations) to characterize the performance of the department and its work (functional) units (Oachs 2016, 803).

Under RBRVS that elements are used to calculate Medicare payment

Work value and practice expenses

The focus of conflict management is:

Working with parties involved to find a mutually acceptable solution Conflict management focuses on working with the individuals involved to find a mutually acceptable solution. There are three ways to address conflict: compromise, control, and constructive confrontation (LeBlanc 2016, 744).

In order to effectively transmit healthcare data between provider and payer, both parties must adhere to which electronics data interchange standards

X12N

All ICD-10-PCS codes must be seven characters, and a character cannot be left blank. If a value does not exist for a given character, what character is used as the value?

Z

At Community Health Services, each budget cycle provides the opportunity to continue or discontinue services based on available resources so that every department or activity must be justified and prioritized annually in order to effectively allocate resources. Community Health uses what type of operational budget?

Zero-based Zero-based budgets apply to organizations for which each budget cycle poses the opportunity to continue or discontinue services based on the availability of resources. Every department or activity must be justified and prioritized annually in order to effectively allocate the organization's resources. Professional associations and charitable foundations, for example, routinely use zero-based budgeting (Revoir and Davis 2016, 859).

Reviewing the following PERT chart, what is the critical path for this project?

a -> d -> g -> h -> i The path with the greatest total duration time is called the critical path and represents the longest amount of time required to compete the total project. The critical path in this project is the sequence a → d → g → h → i, which will require 23 days (Shaw and Carter 2019, 370).

Claim rejection vs denied claim

a CLAIM REJECTION occurs prior to claim processing and is typically related to input errors or invalid data a DENIED CLAIM is processed by the payer and determined to be unpayable

reliability

a measure of consistency of data items based on their reproducibility and an estimation of their error of measurement

interrater reliability

a measure of research instrument's consistency in data collection when used by different abstractors

intrarater reliability

a measure of research instrument's reliability in which the same person repeating the test will get reasonably similar findings

Permanent

a permanent revision that affects the budget in the current fiscal year and all years going forward - ex: payroll

needs assessment

a procedure performed by collecting and analyzing data to determine what is required, lacking, or desired by an employee, group, or organization

scope creep

a process in which the scope of a project grows while the project is in process, virtually guaranteeing that it will be over budget and behind schedule

MEDCIN

a proprietary clinical terminology developed as a point-of-care tool for electronic medical record documentation at the time and place of patient care

reference terminology

a set of concepts and relationships that provide a common consultation point for the comparison and aggregation of data about the entire healthcare process, recorded by multiple individuals, systems, or institutions

meta-analysis

a specialized form of systematic literature review that involves the statistical analysis of a large collection of results from individual studies for the purpose of integrating the studies' findings

Generally Accepted Accounting Principles (GAAP)

accepted set of accounting principles or standards, and recognized procedures central to financial accounting and reporting

reasonable cause

act or omission in which a covered entity or business associate knew, or by exercising reasonable diligence would have known, that the act or omission violated an administrative simplification provision, but in which the covered entity or business associate did not act with willful neglect

Administrative Safeguards

actions and policies and procedures to manage selection, development, implementation, maintenance of security measures to protect ePHI; manage conduct of covered entity's or business associate's workforce in relation to protection of ePHI

Security Rule safeguard categories

administrative safeguards, technical safeguards, physical safeguards

allows team to organize and group similar ideas together

affinity grouping

addressable standards

amended by HITECH, implementation specifications of HIPAA that are designated as "addressable" rather than "required"; to be in compliance with the rule, covered entity must implement the specification as written, implement an alternative, or document that the risk for which the addressable implementation specification was provided either does not exist in the organization, or exists with a negligible probability of occurrence

internal validity

an attribute of a study's design that contributes to the accuracy of its findings

business case

an economic argument or justification, usually for a capital expenditure

vulnerability

an inherent weakness or absence of a safeguard that could be exploited by a threat; grouped into technical or nontechnical categories

secondary analysis

analysis of the original work of others; reanalyze original data by combining data sets to answer new questions

SWOT analysis

analysis tool used to outline the organization's strengths (S) and weaknesses (W), which are internal to the organization, and the opportunities (O) and threats (T) external to the organization

stores extracted pieces of data from selected transactional databases, designed to support high-level managers in making strategic and tactical decisions, used to analyze complex relationships, discover trends, perform "what if" explorations

analytical database

malware

any program that causes harm to systems by unauthorized access, disclosure, destruction, or loss of integrity of any information

Surgeon General

appointed by POTUS. has responsibility for public health service workforce

blanket authorization

authorization signed by patient allowing ROI specialist to release any and all information from that point forward

industry knowledge

awareness of regulatory and legal requirements, past and future trends within the industry, and experience with projects in the industry

Bob has been hired to implement an information system for the radiology department. Which of the following will provide him with the ability to determine the best staffing pattern for efficient patient care? A. executive information system b. decision support system c. knowledge management system d. expert system

b

Strategic thinkers exhibit which of the following skills?

b. The ability to gain a powerful core of healthcare entity supporters and customers Strategic thinking is a way of introducing innovation into decision making and engaging others in the process of change. The skills that distinguish a strategic thinker include the ability to plan and strategize, flexibility and creativity, comfort with uncertainty and risk, a sense of urgency and vision of how to move change forward positively, being able to gain a powerful core of organizational supporters and customers, and the capability to communicate the vision and plans (McClernon 2016, 929).

