Practice Exam04 (D5,6)
During a review of documentation practices, the HIM director finds that nurses are routinely using the copy and paste functionality of the hospital's EHR system for documenting nursing notes. Which of the following should the HIM director do to ensure that the nurses are following acceptable documentation practices? a. Inform the nurses that copy and paste is not acceptable and to stop this practice immediately b. Determine how many nurses are involved in this practice c. Institute an in-service training session on documentation practices d. Develop policy and procedures related to cutting, copying, and pasting documentation in the EHR system
Correct Answer: D The ability to copy previous entries and paste into a current entry leads to a record in which a clinician may, upon signing the documentation, unwittingly swear to the accuracy and comprehensiveness of substantial amounts of duplicated or inapplicable information as well as the incorporation of misleading or erroneous documentation. The HIM professional plays a critical role in developing policies and procedures to ensure the integrity of patient information (Russo 2013b, 339-340).
In a typical acute-care setting, the Explanation of Benefits, Medicare Summary Notice, and Remittance Advice documents (provided by the payer) are monitored in which revenue cycle area? a. Preclaims submission b. Claims processing c. Accounts receivable d. Claims reconciliation and collections
Correct Answer: D The last component of the revenue cycle is reconciliation and collections. The healthcare facility uses the EOB, MSN, and RA to reconcile accounts. These are monitored in the claims reconciliation and collections area of the revenue cycle (Casto and Forrestal 2015, 256).
The national patient safety goals score organizations on areas that: a. Affect the financial stability of the organization b. Commonly lead to overpayment c. Affect compliance with state law d. Commonly lead to patient injury
Correct Answer: D The national patient safety goals outline for healthcare organizations the areas of organizational practice that most commonly lead to patient injury or other negative outcomes that can be prevented when staff utilize standardized procedures (Carter and Palmer 2016, 520).
The policies and procedures section of a coding compliance plan should include all except which of the following? a. Physician query process b. Unbundling c. Assignment of discharge disposition codes d. Utilization review
Correct Answer: D The policies and procedures section of a coding compliance plan should include physician query process, coding diagnosis not supported by health documentation, upcoding, correct use of encoder software, unbundling, coding health records without complete documentation, assignment of discharge destination codes, and complete process for using scrubber software. Utilization review would not be part of the policies and procedures section of a Coding Compliance Plan (Casto and Forrestal 2015, 44).
HIPAA requires a covered entity to establish policy to ensure that protected health information could not identify a specific individual. One method used to meet this deidentification standard is the expert determination model. The expert determination model requires these four steps: 1.Determine the statistical and scientific method to be used to determine the risk of reidentification 2. Analyze and assess the risk to the deidentified data 3. The expert applies the method to the deidentified data 4. The facility should choose the expert for the deidentification analysis What is the correct order in which these steps should be performed? a. 4, 1, 2, 3 b. 1, 2, 3, 4 c. 2, 4, 3, 1 d. 4, 1, 3, 2
Correct Answer: D The process for expert determination of de-identification has four recommended steps that include: Step 1: The facility should choose the expert for the deidentification analysis; Step 2: Determine the statistical and scientific method to be used to determine the risk of reidentification; Step 3: The expert applies the method to the deidentified data; and Step 4: Analyze and assess the risk to the deidentified data (Marc and Sandefer 2016, 22-23).
The basic functions of healthcare risk management programs are similar for most organizations and should include which of the following? a. Reporting of claims, initial investigation of claims, protection of primary and secondary health records, negotiation of settlements, management of litigations, and use of information for claim's resolution in performance management activities b. Risk acceptance, risk avoidance, risk reduction or minimization, and risk transfer c. Safety management, security management, claims management, technology management, and facilities management d. Risk identification and analysis, loss prevention and reduction, and claims management
Correct Answer: D The purpose of the risk management program is to link risk management functions to related processes of quality assessment and PI. The basic functions of healthcare risk management programs are similar for most organizations and include: risk identification and analysis, loss prevention and reduction, and claims management (Carter and Palmer 2016, 522).
The Medical Record Committee wants to determine if the hospital is in compliance with medical staff rules and regulations for medical record delinquency rates. The HIM director has compiled a report that shows that records are delinquent for an average of 29 days after discharge. Given this information, what can the committee conclude? a. Delinquency rate is within medical staff rules and regulations. b. All physicians are performing at optimal levels. c. The chart deficiency process is working well. d. Data are insufficient to determine whether the hospital is in compliance.
Correct Answer: D When an incomplete record is not rectified within a specific number of days as indicated in the medical staff rules and regulations, the record is considered to be a delinquent record. Generally, an incomplete record is considered delinquent after it has been available to the physician for completion for 15-30 days. This question does not provide enough information on the standard as the medical staff rules and regulations on delinquent records are not defined (Sayles 2016b, 64-65).
Which of the following can assist managers with the tasks of monitoring productivity and forecasting budgets? a. Intermediary bulletins b. Mapping errors c. Revenue codes d. Workload statistics
Correct Answer: D Workload statistics can assist managers with the tasks of monitoring productivity and provide data regarding resources used, such as equipment, personnel, services, and supplies (Schraffenberger and Kuehn 2011, 223).
How many basic elements are included in an effective compliance program? a. Five b. Seven c. Nine d. Three
Each healthcare facility should have a compliance program. There are seven basic elements that should be included in an effective compliance program. These include: policies, procedures and standards of conduct; identifying a compliance officer and committee; educating staff; establish communication channels; perform internal monitoring; penalties for noncompliance with standards; and taking immediate corrective action when a problem is identified (Fotlz et al. 2016, 457-458).
Which of the following is the process of establishing an organizational culture that promotes the prevention, detection, and resolution of instances of conduct that do not conform to federal, state, or private payer healthcare program requirements or the healthcare organization's ethical and business policies? a. Corporate integrity b. Meaningful Use c. Benchmarking d. Compliance
Why is it essential for members of the compliance team to be involved in the entire EHR implementation process? a. To ensure HIPAA compliance b. Evolving regulatory guidelines c. To monitor cut and paste documentation d. Reimbursement risk
Federal Sentencing Guidelines
federal standards used by judges in determining mandatory sentence terms for those convicted of federal crimes
Organizations use of audits in data analysis in order to ensure compliance with policies and procedures is a component of: a. Internal monitoring b. Benchmarking c. Corrective action d. Educating staff
orrect Answer: A As part of an effective compliance plan organizations must perform internal monitoring. These organizations must be diligent to ensure compliance with policies and procedures, such as through the use of audits and data analysis (Foltz et al. 2016, 458).
