Final Exam Review
The duration of skilled nursing facility Medicare Part A coverage is limited to the need for daily skilled care up to a maximum of ____ days per spell of illness.
100
Dr. Moore admits Mary Knight to Tanner Hospital for observation. If he feels that Mary meets the criteria for admission as an inpatient, Dr. Moore must generally make that decision within a ___________ timeframe. 12-hour 24-hour 48-hour 72-hour
24-hour
Medicare Part A coverage is limited in that a long-term care resident must first qualify with a minimum of a ____ hospital stay
3 day
The timeline for completion of the comprehensive patient assessment and initial implementation of the plan of care is within _____________________. 10 calendar days after admission to the dialysis facility or 4 outpatient hemodialysis sessions 30 calendar days after admission to the dialysis facility or 13 outpatient hemodialysis sessions 90 calendar days after admission to the dialysis facility or 37 outpatient hemodialysis sessions 180 calendar days after admission to the dialysis facility or 75 outpatient hemodialysis sessions
30 calendar days after admission to the dialysis facility or 13 outpatient hemodialysis sessions
An individual is considered to be terminally ill if he or she has a life expectancy of _____ or less based on the physician's clinical judgment regarding the normal course of the individual's illness.
6 months
According to federal regulations, the care plan should be completed within ______ of the comprehensive assessment.
7 days
To promote uniformity among state laws related to the practice of veterinary medicine, the American Veterinary Medical Association developed __________________________________. a model act the veterinary medical database an educational program for members of Congress a nationwide network of lobbyists, each of whom reports directly to the AVMA
A model act
A formal way of checking financial and other records
Audit
Children who are allowed to go to bed at night with a bottle filled with liquid other than water are prone to develop ____________________. BBTD gingivitis periodontal disease endodontal disease
BBTD (Baby Bottle Tooth Decay)
In most states, which of the following issues licenses to dentists so they can practice? Dental Society Board of Dentistry Drug Enforcement Agency American Dental Association
Board of Dentistry
________________________________ is a voluntary accreditation agency that sets standards that promote "the delivery of quality services to people with disabilities."
CARF International
Two voluntary accreditation organizations that set standards for substance abuse treatment facilities are __________________. CARF and The Joint Commission ASAM and SAMHSA Alcoholics Anonymous and American Psychiatric Association National Institute on Alcohol Abuse and Alcoholism (NIAAA) and Center for Substance Abuse Prevention
CARF and The Joint Commission
An early initiative to create a comprehensive network of services for emotionally disturbed children and adolescents through a series of demonstration grants, now known as system of care grants
CASSP
Which coding system is commonly used to report dental procedures performed in a dental office? CDT CPT SNDO current modification of ICD
CDT
The agency that oversees administration of demonstration and research grants and other initiatives at the federal level related to mental health issues
CMHS
Developed by an interdisciplinary team, the _____ includes measurable objectives and timetables to meet a resident's medical, nursing, mental, and psychosocial needs.
Care Plan
Which of the following provide(s) structure for assessing social , medical, and psychological problems by providing a systemized method of reviewing key components of the minimum data set and directing caregivers to evaluate causes, interrelationships, and particular strengths that affect development of the care plan?
Care area assessment process
May assist the client with non-treatment activities, such as obtaining adequate housing, securing financial assistance, keeping medical and counseling appointments, or organizing plans for follow-up care
Case Managers
The prospective payment system for inpatient rehabilitation is based on ____________.
Case Mix Groups (CMGs)
______ deals with the number of admissions, discharges, transfers and number of patients under the care of a hospice on a given day
Census data
An agency of SAMHSA that provides national leadership for community-based substance abuse prevention programs through grant programs aimed at reducing the incidence of substance abuse
Center for Substance Abuse Prevention (CSAP)
An agency of SAMHSA that promotes community-based substance abuse treatment services by working with states and community-based groups to improve and expand existing substance abuse treatment services through block grants and other means
Center for Substance Abuse Treatment (CSAT)
The federal agency within the DHHS responsible for administering Medicare programs related to home health is the _______
Centers for Medicare and Medicaid Services (CMS)
Aggressive and consistent implementation of specialized and generic training, treatment, health and related services received by each ICF/IID client.
Active Treatment
Responsible for assessing the therapeutic recreational needs and preferences of each resident and developing and individualized program
Activities Staff
Ability to bathe, dress, groom, transfer and ambulate, toilet, eat, use speech, languages, etc.