Which of the following is supported by a tactical database? A. executive information system B. results reporting C. ADT D. staff scheduling

c

interoperability

capability of different information systems and software applications to communicate and exchange data

care path

care-planning tool similar to a clinical practice guideline that has a multidisciplinary focus emphasizing the coordination of clinical services

Coordination, development, and provision of patient care plans for the patients with complicated cases

case management

categorically needy eligibility group

categories of individuals to whom states must provide coverage under the federal Medicaid program

compensable factor

characteristic used to compare the worth of jobs (ex. skill, effort, responsibility, working conditions)

ancillary systems

clinical department applications that include laboratory information systems (LISs), radiology information systems (RISs), pharmacy information systems, and others

RxNorm

clinical drug nomenclature developed by FDA, Department of Veterans Affairs, and HL7 to provide standard names for clinical drugs and administered dose forms

step-by-step description of an accepted procedure

clinical protocols

joinder

codefendant where defendant brings a claim against an outsider

utilization management

collection of systems and processes to ensure that facilities and resources, both human and nonhuman, are used maximally and are consistent with patient care needs; program evaluates healthcare facility's efficiency in providing necessary care to patients in most effective manner

Wiki

collection of webpages that together form a collaborative website

Integrated Delivery System (IDS)

combines financial and clinical aspects of healthcare and uses a group of healthcare providers, selected on basis of quality and cost management criteria, to furnish comprehensive health services across the continuum of care

executive data governance council

committee or board that leads data governance (DG) program and is responsible for making business case for DG program, providing authorization for DG program, establishing program's mission and scope, setting program's strategic direction, securing funding and resources for the program, evaluating and measuring the overall program success

process knowledge

competency developed by identifying and understanding all of the processes used across one or more project management methodologies

conservatism

compliance of financial data in that they fairly represent the financial results of the period and do not overstate or understate information in a. significant way

corporate integrity agreement (CIA)

compliance program imposed by government which involves substantial government oversight and outside expert involvement in the organization's compliance activities and is generally required as a condition of settling a fraud and abuse investigation

There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a ________.

complication

Minimum data set (MDS)

component of the resident assessment instrument (RAI) and is used to collect information about the residents risk factors and to plan the ongoing care and treatment of the resident in the long term care facility.

employment-at-will

concept that employees can be fired at any time and for almost any reason based on the idea that employees can quit at any time for any reason

framework

conceptual structure for classifying, organizing, and showing interrelationships among activities used as a guide for taking action to achieve a goal

serial work division

consecutive handling of tasks or products by individuals who perform a specific function in sequence

criticality analysis

consists of evaluating each of the different systems in an organization to determine how crucial the information in the system is to day-to-day healthcare operations and patient care

derived data

consists of factual details aggregated or summarized from a group of health records that provides no means to identify specific patients. not considered part of the legal health record

Retention policy would be in place for which building block of enterprise management(EIM)

content and record management

Rolling budget

continually update to a new budget period as the most recent period is completed

adhesion contract

contract provision that places provider in significant position of power over patient who relies on provider's services; may be against public policy

firewall

controls external access to networks

facility access

controls visitor access to a facility, including visitor sign-ins

autonomy

core ethical principle centered on the individual's right to self-determination that includes respect for the individual; in clinical applications, patient's right to determine what does or does not happen to him/her in terms of healthcare

quality means zero defects

crosby

Federal Register

daily publication of US Government Printing Office that reports all changes and regulations in federally mandated standards, including HCPCS and ICD-10-CM codes

aggregate data

data extracted from individual health records and combined to form de-identified information about groups of patients that can be compared and analyzed

structured data

data organized and easily retrievable and interpreted by traditional databases and models; data can be captured in a fixed field; comprised of values that can be stored as either numbers or a finite number of categories

data information, knowledge, and wisdom (DIKW) hierarchy

data--raw facts information--understanding relationships or context of data knowledge--learning, interpretation, pattern recognition of information wisdom--understanding principles of knowledge data comes first, wisdom comes last. they build on each other; cannot have information without data

data warehouse

database that makes it possible to access data from multiple databases and combine the results into a single query and reporting interface

safe harbor method

deidentification method that requires covered entity or business associate to remove 18 data elements from health information