A hospital currently uses the patient's Social Security number as their patient identifier. The hospital risk manager has identified this as a potential identity fraud risk and wants the information removed. The risk manager is not getting cooperation from the physicians and others in the hospital who say 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
orrect 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 (Sayles 2016b, 59).
When a staff member documents in the health record that an incident report was completed about a specific incident, in a legal proceeding how is the confidentiality of the incident report affected? a. There is no impact. b. The person making the entry in the health record may not be called as a witness in trial. c. The incident report likely becomes discoverable because it is mentioned in a discoverable document. d. The incident report cannot be discovered even though it is mentioned in a discoverable document.
orrect Answer: C Hospitals strive to keep incident reports confidential, and in some states, incident reports are protected under statutes protecting quality improvement studies and activities. Incident reports themselves should not be considered a part of the health record. Because the staff member mentioned in the record that an incident report was completed, it will likely be discoverable as the health record is already a discoverable document (Carter and Palmer 2016, 522).
The HIM director is part of the revenue cycle management team. The discharged-not-final-billed days are increasing because discharges are increasing. The number of coding staff is five. In an effort to increase productivity, the HIM director is researching staffing alternatives. With the implementation of an electronic document storage system, telecommuting has been suggested as an alternative. Studies report that coding productivity can increase as much as 20 percent with telecommuting. Given that discharges have increased from 100 per day to 144, how many more FTEs would need to be hired if the department went to telecommuting? a. 0.5 FTE b. 0.75 FTE c. 1 FTE d. 2 FTEs
*Correct Answer: C*, The productivity increase with telecommuting is 20 percent. The facility has five coders who are currently coding a total of 100 charts a day. With this 20 percent increase, each of the existing five coders can code four records more per day each (a 20 percent increase). This amounts to 120 charts: 24 × 5 = 120. If the discharges increase by 44 charts, the facility would need one more FTE in the telecommuting staffing model, since each coder can code 24 records per day (Horton 2016a, 185-186).
If steps in a revenue cycle process are handled separately in sequence by individual workers, the method of organizing work is called which of the following? a. Serial work division b. Parallel work division c. Processing d. Benchmarking
Correct Answer: A One of two major ways to organize process work is serial work division, assembly line fashion, where tasks or steps are handled separately in sequence by multiple individuals (Prater 2016, 584).
If an HIM department acts in deliberate ignorance or in disregard of official coding guidelines, it may be committing: a. Abuse b. Fraud c. Malpractice d. Kickbacks
Correct Answer: B Medicare defines fraud as an intentional representation that an individual knows to be false or does not believe to be true but makes, knowing that the representation could result in some unauthorized benefit to himself or herself or some other person. Disregard for official coding guidelines would be considered fraud (Casto and Forrestal 2015, 36).
Every healthcare organization's risk management plan should include the following components except: a. Loss prevention and reduction b. Safety and security management c. Peer review d. Claims management
Correct Answer: C *Risk management* programs have three functions: *risk identification and analysis, loss prevention and reduction, and claims management* (Carter and Palmer 2016, 522).
Coding productivity is measured by: a. Quantity b. Quality c. Quantity and quality d. Volume
Correct Answer: C Coding productivity is measured by two indicators of a coder's skill are the types of errors he or she makes and the speed at which he or she can work (Sayles 2016b, 74).
The overutilization or inappropriate utilization of services and misuse of resources, typically not a criminal or intentional act is called which of the following? a. Fraud b. Abuse c. Waste d. Audit
Correct Answer: C Waste is the overutilization or inappropriate utilization of services and misuse of resources, and typically is not a criminal or intentional act. Waste includes practice like over prescribing and ordering tests inappropriately (Foltz et al. 2016, 448).
Which of the following issues compliance program guidance? a. AHIMA b. CMS c. Federal Register d. HHS Office of Inspector General
Correct Answer: D From February 1998 until the present, the Office the Inspector General (OIG) continues to issue compliance program guidance for various types of healthcare organizations. The OIG website (www.oig.hhs.gov) posts the documents that most healthcare organizations need to develop fraud and abuse compliance plans (Casto and Forrestal 2015, 37).
Which plan should be devised to respond to issues arising from the clinical documentation improvement (CDI) compliance and operational audit process? a. CDI response plan b. Quality assurance plan c. CDI plan d. Corrective action plan
Correct Answer: D Most audits should identify some issues, either operational or compliance, in the clinical documentation improvement (CDI) process, even if they are minor issues. An organization needs to develop a corrective action plan for any identified issues (Hess 2015, 214).
A patient was taken into surgery at a local hospital for treatment of colon cancer. A large section of the colon was removed during surgery and the patient was taken to the medical floor after surgery. Within the first 24 hours post-op, the patient developed fever, chills, and abdominal pain. An abdominal CT scan revealed the presence of a foreign body. This situation describes a: a. Near miss b. Sentinel event c. Security incident d. Time out
A patient was taken into surgery at a local hospital for treatment of colon cancer. A large section of the colon was removed during surgery and the patient was taken to the medical floor after surgery. Within the first 24 hours post-op, the patient developed fever, chills, and abdominal pain. An abdominal CT scan revealed the presence of a foreign body. This situation describes a: a. Near miss b. Sentinel event c. Security incident d. Time out
Position descriptions, policies and procedures, training checklists, and performance standards are all examples of: a. Staffing tools b. Organizational policies c. Strategic plans d. Items on a training checklist
Correct Answer: A *Staffing tools* may be used to plan and manage staff resources. Staffing tools include: position descriptions, which outline the work and qualifications required by the job; performance standards, which establish expectations for how well the job will be done and how much work will be accomplished; and written policies and procedures explaining staffing requirements and scheduling, which assist the supervisor in being fair and objective and help the staff understand the rules (Prater 2016, 568, 584-592).
The acute-care hospital discharges an average of 55 patients per day. The *HIM department is open during normal business hours onl*y. The volume productivity standard is six records per hour when coding 4.5 hours per day. Assuming that standards are met, how many FTE coders does the facility need to have on staff in order to ensure that there is no backlog? a. 2.85 b. 5 c. 14.26 d. 27
Correct Answer: A 385 charts *per week* / 5 days / 27 standard charts per day = 2.85 (Horton 2016a, 185-186).