Activities of daily living
The ______________________________ is a rating scale that was developed to be used by clinicians to measure the severity of a client's substance abuse problems by measuring seven substance abuse-related problem areas: medical condition, drug use, alcohol use, employment, illegal activity, social relations, and psychological findings.
Addiction Severity Index
An associate or member of a particular business
Affiliate
______________________________ is a worldwide organization of self-help recovery groups that support individuals in maintaining sobriety based on a 12-step recovery process.
Alcoholics Anonymous
What types of coding may be utilized in an ICF/IID? ICD DSM Intellectual Disability: Definition, Classification, and Systems of Supports, Eleventh Edition All of the above None of the above
All of the above
In-home respite care______
Allows the primary caregiver to have some free time
____________________ are the silver-colored fillings composed of several metals that are usually placed on posterior teeth: Bitewings Amalgams Bridges Caries
Amalgams
Which of the following groups does NOT publish standards for some type of ambulatory health care? The Joint Commission Accreditation Association for Ambulatory Health Care Commission for the Accreditation of Birth Centers American Association for On-Site Health Care
American Association for On-Site Health Care
The publisher of Intellectual Disability: Definition, Classification, and Systems of Supports, Eleventh Edition is ________________________. National Association of Qualified Developmental Disability Professionals (NAQ) American Association on Intellectual and Developmental Disabilities (AAIDD) Council on Quality and Leadership (CQL) American Psychiatric Association (APA)
American Association on Intellectual and Developmental Disabilities (AAIDD)
Which of the following statements is FALSE in relation to APC status indicators? "S" represents a significant service that is not discounted when more than one APC is present on a claim. "T" represents a significant procedure that is discounted when other procedures are performed with it. "P" represents a partial hospitalization service. "V" represents those services which are not billable under the OPPS.
"V" represents those services which are not billable under the OPPS.
Services provided by an NP or PA while a physician is on-site are termed ________ and are fully reimbursed. LCD EPSDT "incident to" locum tenens
"incident to"
Under an inpatient prospective payment system (IPPS) that pays a hospital according to the diagnosis related group (DRG) assigned to each patient's stay, what would the payment be for a DRG with a relative weight of 1.75 if the hospital's PPS rate is $8,225? $4,700.00 $14,393.75 $21,276.60 Not enough information to calculate
$14,393.75
The legislative act that provides incentives to health care providers who utilize EHRs to enhance the quality of care provided their patients is the _____________________________. Emergency Medical Treatment and Active Labor Act (EMTALA) American Recovery and Reinvestment Act (ARRA) Health Insurance Portability and Accountability Act (HIPAA) Electronic Health Record Adoption Act (EHRAA)
American Recovery and Reinvestment Act (ARRA)
Medical record or health information services in a veterinary teaching hospital will be surveyed as part of a site visit for accreditation of a school of veterinary medicine by the Council on Education of the _______________________________. American Animal Hospital Association (AAHA) American Veterinary Medical Association (AVMA) Veterinary Hospital Manager's Association (VHMA) American Veterinary Health Information Management Association (AVHIMA)
American Veterinary Medical Association (AVMA)
In some states, can assume responsibilities to lessen the load of the licensed nursing professionals
Certified medication technicians
______________________ is the use of a drug or medication not part of a person's usual medical regimen that is administered to control behavior or restrict freedom of movement.
Chemical Restraint
All of the following are potential roles for HIM professionals within a hospital setting EXCEPT __________________. Performance Improvement Analyst Coding Supervisor Cancer Registrar Chief Medical Officer EHR Implementation Specialist
Chief Medical Officer
A _______________________________ is used as a basis for the client's diagnosis and individualized treatment plan and is conducted by a clinician for every client who enters a substance abuse treatment program.
Clinical assessment
_________________________ are publicly funded mental health organizations established in communities throughout the United States by the Mental Health Act of 1965.