Intentional torts

deliberate act, not negligence assault and battery: threat of/actual physical touching without consent Defamation: using false info that injures a person's reputation, in print, libel; oral, slander Invasion of privacy - deliberate use of private info without consent Medical abandonment - physician servers relationship with patient, harm results

assault vs. battery

deliberate threat and apparent ability to cause offense or harm to another person vs. intentional and nonconsensual touching of another person's body

Managed Care/Managed Care Organization (MCO)

delivers medical care and manages all aspects of care or payment of care by limiting providers, discounting payment, or limiting access to care. AKA coordinated care organization

deemed status

designates facility is in compliance with Medicare Conditions of Participation

Chi-Square test of independence

determines association between two categorical variables

managerial accounting

development, implementation, and analysis of systems that track financial transactions for management control purposes, including both budget systems and cost analysis systems

six sigma

disciplined and data-driven methodology for getting rid of defects in any process; getting as near to perfect as possible

External procedures to reduce the risk of groupthink?

discussing decisions with outside experts and non team members and inviting external observers to provide feedback on meetings, decisions and team processes,

Legal Health Record (LHR)

documents and data elements that provider may include in response to legally permissible requests for patient information

four elements of negligence

duty, breach, damage, cause

personal health record (PHR)

electronic or paper record maintained and updated by an individual for himself/herself; tool that individuals can use to collect, track, and share past and current information about their health or the health of someone in their care

Computerized Provider Order Entry (CPOE) system

electronic prescribing systems that allow physicians to write prescriptions and transmit them electronically; usually contain error prevention software that provides the user with prompts that warn against the possibility of drug interaction, allergy, or overdose and other relevant information

Emergency Medical Treatment and Active Labor Act (EMTALA)

enacted as part of Consolidated Omnibus Reconciliation Act largely to combat "patient dumping" --transferring, discharging, or refusal to treat indigent emergency department patients because of their inability to pay

HIPAA Security Rule on ePHI requires entities to

ensure confidentiality, integrity, and availability of ePHI

enterprise HIM

ensuring value of information assets, requiring an organization-wide perspective of information management functions; infrastructure and processes to ensure the information is trustworthy and actionable

Freedom of Information Act (FOIA)

established 1967; applicable only to federal agencies; individuals can seek access to information without authorization of person to whom the information applies

consequentialism

ethical principle where one considers the consequences before making a decision, and the decision is based on the end result

Health Technology Assessment (HTA)

evaluation of the usefulness (utility) of a health technology in relation to cost, efficacy, utilization, and other factors in terms of its impact on social, ethical, and legal systems

Likert scale

example of ordinal data; ordinal scaling and summated rating technique for measure the attitudes of respondents; measure that records level of agreement or disagreement along a progression of categories, usually five (like a 5-point scale), often administered int he form of a questionnaire (like a pain scale)

Health Information Exchange (HIE)

exchange of health information electronically between providers and others with the same level of interoperability, such as labs and pharmacies

validity

extent to which data correspond to the actual state of affairs or that an instrument measures what it purports to measure; term referring to a test's ability to accurately and consistently measure what it purports to measure

Non intentional torts

failure to do something, mistake; injury/loss occurs reasonably prudent person standard Commonly malpractice: failure to follow standard of care; patient-provider relationship

ordinary negligence

failure to do what a reasonably prudent person would do in the same or similar situation; doing something that a reasonably prudent would not do in the same or similar situation

National Committee for Quality Assurance (NCQA)

federal agency responsible for collecting and disseminating information on health services utilization and the health status of the population in the US; developed the clinical modification to ICD-10 and is responsible for updating the diagnosis portion of ICD-10-CM

Patient Self-Determination Act

federal legislation (passed through amendment to Omnibus Budget Reconciliation Act) that requires healthcare facilities to provide written information on patient's right to issue advance directives or to accept/refuse medical treatment

Privacy Rule

federal regulations created to implement the privacy requirements of the simplification subtitle of HIPAA, effective in 2002; afforded patients certain rights to and about their PHI

biotechnology

field devoted to applying techniques of biochemistry, cellular biology, biophysics, and molecular biology to address issues related to humans, agriculture, and the environment (EX: Pharma and medical device)

healthcare informatics

field of information science concerned with the management of all aspects of health data and information through the application of computers and computer technologies

Charge Description Master (CDM)

financial management form that contains information about the organization's charges for the healthcare services it provides to patients

sequenced steps to complete a process

flow chart

progressive discipline

four-step process for shaping employee behavior to conform to the requirements of the employee's job position that begins with a verbal caution and progresses to written reprimand, suspension, and dismissal upon subsequent offenses

information management

generation, collection, organization, validation, analysis, storage, and integration of data as well as dissemination, communication, presentation, utilization, transmission, and safeguarding of the information