A(n) ________ is imposed on providers by the OIG when fraud and abuse is discovered through an audit or self-disclosure. a. Corporate Integrity Agreement b. OIG Workplan c. Red Flags Rule d. Resource Agreement
Correct Answer: A A *corporate integrity agreement (CIA)* is essentially a compliance program imposed by the government, with substantial government oversight and outside expert involvement in the organization's compliance activities. The OIG negotiates CIAs with health care providers and other entities as part of the settlement of federal health care program investigations arising under a variety of civil false claims statutes. Providers or entities agree to the obligations, and in exchange, OIG agrees not to seek their exclusion from participation in Medicare, Medicaid, or other federal healthcare programs (Bowman 2017, 460).
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
Correct Answer: A Accuracy of coding is best determined by a predefined audit process. The audits allow the facility to confirm that the policies and procedures of the organization are being met and to identify problems that need to be addressed and corrected (Foltz et al. 2016, 459).
Which of the following is a good question for a supervisor of coding to ask when evaluating potential fraud or abuse risk areas in the coding area? a. Are the assigned codes supported by the health record documentation? b. Does the hospital have a compliance plan? c. How many claims have not been coded? d. Which members of the medical staff have the most admissions to the hospital?
Correct Answer: A Codes are used to determine reimbursement, therefore code assignment is critical. Assigning the incorrect codes with the intent of receiving more money is fraudulent. The coding supervisor should regularly compare assigned codes to health record documentation to ensure compliance (Foltz et al. 2016, 461).
An HIM supervisor is revising job descriptions for record scanning positions. These positions have been in existence for just over one year. Which of the following would be the most appropriate action to take to make sure all tasks being performed are included in the new job descriptions? a. Ask current staff members to keep a diary for a certain period of time on how they spend their time b. Review job descriptions from other hospitals c. Make random observations of job tasks d. Refer the matter to the human resources department
Correct Answer: A Collecting data on current performance and tasks allows the HIM supervisor to include all tasks that are being performed in the new job descriptions. When more than one person is performing a task, the data could be collected over time and averaged. One method of doing this is to keep a diary for a period of time on how they spend their time. The experience and overall performance of each person must be considered in setting the standard (Prater 2016, 588).
Which type of identity theft occurs when a patient uses another person's name and insurance information to receive healthcare benefits? a. Medical b. Financial c. Criminal d. Health
Correct Answer: A 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 healthcare with an insurance benefit and pay less or nothing for the care received (Rinehart- Thompson 2016b, 247).
Which of the following strategies would be best to ensure that all stakeholders are engaged in the planning and development of an organization EHR system? a. Form an EHR steering committee b. Put out a press release c. Distribute an organization-wide memorandum from the CEO d. Put out a notice on the organization's intranet
Correct Answer: A Most organizations create an electronic health records (EHR) steering committee to engage all the various stakeholders in EHR planning and development. This ensures that the EHR planning is comprehensive and also starts the process of introducing change and gaining buy-in (Amatayakul 2016, 310).
Which of the following is part of qualitative analysis review? a. Checking that only approved abbreviations are used b. Checking that all forms and reports are present c. Checking that documents have patient identification information d. Checking that reports requiring authentication have signatures
Correct Answer: A Qualitative analysis is about the quality of the documentation including the use of approved abbreviations (Sayles 2016b, 63).
Using data mining, an RAC makes a claim determination at the system-level without a human review of the health record. This type of review is called: a. Automated review b. Complex review c. Detailed review d. Systematic review
Correct Answer: A RACs conduct three types of audits: automated reviews, semi-automated reviews, and complex reviews. An automated review occurs when an RAC makes a claim determination at the system level without a human review of the health record, such as data mining. Errors found must be clearly non-covered services or incorrect applications of coding rules and must be supported by Medicare policy, approved article, or coding guidance (Foltz et al. 2016, 453-454).
Risk determination considers the factors of: a. Likelihood and impact b. Risk prioritization and control recommendations c. Risk prioritization and impact d. Likelihood and control recommendations
Correct Answer: A Risk determination considers how likely is it that a particular threat will actually occur and, if it does occur, how great its impact or severity will be. Risk determination quantifies an organization's threats and enables it to both prioritize its risks and appropriately allocate its limited resources (namely, people, time, and money) accordingly (Rinehart-Thompson 2013, 124).
Which of the following groups are included in the feedback loop between denials, management, and clinical documentation improvement (CDI) program staff? a. Compliance b. Office of the Inspector General c. Center for Medicare and Medicaid Services d. Payers
Correct Answer: A The clinical documentation improvement (CDI) manager should coordinate a feedback loop with functional managers that involved reporting data from the department to CDI and then from CDI back to the department. The three areas for CDI best practices include operationalizing feedback loops with denials management, compliance, and HIM (Hess 2015, 242).
Quality Improvement Organizations perform medical peer review of Medicare and Medicaid claims through a review of which of the following? a. Validity of hospital diagnosis and procedure coding data completeness b. Appropriateness of EHR used c. Policies, procedures and standards of conduct d. Professional standards
Correct Answer: A The responsibilities of the quality improvement organizations include reviewing health records to confirm the validity of hospital diagnosis and procedure coding data completeness (Foltz et al. 2016, 454).
Which of the following is a problem-solving technique that focuses on working with individuals to find a mutually acceptable solution? a. Nominal group technique b. Change management c. Brainstorming d. New beginnings
Correct Answer: A Using the *nominal group technique*, the group writes down their suggestions anonymously and then votes on which ideas are the most appropriate for the context of the discussion. This technique focuses on finding a communally acceptable solution (Kellogg 2016b, 483).
Incorporating a workflow function in an electronic information system would help support: a. Tasks that need to be performed in a specific sequence b. Moving patients from point to point c. Registration of patients d. Making computer output available on laser disk
Correct Answer: A Workflow and process designs ensure the most efficient and effective use of electronic information systems (Amatayakul 2016, 287).
Per the HITECH breach notification requirements, what is the threshold for the *immediate* notification of each individual? a. 1,000 individuals affected b. 500 individuals affected c. 250 individuals affected d. Any number of individuals affected requires individual notification.
Correct Answer: B All individuals whose information has been breached must be notified without unreasonable delay, and not more than *60 days*, by first-class mail or a faster method (such as telephone) if there is the potential for imminent misuse.*If 500 or more* individuals are affected, they must be individually *notified immediately* and media outlets must be used as a notification mechanism as well. The Secretary of HHS must specifically be notified of the breach (AHIMA 2009; Rinehart-Thompson 2016b, 240).