Community Mental Health Centers
This ambulatory setting was developed in the 1960s specifically to bring health care to the economically disadvantaged of a particular geographical area of a community. Urgent care center Community health center On-site ambulatory care facility Group model health maintenance organization
Community health center
Susan Smith, Director of Health Information Services, is preparing a presentation for the new employee orientation at the drug and alcohol rehabilitation program where she is employed. She will be presenting information on 42 CFR, Part 2. The topic of her talk will be _______________. Confidentiality of Drug and Alcohol Abuse Record Health Information Exchange in Behavioral Health Care The Role of Twelve-Step Programs in Drug and Alcohol Rehabilitation Federal Data Sets and Reporting Requirements for Drug and Alcohol Abuse Treatment Centers
Confidentiality of Drug and Alcohol Abuse Record
A patient receives predominantly nursing care for a minimum of 8 out of 24 hours at his or her place of residence during a period of crisis
Continuous care
Which accrediting agency for organizations that provide services to individuals with intellectual disabilities is sponsored by the American Association on Intellectual and Developmental Disabilities, American Network of Community Options and Resources, The Arc, Autism Society of America, Mosaic, National Association of QDDPs, Self-Advocates Becoming Empowered, and United Cerebral Palsy Associations, Inc.? Council on Quality and Leadership The Joint Commission Commission on Accreditation of Rehabilitation Facilities National Committee on Quality Assurance
Council on Quality and Leadership
Specially trained professionals such as social workers and psychologists who provide therapy to substance abuse clients and their families according to the treatment plan
Counselors
Dentists are required to follow which regulations when prescribing narcotics? ADA DEA FDA WHO
DEA
_________________________ is the 2013 update to the classification system and nomenclature of mental disorders developed by the American Psychiatric Association used as a coding system for mental disorders.
DSM-5
__________________ is the term for a form of disordered thinking in which a person holds unrealistic beliefs. Hallucination Delusion Depression Bipolar disorder
Delusion
Lack of payment for services rendered due to failure to meet requirements or some other reason
Denial
A term used almost interchangeably with the term intellectual disability
Developmental Disability
A data system managed by SAMHSA and comprised of three components providing national- and state-level data on substance abuse clients and on the facilities that receive federal grants or contracts to provide substance abuse treatment.
Drug and Alcohol Services Information System (DASIS)
Which of the following terms can be equally applied either to mental illness and intellectual disability in the same person or to mental illness and chemical dependency in the same person? Dual diagnosis MICA Bipolar MIID
Dual diagnosis
__________________________clients have both a substance abuse disorder and a chronic mental illness and typically have special treatment needs.
Dually Diagnosed
Although not the preferred clinical term, irreversible stage 5 chronic kidney disease is denoted by the term_______________ in many federal publications. dialysate dependence BUN depression CAPD ESRD
ESRD
Which of the following has a contract with CMS to assess the quality of care rendered to ESRD patients? ESRD network transplantation surgeon National Committee for Quality Assurance (NCQA) Accreditation Association for Ambulatory Health Care (AAAHC)
ESRD network
______________________________ is a program of Medicaid for children younger than 21 which ensures that certain services are provided and paid for whether or not they are normally included under the state's Medicaid program. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services Children's Health Assurance Program (CHAP) Federally Qualified Health Center (FQHC) program National Coverage Determination (NCD) program
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services
_____ scores provide a reliable and valid method of documenting the severity of disabilities as well as outcomes in rehabilitation. Scores are assigned in thirteen motor areas and five cognitive areas.
FIM
A case manager provides therapy to substance abuse clients. True False
False
All substance abuse treatment is voluntary: no one can be forced into a substance abuse treatment program. True False
False
An ICF/IID differs from other health care facilities in that ICF/IID clients receive no training in activities of daily living. True False
False
CARF accreditation may be sought by substance abuse programs that provide detoxification and partial hospitalization, but not by those that offer only drug court treatment or employee assistance. True False
False
CQI is a management concept that is at odds with the consumer empowerment movement because of its focus on provider control in planning services and its lack of feedback mechanisms. True False
False
Children's home-based mental health services are individual-centered rather than family- centered. True False
False
For security purposes, no part of the individual's record is stored on the person's living unit at any time. True False
False
In the United States, less than $10 million a year is spent for substance abuse treatment and prevention. True False
False
It is important to prevent the individual receiving services from participating in interdisciplinary team meetings. True False
False
Mental retardation is characterized by limitations in intellectual functioning and adaptive behavior that begin prior to age 12. True False
False
Partial hospitalization is usually an evening program whereas intensive outpatient treatment is usually a daytime program. True False
False
Personality disorder is a form of serious mental illness in which a person alternates between states of ecstatic mania and severe depression. True False
False
Reimbursement for intellectual disabilities services is usually a capitation payment, which is an easily determined amount based on services received. True False
False
T/F: The Medicare prospective payment system reimburses rehabilitation services under DRGs.
False
T/F: The categories that form the basis of the inpatient rehabilitation facility prospective payment system are known as Impairments, Disabilities, and Handicaps (IDHs)
False
The FIM instrument for measuring independence has not yet been proven reliable or valid.
False
The Glasgow Coma Scale is associated with the assessment of spinal cord injuries.