National Committee on Vital and Health Statistics (NCVHS)

government agency that led development of basic data sets for health records and computer databases

Gantt chart

graphic tool used to plot tasks in project management that shows the duration of project tasks and overlapping tasks

eHealth Exchange

group of federal agencies and non-federal organizations that came together under a common mission and purpose to improve patient care, streamline disability benefit claims, and improve public health reporting through secure, trusted, and interoperable health information exchange. Participating organizations mutually agree to support a common set of standards and specifications that enable the establishment of a secure, trusted, and interoperable connection among all participating Exchange organizations for the standardized flow of information

investor-owned hospital chain

group of for-profit healthcare facilities owned by stockholders

trust community

group of organizations that have identified a set of mutual goals and dependencies that through collaborative effort lead to mutual benefit

Accountable Care Organizations (ACOs)

group of service providers working together to manage and coordinate care to Medicare fee-for-service beneficiaries

Nominal Group Technique (NGT)

group process technique that involves the steps of silent listing, recording each participant's list, discussing, and rank ordering the priority or importance of items; allows groups to narrow the focus of discussion or make decisions without becoming involved in extended, circular discussions

assist decisions

guidelines

centralized model

health information exchange model in which data are stored in a shared data repository

unit numbering system

health record identification system in which patient receives a unique MRN at time of first encounter that is used for all subsequent encounters

entities that process nonstandard information they receive from another entity into a standard

healthcare clearinghouses

Work Breakdown Structure (WBS)

hierarchical structure that decomposes project activities into levels of detail

Exclusive Provider Organization (EPO)

hybrid MCO that provides benefits to subscribers only when healthcare services are performed by network providers; sponsored by self-insured employers or associations and exhibits characteristics of both HMOs and PPOs

Auditing Integrity

inadequate functions that make it impossible to detect when an entry was modified or borrowed from another source and misrepresented as an original entry by an authorized user

delinquent health record

incomplete record not finished or made complete within the time frame determined by the medical staff of the facility

Common reasons for claim denials include all of the following except: Billing non-covered services Lack of medical necessity Beneficiary not covered Coverage not in effect for date of service

incorrect: coverage not in effect for date of service

enterprise master patient index (EMPI)

index that provides access to multiple repositories of information from overlapping patient populations that are maintained in separate systems and databases

criminal negligence

individual is liable if his or her behavior is categorized as reckless disregard or deliberate indifference

physician champion

individual who assists in communicating and educating medical staff in areas such as documentation procedures for accurate billing and appropriate EHR processes; AKA physician advisor

Nationwide Health Information Network (NHIN)

initiated to create a governance, standards, and policy structure that could be easily adopted and scaled to enable health information exchange across organizational, regional, and state boundaries; set of guidelines, recommended technology standards, and data use and service level agreements that can facilitate data exchange

Documentation from various sources is intermingled and organized in strict chronological or reverse chronological order

integrated health record

data architecture

integrated set of specification artifacts used to define data requirements, guide integration and control of data assets, and align data investments with business strategy

e-commerce

integration of all aspects of business-to-business (B2B) and business-to-consumer (B2C) activities, processes, and communications, including electronic data interchange (EDI)

fraud

intentional deception or misrepresentation that an individual knows or should know is false and makes anyway, knowing deception could result in some unauthorized benefit to himself or some other persons

clinical decision support (CDS) systems

interactive programs designed to assist clinicians in making patient care decisions

internal rate of return (IRR)

interest rate that makes net present value calculation equal to 0

Private network that has its servers located inside a firewall

intranet

What is public law?

involved rights and duties between government and private parties (individuals or business) or between parts of federal, state, or local government criminal law (felonies, misdemeanors) Constitutional law Statutes and regulations intended for compliance

debt ratio

liability/asset; preferable debt ratio smaller than 1

execution of an unlawful or improper act

malfeasance

logic bombs

malware that will execute a program, or a string of code, when a certain event happens

lean

management strategy in which the core idea is to maximize value while minimizing waste, basically creating more value with fewer resources

Learning Content Management System (LCMS)

management system that provides a technical framework to develop the content and permit sharing and reusing content

Office of Inspector General (OIG)

mandated to protect the integrity of HHS programs, as well as health and welfare of beneficiaries of those programs; responsibility to report both to Secretary and Congress program, and management problems and recommendations to correct them

general ledger

master list of individual revenue and expense accounts maintained by an organization

Algorithms

mathematical formulas used by an organization or enterprise that combine weighted data elements to determine the probability of a duplicate in order MPI entries 3 types: Deterministic Rules based Probabilistic