During an audit of health records, the HIM director finds that transcribed reports are being changed by the author up to a week after initial transcription. To remedy this situation, the HIM director should recommend which of the following? a. Immediately stop the practice of changing transcribed reports b. Develop a facility policy that defines the acceptable period of time allowed for a transcribed document to remain in draft form c. Conduct a verification audit d. Alert hospital legal counsel of the practice
Correct Answer: B An example of unethical documentation in healthcare is retrospective documentation— when healthcare providers add documentation after care has been given, possibly for the purpose of increasing reimbursement or avoiding a medical legal action. The HIM professional is responsible for maintaining accurate and complete records and is able to identify the occurrence and either correct the error or indicate that the entry is a late entry into the health record (Gordon and Gordon 2016c, 615).
The breach notification requirement applies to: a. All PHI b. Unsecured PHI only c. Electronic PHI only d. PHI on paper only
Correct Answer: B Breach notification requirements only apply to unsecured PHI that technology has not made unusable, unreadable, or indecipherable to unauthorized persons. This PHI is considered to be the most at-risk (Rinehart-Thompson 2016b, 240).
What is the goal of the clinical documentation improvement (CDI) compliance review? a. To ensure adequate CDI improvement b. Compliant query generation and physician responses c. To ensure corrective action for any compliance concerns d. To ensure compliance between CDI program staff
Correct Answer: B Clinical documentation improvement (CDI) should be part of the organizational compliance program. The goal of a CDI compliance review is to monitor compliant query generation and physician responses (Hess 2015, 221-222)
The evaluation of coders is recommended at least quarterly for the purpose of measurement and assurance of: a. Speed b. Data quality and integrity c. Accuracy d. Effective relationships with physicians and facility personnel
Correct Answer: B Coders should be evaluated at least quarterly, with appropriate training needs identified, facilitated, and reassessed over time. Only through this continuous process of evaluation can data quality and integrity be accurately measured and ensured (Schraffenberger and Kuehn 2011, 270).
Each healthcare organization must identify and prioritize which processes and outcomes (in other words, which types of data) are important to monitor. This data collection should be based on the scope of care and services they provide and: a. The number of employees they employ b. Their mission c. The QI methodology used d. Their accreditation status
Correct Answer: B Each healthcare organization must identify and prioritize which processes and outcomes are important to monitor on the basis of its mission and the scope of care and services it provides (Shaw and Carter 2015, 27-28).
The clinical documentation improvement (CDI) program must keep high-quality records of the query process for: a. Revenue cycle analysis b. Compliance issues c. Chart deficiency tracking d. Reducing the workload on HIM
Correct Answer: B Every organization should apply the same criteria for high-quality clinical documentation to the recording of clinical documentation improvement (CDI) program activities (queries and case notes) as it does to the review of clinical documentation. Maintaining thorough query documentation is necessary for compliance purposes (Hess 2015, 241-242).
The Joint Commission is conducting an audit at Community Hospital to determine the hospital's compliance with The Joint Commission standards regarding patient rights. This is an example of a(n): a. Complex review b. External audit c. Internal audit d. Casefinding review
Correct Answer: B External audits are conducted by accreditation, insurance companies, or other organizations monitoring the healthcare provider for compliance with their standards and regulations. In this scenario The Joint Commission is doing an external audit to determine compliance with The Joint Commission standards regarding patients' rights (Foltz et al. 2016, 461).
A pharmacist who submits Medicaid claims for reimbursement on brand name drugs when less expensive generic drugs were actually dispensed has committed the crime of: a. Criminal negligence b. Fraud c. Perjury d. Products' liability
Correct Answer: B Fraud in healthcare is defined as a deliberate false representation of fact, a failure to disclose a fact that is material (relevant) to a healthcare transaction, damage to another party that reasonably relies on the misrepresentation, or failure to disclose. This situation would fall under category 2 (Foltz et al. 2016, 448).
Detailed query documentation can be used to: a. Protect the hospital from lawsuits b. Protect the hospital against claims from physicians about leading queries c. Show the effects of follow-up training d. Protect the auditor from corrective action
Correct Answer: B Healthcare organizations should keep detailed query data. There should be documented evidence of all queries the clinical documentation improvement (CDI) specialists ask, to whom they ask them, the clinical documentation or information supporting the query, and responses to queries. Detailed query documentation can also protect the hospital when against claims from physicians about leading queries (Hess 2015, 209).
Which of the following is a positive aspect of using employee self-appraisal as a source of data for performance appraisal? a. Employees are in the best position to provide objective review without overstatement b. The supervisor is kept informed of the employee's accomplishments c. Appraiser and employee training on the purpose and procedures of this process is essential d. Peer pressure of evaluation can motivate team members to be more productive
Correct Answer: B Methods used in performance appraisal must meet criteria for validity and reliability. Management decisions on pay, promotion, or dismissal based on performance appraisal are subject to defense in discrimination lawsuits. Employee self-appraisal provides the opportunity for the employee to keep the supervisor informed of accomplishments and issues (Prater 2016, 575-576).
Which of the following should be the first step in any quality improvement process? a. Analyzing the problem b. Identifying the performance measures c. Developing an alternative solution d. Deciding on the best solution
Correct Answer: B Most quality improvement methodologies recognize that the organization must identify and continuously monitor the important organizational and patient-focused functions that they perform. The first step in this process is to identify performance measures (Shaw and Carter 2015, 45).
In developing an internal audit review program, which of the following would be risk areas that should be targeted for audit? a. Admission diagnosis and complaints b. Chargemaster description c. Clinical laboratory results d. Radiology orders
Correct Answer: B One of the elements of the auditing process is identification of risk areas. Selecting the types of cases to review is also important. Examples of various case selection possibilities include chargemaster description for accuracy (Foltz et al. 2016, 458-459).
The process that is followed to mitigate and fix issues that arise during a review of systems that contain PHI to reduce vulnerabilities is called: a. Risk analysis b. Risk management c. Results documentation d. Recommendations for controls
Correct Answer: B One strategy in protecting the organization's data is to establish a risk management program. Risk management encompasses the identification, evaluation, and control of risks that are inherent in unexpected and inappropriate events (Rinehart-Thompson 2016c, 260).
Which of the following is the principal goal of internal auditing programs for billing and coding? a. Increase revenues b. Protect providers from sanctions or fines c. Improve patient care d. Limit unnecessary changes to the chargemaster
Correct Answer: B Ongoing evaluation is critical to successful coding and billing for third-party payer reimbursement. In the past, the goal of internal audit programs was to increase revenues for the provider. Today, *the goal is to protect providers from sanctions or fines*. Healthcare organizations can implement monitoring programs by conducting regular, periodic audits (Foltz et al. 2016, 457-458).
City Hospital has implemented a procedure that allows inpatients to decide whether they want to be listed in the hospital's directory. The directory information includes the patient's name, location in the hospital, and general condition. If a patient elects to be in the directory, this information is used to inform callers who know the patient's name. Some patients have requested that they be listed in the directory but information is to be released to only a list of specific people the patient provides. A hospital committee is considering changing the policy to accommodate these types of patients. In this case, what type of advice should the HIM director provide? a. Approve the requests because this is a patient right under HIPAA regulations. b. Deny these requests because screening of calls is difficult to manage and if information is given in error, this would be considered a violation of HIPAA. c. Develop two different types of directories—one directory for provision of all information and one directory for provision of information to selected friends and family of the patient. d. Deny these requests and seek approval from the Office for Civil Rights.
Correct Answer: B The HIPAA Privacy Rule allows individuals to decide whether they want to be listed in a facility directory when they are admitted to a facility. If the patient decides to be listed in the facility directory, the patient should be informed that only callers who know his or her name will be given any of this limited information. Covered entities generally do not, however, have to provide screening of visitors or calls for patients because such an activity is too difficult to manage with the number of employees and volunteers involved in the process of forwarding calls and directing visitors. If the covered entity agreed to the screening and could not meet the agreement, it could be considered a violation of this standard of the Privacy Rule (Thomason 2013, 105).
The Medicare Integrity Program was established to battle fraud and abuse and is charged with which of the following responsibilities? a. Audit of expense reports and notifying beneficiaries of their rights b. Payment determinations and audit of cost reports c. Publishing of new coding guidelines and code changes d. Monitoring of physician credentials and payment determinations
Correct Answer: B The Medicare Integrity Program was established under the HIPAA legislation to battle healthcare fraud and abuse. Not only did Medicare continue to review provider claims for fraud and abuse, but the focus expanded to cost reports, payment determinations, and the need for ongoing compliance education (Casto and Forrestal 2015, 37)
A group practice has hired an HIT as its chief compliance officer. The current compliance program includes written standards of conduct and policies, and procedures that address specific areas of potential fraud. It also has audits in place to monitor compliance. Which of the following should the compliance officer also ensure are in place? a. A bonus program for coders who code charts with higher paying MS-DRGs b. A hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation c. Procedures to adequately identify individuals who make complaints so that appropriate followup can be conducted d. A corporate compliance committee that reports directly to the CFO
Correct Answer: B The OIG has outlined seven elements as the minimum necessary for a comprehensive compliance program. One of the seven elements is the maintenance of a process, such as a hotline, to receive complaints and the adoption of procedures to protect the anonymity of complainants and to protect whistleblowers from retaliation (Foltz et al. 2016, 457; Casto and Forrestal 2015, 37).
Corporate compliance programs became common after adoption of which of the following? a. False Claims Act b. Federal Sentencing Guidelines c. Office of the Inspector General for HHS d. Federal Physician Self-Referral Statute
Correct Answer: B The U.S. Federal Sentencing Guidelines outline seven steps as the hallmark of an effective program to prevent and detect violations of law. These seven steps were the basis for the OIG's recommendations regarding the fundamental elements of an effective compliance program (Bowman 2017, 463).
What is one key component of a compliant clinical documentation improvement program? a. Detailed review of Joint Commission findings b. Documented, mandatory physician education c. Revenue cycle team involvement d. Exceeding query response targets
Correct Answer: B There are three components an organization should include early in the implementation of a compliant clinical documentation improvement (CDI) program. These include: documented, mandatory physician education; detailed query documentation; CDI policies and procedures with annual sign-off from all program staff (Hess 2015, 208).
Which of the following would be an example of a reviewable sentinel event? a. Incidence of hospital acquired infection b. Incidence of an unruly patient c. Incidence of infant abduction d. Incidence of blood transfusion reaction
Correct Answer: C *Sentinel events* usually involve significant injury to, or the death of, a patient or an employee through avoidable causes. Hospital acquired infections, blood transfusion reactions, or incidences of an unruly patient are monitored processes, but in and of themselves would not be considered sentinel events. An infant abduction would be considered an avoidable occurrence and therefore a sentinel event (Shaw and Carter 2015, 46).
A statement or guideline that directs decision making or behavior is called a: a. Directive b. Procedure c. Policy d. Rule
Correct Answer: C A *policy* is a statement that describes general guidelines that direct behavior or direct and constrain decision making in the organization (Gordon and Gordon 2016b, 537).
Exceptions to the Federal Anti-Kickback Statute that allow legitimate business arrangements and are not subject to prosecution are: a. Qui tam practices b. Safe practices c. Safe harbors d. Exclusions
Correct Answer: C A common theme runs through *safe harbors* and that is the intent to protect certain arrangements in which commercially reasonable items or services are exchanged for fair market value compensation. Safe harbors are an exception to the Federal Anti-Kickback Statute. Congress authorized HHS to establish additional safe harbors by regulation. These safe harbors are activities that are not subject to prosecution and protect the organization from civil or criminal penalties (Bowman 2017, 445).
Healthcare abuse relates to practices that may result in: a. False representation of fact b. Failure to disclose a fact c. Medically unnecessary services d. Knowingly submitting altered claim forms
Correct Answer: C Abuse occurs when a healthcare provider unknowingly or unintentionally submits an inaccurate claim for payment. Abuse generally results from unsound medical, business, or fiscal practices that directly or indirectly result in unnecessary costs to the Medicare program. The performance of medically unnecessary services and submitting them for payment would be an example of healthcare abuse (Casto and Forrestal 2015, 36).
Why is it essential for members of the compliance team to be involved in the entire EHR implementation process? a. To ensure HIPAA compliance b. Evolving regulatory guidelines c. To monitor cut and paste documentation d. Reimbursement risk
Correct Answer: C Because of compliance concerns, such as cutting and pasting documentation in the EHR, it is essential to ensure that a member of the compliance team is involved in the entire EHR implementation process, as well as the part of the process involving clinical documentation practice (Hess 2015, 269).
Community Hospital wants to offer information technology services to City Hospital, another smaller hospital in the area. This arrangement will financially help both institutions. In reviewing the process to establish this arrangement, the CEO asks the HIM director if there are any barriers to establishing this relationship with regard to HIPAA. In this situation, which of the following should the HIM director advise? a. There are no barriers prescribed by HIPAA for this arrangement. b. Community Hospital needs to expand their organized healthcare arrangement to include the other hospital. c. City Hospital should obtain a business associate agreement with Community Hospital. d. Community Hospital should obtain a business associate agreement with City Hospital.