This scheme supports general managers who focus on managing people and processes, as opposed to strategy and structure; flexible and supports multidimensional organization; employees have dual responsibilities and may have two or more supervisors

matrix

cardinality

maximum number of occurrences of each entity that occurrences of other entities can link to

attributable risk (AR)

measure of the impact of a disease on a population (for example, measuring additional risk of illness as a result of exposure to a risk factor)

total margin ratio

measurement of overall profitability of an organization that compares excess of revenue over expense by total revenue

extrapolation method

method of auditing claims by looking at small sample of records an applying correction in payment/reimbursement across a large number of claims in a time period or service area

episode-of-care (EOC) reimbursement

method that issues lump-sum payments to providers to compensate for all healthcare services delivered to a patient for a specific illness OR over a specific period of time

project portfolio management

method used to identify, select, and prioritize projects and programs in a manner to make best use of the limited resources

nonrepudiation

methods (along with documentation) by which data are maintained in an accurate form after their creation, free of unauthorized changes, modifications, updates, or similar edits

federated model

model of health information exchange where there is not a centralized database of patient information; AKA decentralized model

Systemized Nomenclature of Medicine--Clinical Terminology/Reference Terminology (SNOMED CT/RT)

most comprehensive, multilingual clinical healthcare terminology in the world CT--contributes to improvement of patient care by underpinning development of EHRs that record clinical information in ways that enable meaning-based retrieval RT--reference terminology by inclusion of elementary mapping to ICD-9-CM

elements of a valid subpoena

name of court; caption of action (names of plaintiff and defendant); case docket number; date/time/place of requested appearance; information commanded (testimony or documents in a duces tecum) and form in which information is to be produced; name of issuing attorney; name of recipient; signature or stamp of court

improve communication, use medicine safely, prevent infection, check patient medicines, prevent falls, prevent bedsores, identify patient safety risk, identify patients correctly

national patient safety goals

Preferred Provider Organization (PPO)

network contractually agreed to specified reimbursement, providing reimbursement for covered benefits regardless if in network, and offered by non-HMOs

A list of proper names for diseases and operations

nomenclature

accession number/registry

number assigned to each case as it is entered in cancer registry; list of cases in cancer registry in order by which they were entered

hay method of job evaluation

numerically measures the levels of three major compensable factors: know-how, problem-solving ability, and accountability

case manager

nurse, doctor, or social worker who arranges all services that are needed to give proper healthcare to a patient or group of patients

object-oriented database

object that contains both data and their relationships in a single structure

mediation

objective third party unrelated to dispute is invited to bring the parties to mutual agreement

incident/incident report

occurrence in medical facility that is inconsistent with accepted standards of care; collects data and information about potentially compensable events (events that may result in death or serious injury)

adverse determination

occurs when a healthcare insurer denies payment for proposed or already rendered services

Type II error

occurs when null hypothesis is not rejected when it actually is false (not rejecting null when should have rejected--> false negative)

esprit de corps

one of Henry Fayol's principles of management that emphasized the work climate in which harmony, cohesion, and high morale promoted good work

matrix organization

organization where employees report to an administrative supervisor from the original functional area to carry out their operational work but may also report to a functional supervisor to manage their work on the project

projected organization

organization where the operational department structures focused on a specialty or subspecialty are replaced by multidisciplinary project teams led by a project manager

balanced matrix organization

organizational structure in which a project organization exists within the already existing functional hierarchy; a project manager is recruited from one of the functional departments to serve as the leader of the project

Not elsewhere classifiable (NEC)

other specified

clinical information model

outcome of the transitions of care (ToC) initiative consisting of the unambiguous, clinically-relevant definitions of the core data elements that should be included in care transitions

data governance

overall management of availability, usability, integrity, and security of data employed in an organization or enterprise

arm's length transaction

parties are dealing from equal bargaining positions; neither is subject to the other's control or dominant influence; transaction treated with fairness, integrity, and legality

serial-unit numbering system

patient is issued a different number for each admission or encounter for care and records of past episodes of care are brought forward to be filed under last number used

Value-Based Purchasing (VBP)

pays for care that rewards better value, patient outcomes, and innovation, rather than just volume of care provided

force-field analysis

performance improvement tool used to identify specific drivers of, and barriers to, an organizational change so that positive factors can be reinforced and negative factors reduced

project management life cycle

period in which the processes involved in carrying out a project are completed, including project definition, project planning and organization, project tracking and analysis, project revisions, change control, and communication

emergency mode operation plan

plan that defines the processes and controls that will be followed until the operations are fully restored; plan to keep PHI protected while in a crisis

upcoding

practice of assigning diagnostic or procedural codes that represent higher payment rates than the codes that actually reflect the services provided to patients (fraud)

unbundling

practice of using multiple codes to bill for the various individual steps in a single procedure, rather than using a single code that includes all the steps of the comprehensive procedure (fraud)

Type I error

probability of incorrectly rejecting the null hypothesis given the values present in the sample (incorrectly rejecting true null--> false positive)

p-value

probability of making a Type 1 error based on a particular set of data (AKA alpha-level)