Correct Answer: C In this situation, the smaller hospital should obtain a business associate agreement with the facility providing the information services (Thomason 2013, 25).
Community Hospital is implementing a hybrid record. Some documentation will be paper-based and digitally scanned postdischarge. Other parts of the record will be totally electronic. The Medical Record Committee is discussing how interim reports in the health record should be handled. Some on the committee think that all interim reports should be discarded and only the final reports retained in the scanned record. Others take the opposite position. What should the HIM director recommend? a. Maintaining only the final results provides the greatest measure of security. b. Maintain only the interim reports and discard the final reports. c. Maintaining all interim reports provides the greatest measure of security. d. Maintaining only final reports results in a high volume of duplicate reports.
Correct Answer: C Maintaining all interim reports provides the greatest measure of security. Managing health information in a hybrid record environment is challenging, but by maintaining the reports, the facility will reduce some potential problems (AHIMA E-HIM Taskforce Report 2010).
Which of the following is the whistleblower provision of the False Claims Act that provides a means for individuals to report healthcare information non-compliance? a. Quid pro quo b. Query c. Qui tam d. Quasi reporting
Correct Answer: C One of the key components of the False Claims Act is qui tam. Qui tam is the whistleblower provisions of the False Claims Act—private persons, known as relators, may enforce the Act by filing a complaint, under seal, alleging fraud committed against the government. For example, if a coder is told to assign codes in violation of coding rules, then he or she can report the facility for fraud (Foltz et al. 2016, 449).
Which of the following is the approved method for implementing an organization's formal position? a. Hierarchy chart b. Organizational chart c. Policy and procedure d. Mission statement
Correct Answer: C Policies and procedures also can be considered organizational tools. Policies are written descriptions of the organization's formal positions. Procedures are the approved methods for implementing those positions. Together, they spell out what the organization expects employees to do and how they are expected to do it (Gordon and Gordon 2016b, 537-538).
The quality improvement organizations (QIOs) under contract with CMS conduct audits on highrisk and hospital-specific data from claims data in this report: a. Hospital Payment Monitoring Program b. Payment Error Prevention Program c. Program for Evaluation Payment Patterns Electronic Report d. Compliance Program Guidance for Hospitals
Correct Answer: C QIOs are currently under contract with CMS to perform a Hospital Payment Monitoring Program. This program targets specific DRGs and discharges that have been identified as at high-risk for payment errors. The high-risk hospital specific data are identified in an electronic report called Program for Evaluating Payment Patterns Electronic Report (PEPPER) (Schraffenberger and Kuehn 2011, 32).
Quality standards for coding accuracy should be: a. At least 80 percent b. At least 90 percent c. As close to 100 percent as possible d. No specific standards are possible
Correct Answer: C Quality coding is an important component of coding compliance. Standards for coding accuracy should be as close to 100 percent as possible (Foltz et al. 2016, 462).
A risk manager is called in to evaluate a situation in which a visitor to the hospital slipped on spilled water, fell, and fractured his femur. This situation was referred to the risk manager because it involves a: a. Medical error b. Claims management issue c. Potentially compensable event d. Sentinel event
Correct Answer: C Risk management systems today are sophisticated programs that function to identify, reduce, or eliminate *potentially compensable events (PCEs)*, thereby decreasing the financial liability of injuries or accidents to patients, staff, or visitors (Carter and Palmer 2016, 522).
In designing input by clinicians for an EHR system, which of the following would be effective for a clinician when the data are repetitive and the vocabulary used is fairly limited? a. Drop-down menus b. Point and click fields c. Speech recognition d. Structured templates
Correct Answer: C Speech recognition can be very effective in certain situations when data entry is fairly repetitive and the vocabulary used is fairly limited. As speech recognition improves, it is becoming a replacement for other forms of dictation. In some cases, the user reviews the speech as it is being converted to type and makes any needed corrections; in other cases, the speech is sent to a special device where it generates type for another individual to review and edit (Sayles and Trawick 2014, 189-191).
A hospital employee destroyed a health record so that its contents—which would be damaging to the employee—could not be used at trial. In legal terms, the employee's action constitutes: a. Mutilation b. Destruction c. Spoliation d. Spoilage
Correct Answer: C Spoliation is a legal concept applicable to both paper and electronic records. When evidence is destroyed that relates to a current or pending civil or criminal proceeding, it is reasonable to infer that the party had a consciousness of guilt or another motive to avoid the evidence (Klaver 2017a, 87-88).
The clinical documentation improvement (CDI) staff might create a feedback loop with which department to prevent disgruntled physicians from filing claims against them? a. Billing or finance b. Health information management c. Compliance d. Case management
Correct Answer: C The clinical documentation improvement (CDI) manager should see the compliance function as an opportunity to discuss concerns about physicians who may not be cooperating with program staff or who are ignoring queries. If not managed appropriately, these physicians may become disgruntled with the CDI process and file complaints with CMS, the state's attorney general, or even the OIG (Hess 2015, 244).
Which step of risk analysis identifies information assets that need protection? a. Identifying vulnerabilities b. Control analysis c. System characterization d. Likelihood determination
Correct Answer: C The first step of risk analysis is system characterization. It focuses on what the organization possesses by identifying which information assets need protection. The assets may be identified either because they are critical to business operations (for example, the data itself, such as e-PHI) or because critical data is processed and stored on the system (such as hardware) (Rinehart-Thompson 2013, 117).
A Joint Commission-accredited organization must review its formulary annually to ensure a medication's continued: a. Safety and dose b. Efficiency and efficacy c. Efficacy and safety d. Dose and efficiency
Correct Answer: C The formulary is composed of medications used for commonly occurring conditions or diagnoses treated in the healthcare organization. Organizations accredited by the Joint Commission are required to maintain a formulary and document that they review it at least annually for a medication's continued safety and efficacy (Shaw and Carter 2015, 246).
When the Medicare Recovery Audit Contractor has determined that incorrect payment has been made to an organization, which document is sent to the provider notifying them of this determination? a. Appeal request b. Claims denial c. Demand letter d. Medicare Summary Notice
Correct Answer: C The provider will be notified of RAC determination in a *demand letter*, which includes the providers identification, reason for the review, list of claims, reasons for any denials, and amount of the overpayment for each claim. *The demand letter is the equivalent of a denial letter* (Foltz et al. 2016, 454).