Clinical Documentation Improvement (CDI)

process an organization undertakes that will improve clinical specificity and documentation that will allow coders to assign more concise disease classification codes

digital dictation

process by which voice sounds are recorded and converted into digital format

Coordination of Benefits (COB) transaction

process for determining the respective responsibilities of two or more health plans that have some financial responsibility for a medical claim

Systems Development Life Cycle (SDLC)

process for planning, creating, testing, and deploying an information system; four steps: analysis, design, implementation, evaluation/maintenance

computer-assisted coding

process of extracting and translating dictated and then transcribed free-text data (or dictated and then computer-generated discrete data) into ICD-10-CM and CPT evaluation/management codes for billing and coding purposes

data security

process of keeping data, both in transit and at rest, safe from unauthorized access, alteration, or destruction

accrue

process of recording known transactions in the appropriate time period before cash payments/receipts are expected or due

systematic random sampling

process of selecting a sample of subjects for a study by drawing every 'n'th unit on a list

stratified random sample

process of selecting the same percentages of subjects for a study sample as they exist in the subgroups (strata) of the population

simple random sample

process of selecting units from a population so that each one has exactly the same chance of being included in the sample

Analysis

process of translating data into information utilized for an application

iterative process

process that initially prioritizes initiatives and focuses on small select business imperatives that quickly deliver value and expands as the program matures

Unified Medical Language System (UMLS)

program initiated by National Library of Medicine to build an intelligent, automated system that can understand biomedical concepts, words, and expressions and their interrelationships; includes concepts and terms from many different source vocabularies

weak matrix organization

project manager role does not exist but a project expediter role is used to work directly with the functional staff rather than through the functional mangers

strong matrix organization

project managers are not functional staff members assuming the role of project manager, but rather are project manager specialists reporting to a manger of project management; it is very similar to the balanced matrix but includes a department of project managers

project sponsor

project owner; often either a functional leader expressing the need for change or a leader over the functional area most likely to be affected or benefited by the project

expense projects

projects where new and improved information is created

Good Samaritan statutes

protects healthcare providers from liability for not obtaining informed consent before rendering care to adults or minors at the scene of an emergency or accidence

consumer-mediated exchange

provides patients with access to their health information, allowing them to manage their healthcare online in a similar fashion to how they might manage their finances through online banking

health statistics

providing information for understanding, monitoring, improving, and planning the use of resources to improve the lives of people, provide services, and promote their well-being

root operation: extraction

pulling or stripping out or off all or a portion of a body part by the use of force; examples are dilation and curettage, vein stripping, suction dilation and curettage, phacoemulsification without intraocular lens implant, nonexcisional debridement of skin, extraction of teeth, bone marrow biopsy, endometrial biopsy, or liposuction for medical purposes

root operation: supplement

putting in or on biologic or synthetic material that physically reinforces and/or augments the function of a portion of a body part; examples are herniorrhaphy using mesh, free nerve graft, mitral valve ring annuloplasty, putting in a new acetabular liner in a previous hip replacement, abdominal wall herniorrhaphy using mesh, and colporrhaphy with mesh reinforcement

EHR

record that conforms to national interoperability standards and can be consulted across multiple organizations

terminal-digit filing system

records are filed according to a 3-part number made up of two-digit pairs; basic filing system contains 10,000 divisions made of 100 sections ranging 00 to 99 with 100 divisions within each section ranging from 00 to 99

functional interoperability

refers to sending messages between computers with a shared understanding of the structure and format of the message

odds ratio

relative measure of occurrence of an illness; odds of exposure in a diseased group divided by odds of exposure in non-diseased group

CMI

relative value assigned to a DRG; used in determining the allocation of resources to care and/or treat the patients in the group

dimensions of Data Quality

relevancy, granularity, timelines, currency, accuracy, precision, consistency

interrater

reliability checks where more than one person abstracts data for the same case, and results are compared to identify discrepancies

gross negligence

represents reckless disregard; extreme departure from ordinary standard of care

breach notification rule

requires covered entities and business associates to establish policies and procedures to investigate an unauthorized use or disclosure of PHI to determine if a breach occurred, conclude the investigation, and to notify affected individuals and the secretary of DHHS within 60 days of breach discovery

The final judgment of a competent court is conclusive

res judicata

Comparative Effectiveness Research (CER)

research that generates and synthesizes evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, or to improve the delivery of care

qualitative analysis

review of health record to ensure that standards are met and to determine the adequacy of entries documenting the quality of care; identify for inefficiencies/incompleteness/errors

concurrent review

review that occurs as the patient care is ongoing; often reviewers are alongside healthcare providers on patient care units to facilitate communication