The risk manager's principal tool for capturing the facts about potentially compensable events is the: a. Accident report b. RM report c. Occurrence report d. Event report
Correct Answer: C The risk manager's principal tool for capturing the facts about potentially compensable events is the occurrence report, sometimes called the incident report. Effective occurrence reports carefully structure the collection of data, information, and facts in a relatively simple format (Shaw and Carter 2015, 222).
The HIM Department has been receiving complaints about the turnaround time for release of information (ROI) requests. A PI team is created to investigate this issue. What data source would be appropriate to use to investigate this issue further? a. ROI employee evaluations b. Survey requestors c. ROI tracking system d. ADT system
Correct Answer: C The supervisor is responsible for ensuring turnaround times are met. Turnaround time is the time between receipt of the request and when the request is sent to the requester. The ROI system tracks requests for the information (Sayles 2016b, 73, 75).
An HIM director is requesting the purchase of a document imaging system. However, the Hospital Budget Committee is reluctant to approve the request because of the expense. The committee thinks that the money is better spent implementing CPOE and other EHR applications. Which of the following might the HIM director use as a cost-benefit justification? a. The EHR system will take too long to implement. b. The Joint Commission requires that the hospital move to digital scanning. c. "Discharged, not final billed" and accounts receivable days can be improved because of workflow efficiencies. d. HIPAA requires the use of digital tracking of release of information.
Correct Answer: C Typical performance statistics maintained by the accounts receivable department include days in accounts receivable and aging of accounts. Facilities typically set performance goals for this standard. Understanding the workflow within a department is crucial for the supervisor in managing the departmental resources. To understand and control the workflow, the supervisor can perform a workflow analysis and then design the process to be more effective and efficient (Casto and Forrestal 2015, 255; Prater 2016, 568).
Dr. Smith always orders the same 10 things when a new patient is admitted to the hospital in addition to some patient-specific orders. What would assist in assuring that the specific patient is not allergic to a drug being ordered? a. Clinical decision support b. Electronic medication administration record system c. Pharmacy information system d. Standard order set
Correct Answer: C When the pharmacy information system receives an order for a drug, it will aid the pharmacist in checking for contraindications, directs staff in compounding any drugs requiring special preparation, and aids in dispensing the drug in the appropriate dose and route of administration. Indication of an allergy would be considered a contraindication (Amatayakul 2016, 292).
The manager calculated a unit and time productivity statistic based on employee self-reported data. He used the ________ method to develop this performance standard. a. Benchmarking b. Work distribution analysis c. Work measurement d. Workflow analysis
Correct Answer: C Work measurement is based on assessment of internal data collected on actual work performed within the organization and the calculation of time it takes to do the work (Prater 2016, 587).
25. The removal of medication from its usual stream of preparation, dispensing, and administration by personnel involved in those steps in order to use or sell the medication in nonhealthcare settings is called: a. Prescribing b. Adverse drug reaction c. Sentinel event d. Diversion
Correct Answer: D *Diversion* is the removal of a medication from its usual stream of preparation, dispensing, and administration by personnel involved in those steps in order to use or sell the medication in non-healthcare settings. An individual might take the medication for personal use, to sell on the street, to sell directly to a user as a dealer or to sell to others who will redistribute for the diverting individual (Shaw and Carter 2015, 253).
A notice that suspends the process or destruction of paper or electronic records is called: a. Subpoena b. Consent form c. Rule d. Legal hold
Correct Answer: D A legal hold (also known as a preservation order, preservation notice, or litigation hold) basically suspends the processing or destruction of paper or electronic records. It may be initiated by a court if there is concern that information may be destroyed in cases of current or anticipated litigation, audit, or government investigation. Or, it may be initiated by the organization as part of their pre-litigation planning and duty to preserve information in anticipation of litigation (Klaver 2017a, 86-87).
A physician takes the medical records of a group of HIV-positive patients out of the hospital to complete research tasks at home. The physician mistakenly leaves the records in a restaurant, where they are read by a newspaper reporter who publishes an article that identifies the patients. The physician can be sued for: a. Slander b. Willful infliction of mental distress c. Libel d. Invasion of privacy
Correct Answer: D A person's right to privacy is the right to be left alone and protected against physical or psychological invasion. It includes freedom from intrusion into one's private affairs to include their healthcare diagnoses (Brodnik 2017a, 6-7).
A patient requested a copy of a payment made by her insurance company for a surgery she had last month. The business office copied the remittance advice (RA) notice the organization received from the insurance company but failed to delete or remove the PHI for 10 other patients listed on the same RA. This is an example of: a. Double billing b. Stereotyping c. Retrospective review d. Security breach
Correct Answer: D A security breach of PHI has occurred in this scenario because business office provided the patient with not only her information on the remittance advice, but also that of 10 other patients (Gordon and Gordon 2016c, 615).
A laboratory employee forgot his password to the computer system while trying to record the results for a STAT request. He asked his coworker to log in for him so that he could record the results and said he would then contact technical support to reset his password. What controls should have been in place to minimize this security breach? a. Access controls b. Security incident procedures c. Security management process d. Workforce security awareness training
Correct Answer: D A strategy included in a good security program is employee security awareness training. Employees are often responsible for threats to data security. Consequently, employee awareness is a particularly important tool in reducing security breaches (Rinehart-Thompson 2016c, 272).
HIPAA requires that data security policies and procedures be maintained for a minimum of: a. 3 years from date of creation b. 5 years from date of creation c. 5 years from date of creation or the date when last in effect, whichever is later d. 6 years from date of creation or the date when last in effect, whichever is later
Correct Answer: D Covered entities must maintain their security policies and procedures in written form. This includes formats that may be electronic. Any actions, assessments, or activities of the HIPAA Security Rule also must be documented in a written format. Documentation must be retained for *six years* from the date of its creation or the date when it last was in effect, whichever is later (Rinehart-Thompson 2016c, 274).
A postoperative patient was prescribed Lortab prn. Nurse Jones documented in the patient record that she administered one dose of Lortab to the patient, but never actually administered this medication. Nurse Jones then took the Lortab herself. This action would be called? a. Drug prescribing b. Adverse drug reaction c. Sentinel event d. Drug diversion
Correct Answer: D Drug diversion is the removal of a medication from its usual stream of preparation, dispensing, and administration by personnel involved in those steps in order to use or sell the medication in non-healthcare settings. An individual might take the medication for personal use, to sell on the street, to sell directly to a user as a dealer or to sell to others who will redistribute for the diverting individual (Shaw and Carter 2015, 253).