DMAIC

scientific methodology of decision making that involves the following steps: Define, Measure, Analyze, Improve, Control

ancillary (services, functions)

secondary. services/functions provided to support the primary function. EX: OT ancillary service for physician, biomedical research ancillary function of health record

physical safeguards

security rule measures such as locking doors to safeguard data and various media from unauthorized access and exposures, including facility access controls, workstation use, workstation security, and device and media controls

optimization

seeking the most accurate documentation, coded data, and resulting payment in the amount the provider is rightly and legally entitled to receive; includes activities that extend use of information systems beyond basic functionality

A new number is assigned to the patient for each new encounter at the facility, but the former records are brought forward and filed under the new number

serial-unit numbering

inpatient services day

services received by one inpatient in one 24-hour period

metadata

set of data that gives information about other data, such as: name of element, locator key, ownership, entity relationship, date entered in system, system origin, etc

descriptive statistics

set of statistical techniques used to describe data such as means, frequency distributions, and standard deviations; statistical information that describes the characteristics of a specific group or a population

electronic performance support system (EPSS)

sets of computerized tools and displays that automate training, as well as documentation, and integrate this automation with the computer application

open communication

sharing all types of information throughout the organization and across functional and hierarchical boundaries

charitable immunity

shields hospitals and other institutions from liability for negligence because of belief that donors would not make contributions if they thought their donation would be used to litigate claims combined with concern that a few lawsuits could bankrupt a hospital

The operative report

should be dictated immediately after surgery and filed in the patients health record. When delays in dictation or transcription are unavoidable surgeons should include a brief description of the operations in their postoperative progress notes.

Covered entities must retain documentation of their security polices for at least

six years from the date when it was last in effect

Medicare Code Editor (MCE)

software that edits claims to detect incorrect billing data that is being submitted.

database management system

software tools used to store, analyze, modify, and access data

methods of two-factor authentication

something you know (password, pin); something you have (swipe card); something you are (fingerprint, voice scan). must have two DIFFERENT methods

Multiuser Virtual Environment (MUVE)

sometimes called virtual worlds; accessed over the internet and can be used to simulate a work environment and bring a new dimension to learning

the number of immediate subordinates a manager can manage effectively

span of control

DIRECT exchange

specify a simple, secure, scalable, standards-based way for participants to send (push) authenticated, encrypted health information directly to known, trusted recipients over the internet

medical staff bylaws

spell out qualifications for physicians before they are able to practice in a given hospital. legally binding--changes to "laws" must be approved by a vote of medical staff and hospital's governing body

Positions that assist and advise the manager in accomplishing objectives

staff

financial counselor

staff dedicated to helping patients and physicians determine sources of reimbursement for services; responsible for identifying and verifying the method of payment and debt resolution for services rendered to patients

heterogeneity

state or fact of containing various components

inferential statistics

statistics used to make inferences from a smaller group of data to a large one; set of statistical techniques that allows researchers to make generalizations about a population's characteristics (parameters) on the basis of a sample's characteristics

Anti-Kickback Statute (AKS)

statute that makes knowingly offering, paying, soliciting, or receiving any remuneration that rewards referrals for services reimbursable by a federal program a criminal offense; criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of federal health care program business

migration plan

strategic plan that identifies applicants, technology, and operational elements needed for the overall information technology program in a healthcare entity

samples of a population that consists of a number of subgroups or strata that may differ in characteristics being studied (e.g., ethnic groups)

stratified sample

single-blind study

study design in which (typically) the investigator, but not the subject, knows the identity of the treatment and control groups

epidemiology

study of distribution and determinants of health problems in specified populations and the application of this study to control health problems

case-control (retrospective) study

study that investigates the development of disease by amassing volumes of data about factors in the lives of persons with the disease (cases) and persons without the disease

charting by exception

system of health record documentation in which progress notes focus on abnormal events and describe any interventions that were ordered and the patient's response

integrated health record

system of health record organization in which all paper forms are arranged chronologically and mixed with forms created by different departments

source-oriented health record

system of health record organization in which information is arranged according to the patient care department that provided the care

telehealth

system that links healthcare organizations and patients from different geographic locations and transmits texts and images for medical consultation and treatment

cybernetic systems

systems that have standards, controls, and feedback mechanisms built into them

project expeditor

tasked with materials management and logistics for the project, this individual works as a staff assistant and communications coordinator

Computer output laser disk/enterprise report management (COLD/ERM) technology

technology that electronically stores documents and distributes them with fax, e-mail, web, and traditional hard-copy print processes

cipher text

text message that has been encrypted, or converted into code, to make it unreadable in order to conceal its meaning

multiaxial

the ability of a nomenclature to express the meaning of a concept across several axes

deontology

the duty or responsibility guiding the decision based on action and not the end result

Coinsurance

the percentage the guarantor pays

data stakeholders

those who have an interest or stake in organizational data and can include customers, front line workers, business units, managers, executives, and even external groups such as state and federal agencies, accreditation bodies, and others

Statue of limitations

time period in which a law suit may be filed, must be considered in establishing a retention schedule

determined by how the data are being used and their context

timeliness

cryptographic key

tool applied to the data in order to turn the information into cypher text (encryption) as well as converting the cipher text back to plain text (decryption)

ADDIE model

training and development method defined as Analyze, Design, Develop, Implement, Evaluate

blended learning

training strategy that uses a combination of techniques (such as lecture, web-based training, or programmed text) to appeal to a variety of learning styles and maximize the advantages of each training method

strives to create an efficient workplace by balancing task accomplishment with interpersonal satisfaction

transactional leadership

retail clinics

treat non-life-threatening acute illness and offer routine wellness services--flu shots, physicals, prescription refills, etc

double-blind study

type of clinical trial conducted with strict procedures for randomization in which neither researcher nor subject knows whether the subject is in the control group or the experimental group

parallel work division

type of concurrent work design in which one employee does several tasks and takes the job from beginning to end

statistical process control (SPC) chart

type of run chart that includes both upper and lower control limits and indicates whether a process is stable or unstable

simple linear regression

type of statistical inference that not only measures the strength of the relationship between two variables, but also estimates a functional relationship between them

Not otherwise specified (NOS)

unspecified

query-based exchange

used by providers to search and discover accessible clinical sources on a patient; a query on database asks a question of the database and pulls information based on the keywords that are used in the query; this type of query is often used when delivering unplanned care such as ED visits

artifacts

used to describe data and the relationships among data and the processes they support

Contingency table

useful method for displaying the relationship between two categorical variables

maximization

using unbundling/upcoding to make the most of reimbursement to the highest possible amount through coded data

Health Maintenance Organization (HMO)

usually only pays for care within own network; primary doctor coordinates care

a method of controlling healthcare costs and quality of care by reviewing the appropriateness and necessity of care provided to patients

utilization management

sole proprietorship

venture with one owner in which all profits are considered owner's personal income

Lexicon

vocabulary used in a language or subject area by a particular speaker or group of speakers; collection of words or terms and meanings for a particular domain (drug terms in healthcare)

HITECH breach notification requirements--media and secretary of HHS should be notified of security breaches

when 500+ individuals are affected

OIG workplan

yearly plan released by OIG that outlines the focus for reviews and investigations in various healthcare settings

Entity relational diagram

developed to depict relational database structures. Graphical display of the relationships between tables in a database

debt ratio

(total liabilities) / (total assets)

Vicarious Liability

Organization responsible for negligent acts of its employees

T/F: Care in a clinic is excluded from determinations of medical necessity

TRUE

M-learning

mobile learning; application of e-learning to mobile computing devices and wireless networks

libel

written defamation

Physician Champion

Assists in educating medical staff members on the documentation needed for accurate billing

ADT

Administrative, discharge and transfer system is a type of core administrative system. It houses most of the patient demographics including finical, insurance, diagnosis and emergency contact info

Logical Observation Identifier Names and Codes(LONIC)

Aimed at standardizing laboratory and clinical codes for use in clinical care outcomes, outcomes management and research -Identifying test results

Measurements need to be?

1.Vaild- Measuring what needs to be measured 2. Reliable- Consistent results over time between users

Per HITECH an accounting of disclosures must include disclosures made during the previous

3 years

Mr. Martin ha asked to review a copy of his PHI. His request must be responded to no later than?

30 days

Encoder

A computer software program that supports a coder in assigning correct codes

Matrix Scheme

Allows general managers to directly manage people and process and distribute overall authority from the board the CEO to general and lower managers Communication is horizontal and less formal than vertical. Advantage: Strong leaders can effectively oversee certain areas of hospital organization.

Per member per month (PMPM)

Amount of money paid each month for each individual enrolled in the health insurance. Characteristic of HMOs

POMR

Chart order format for paper based records 4 Parts: Database Problem list Initial plan Progress notes(SOAP) -hard to maintain

Secondary data source

Data taken from the health record and entered into registries and databases

Nominal Group Technique(NGT)

Involves written submission of ideas from a group.

EXR Extension Model

Personal Health Record model that maintains provider control of context while allowing online access to the authorized patient

Nonrepudiation

Practices or methods that defend against charges questioning the integrity of the data and documents

Data Mining

Process of sorting through the organizations data to identify unusual patterns or to apply analytical models that will assist in predicting future events

Document imaging is an example of a function performed in which stage of the information lifecycle?

Record creation, capture or receipt

Demiltarized Zone(DMZ)

Which sits between the internal network and the VPN. It allows outside access to a portion of the network while protecting the intranet or internal information

Unjust termination

Wrongful dismissal 4 types: Tort Law Implied consent Implied covenant of good faith Public policy Exeception Pg.118