Community Hospital has launched a clinical documentation improvement (CDI) initiative. Currently, clinical documentation does not always adequately reflect the severity of illness of the patient or support optimal HIM coding accuracy. Given this situation, which of the following would be the best action to validate that the new program is achieving its goals? a. Hire clinical documentation specialists to review records prior to coding b. Ask coders to query physicians more often c. Provide physicians the opportunity to add addenda to their reports to clarify documentation issues d. Conduct a retrospective review of all query opportunities for the year
Correct Answer: D Facilities may design the 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. Staffing models may include the involvement of the CDS discussed previously or could be done by enhancing the role of the utilization review staff or case managers or a combination of these models. Retrospective review of all query opportunities for the year would help to validate the effectiveness of the new program (Schraffenberger and Kuehn 2011, 363).
Dr. Smith wants to use a lot of free text in his EHR. What should be your response? a. Good idea, Dr. Smith. This allows you to customize the documentation for each patient. b. Dr. Smith, we recommend that you do not use any free text in the EHR. c. Dr. Smith, we recommend that you should use free text only in your more complex cases. d. Dr. Smith, we recommend that you use little, if any, free text in the EHR.
Correct Answer: D Free-text data is the unstructured narrative data that is the result of a person typing data into an information system. It is undefined, unlimited, and unstructured, meaning that the typist can type anything into the field or document. The amount of free-text in the EHR should be limited as the ability to manipulate data is diminished (Sayles 2016b, 69).
What is the most constant threat to health information integrity? a. Natural threats b. Environmental threats c. Internal threats d. Humans
Correct Answer: D Health information can be threatened by humans as well as by natural and environmental factors. Threats posed by humans can be either unintentional or intentional. Threats to health information can result in compromised integrity (that is, alteration of information, either intentional or unintentional), theft (intentional by nature), loss (unintentional) or intentional misplacement, other wrongful uses or disclosures (either intentional or unintentional), and destruction (intentional or unintentional) (Rinehart-Thompson 2013, 118).
Healthcare fraud is all except which of the following? a. Damage to another party that reasonably relied on misrepresentation b. False representation of fact c. Failure to disclose a material fact d. Unnecessary costs to a program
Correct Answer: D Healthcare fraud is the intentional deception or misrepresentation that an individual knows (or should know) to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s). Unnecessary costs to a program, in and of itself, would not be healthcare fraud, there would need to be some intentional deception for it to be considered fraud (Sayles and Gordon 2016, 651).
If a patient receives a ________ from a healthcare organization it indicated that the patient's protected health information was involved in a data breach. a. Notice of Breach b. Release of Information c. Protected Health Breach Notice d. Receipt of Breach Notice
Correct Answer: D If a patient receives a Receipt of Breach Notice from a healthcare organization it indicates that the patient's protected health information was involved in a data breach (Gordon and Gordon 2016c, 613).
In developing a coding compliance program, which of the following would not be ordinarily included as participants in coding compliance education? a. Current coding personnel b. Medical staff c. Newly hired coding personnel d. Nursing staff
Correct Answer: D In conjunction with the corporate compliance officer, the health information manager should provide education and training related to the importance of complete and accurate coding, documentation, and billing on an annual basis. Technical education for all coders should be provided. Documentation education is also part of compliance education. A focused effort should be made to provide documentation education to the medical staff (Schraffenberger and Kuehn 2011, 386-387).
The coding staff should be updated at least ________ on compliance requirements. a. Weekly b. Monthly c. Every six months d. Annually
Correct Answer: D It is imperative that all staff be trained in compliance policies, procedures, and standards of conduct as it applies to their position in the organization. This training should occur, at a minimum, in their initial orientation training and on an annual basis (Foltz et al. 2016, 457).
The role of the HIM professional in medical identity theft protection programs includes all of the following except: a. Ensure safeguards are in place to protect the privacy and security of PHI b. Balance patient privacy protection with disclosing medical identity theft to victims c. Identify resources to assist patients who are victims of medical identity theft d. Send all issues related to medical identity theft to the in-house attorney
Correct Answer: D Medical identity theft is distinguished from other types of identity theft because it creates negative consequences to both the victim's financial status and health information. The HIM professional should ensure safeguards are in place to protect PHI and provide resources to assist victims of medical identity theft. It is important to balance patient privacy protection with disclosure of medical identity theft to victims (Gordon and Gordon 2016c, 612-613).
The people within the organization who oversee the operation of a broad scope of functions such as coding, transcription, and release of information at the department level are referred to as: a. Senior managers b. The board of directors c. Supervisory managers d. Middle managers
Correct Answer: D Middle management involves the people within the organization who oversee the operation of a broad scope of functions; for example, the HIM manager may oversee coding, transcription, and release of information at the departmental level or they may oversee a defined product or line of service, such as in the case of a radiology department manager (Gordon and Gordon 2016b, 536).
Events that occur in a healthcare organization that do not necessarily affect an outcome but carry significant chance of being a serious adverse event if they were to recur are: a. Time-out b. Serious events c. Sentinel events d. Near misses
Correct Answer: D Near misses include occurrences that do not necessarily affect an outcome but if they were to recur they would carry significant chance of being a serious adverse event. Near misses fall under the definition of a sentinel event, but are not reviewable by The Joint Commission under its current sentinel event policy (Shaw and Carter 2015, 221).
Which of the following is a principle of contemporary performance improvement? a. Success must never be celebrated as this does not encourage more success. b. Systems never demonstrate variation. c. Performance improvement works by identifying the individuals responsible for quality problems and reprimanding them. d. Performance improvement relies on the collection and analysis of data to increase knowledge.
Correct Answer: D Performance improvement (PI) is based on several fundamental principles, including: the structure of a system determines its performance; all systems demonstrate variation; improvements rely on the collection and analysis of data that increase knowledge; PI requires the commitment and support of top administration; PI works best when leaders and employees know and share the organization's mission, vision, and values (Carter and Palmer 2016, 505).
When reviewing the monthly performance report, a manager noticed the coding accuracy rate was below standard. She considered whether this difference might be related to a recent change in systems or attributed to another factor. This manager is performing which of the following? a. Performance measurement b. Workforce planning c. Work observation study d. Variance analysis
Correct Answer: D Reported performance data are regularly analyzed for variance. Variance—where actual performance does not meet, varies, or is significantly different from the standard—should be further assessed (Prater 2016, 588).