False
The IPF PPS is Medicare's method of payment for services received by beneficiaries at Community Mental Health Centers (CMHCs). True False
False
The IRF-PAI utilizes the same coding rules as the UB-92.
False
The group program plan (GPP) is the sole responsibility of the case manager and is a summary of the goals and objectives that the staff will assist the individual to attain. True False
False
True or False: A physician must have a face to face encounter with the home health patient within 7 days prior to the start of home health care, or within 3 days after the start of care
False
True or False: An upcode occurs when the provision of care to a patient results in unusually high costs to the home care agency
False
True or False: By definition, the patient's primary caregiver is also the patient's legal representative
False
True or False: Contracted providers, such as physical therapists, bill Medicare directly for their services to residents in a skilled nursing facility
False
True or False: Hospice benefit periods are categorized as an initial 60-day period, a subsequent 60-day period, then a final 90 day period
False
True or False: Hospice care focuses exclusively on the needs of the patient as the unit of care
False
True or False: Hospice provide curative therapy rather than symptom management
False
True or False: In long-term care facilities such as nursing facilities, records are generally audited for completeness only at the resident's death or discharge
False
True or False: Medicare regulations permit certification of terminal illness with a life expectancy that is unknown and/or unspecified
False
True or False: Medicare-certified home health agencies are required to use OASIS-1 for evaluating children and maternity patients
False
True or False: Most LTC facilities are accredited by the Joint Commission
False
True or False: No more than 50 percent of hospice care can be provided in the patient's place of residence
False
True or False: Resource Utilization Groups (RUGs) compromise a case-mix methodology based solely on diagnosis and procedure codes submitted on Medicare bills.
False
True or False: The Affordable Care Act requires that hospice physician or nurse Practioner have a face-to-face encounter with a hospice patient not more than 15 days prior to the start of the hospice patient's second benefit period
False
True or False: The Community Health Accreditation Program (CHAP) us responsible for the development of the OASIS data set and manages data collection using OASIS for home care providers nation wide.
False
True or False: The home care patient's physician must review, update and recently (if necessary) the plan of care at least every 6 months, a time frame referred to as the certification period.
False
True or False: The medical program for the indigent is called Medicare
False
True or False: There is no voluntary accreditation organization with deeming authority for hospice programs and facilities
False
True or False: Volunteers may be paid at a lower hourly rate than other hospice employees
False
True or False: When a hospice patient is admitted to the hospital for pain and symptom management, the hospital is reimbursed by Medicare for the DRG and the hospice receives a reduced per diem payment for each day of the patient's stay
False
True or False: When federal and state laws conflict, the facility is required to follow federal law
False
When a consumer fails to abide by the stipulations of an outpatient commitment, it rarely results in involuntary commitment to an inpatient facility. True False
False
A patient receives care in an approved facility for pain control or acute or chronic symptom management
General inpatient care
Software available from CMS which can be used for data entry, editing, and validation of OASIS data is called
HAVEN
A core set of standard performance measures for managed care in the areas of quality, access and patient satisfaction, membership, utilization, finance, and health plan management is named ______________. MCO ISDN HEDIS SPM-MC
HEDIS
______ are the basis for home health reimbursement under Medicare.
HHRGs
A(n) _________ links data provided by various health care providers. HIE organization/RHIO patient-focused record fee-for-service network prospective payment system
HIE organization/RHIO
______________ is a standard for data exchange in health care. HL7 OFA ONC ISIS
HL7
_______________ is the process by which a person is assisted to acquire and maintain life skills that enable the person to cope more effectively with personal and environmental demands and to raise the level of his or her physical, mental, and social efficiency. Assessment Direct care Habilitation Training objective
Habilitation
This legislation amends the HIPAA privacy and security rules. Hill-Burton Act Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) Health Information Technology for Economic and Clinical Health Act (HITECH) Clinical documentation improvement (CDI)
Health Information Technology for Economic and Clinical Health Act (HITECH)
The ________________________________ program is a federal program that allows states to use Medicaid funding to serve persons in their own homes and communities, not just in institutional settings.
Home and Community Based Services Waiver
Which of the following statements is TRUE? Hospitals must be accredited by The Joint Commission. Hospitals must be licensed by the state in which they are located. Hospitals must have a hospitalist on staff to qualify for CMS certification. Hospitals do not have to be licensed to admit patients.
Hospitals must be licensed by the state in which they are located.
Which of the following statements is FALSE? Documentation of telephone calls is an important element in good risk management for ambulatory care. A hospital compliance officer may be concerned with avoiding fraudulent coding and billing as well as with monitoring compliance with federal regulations such as HIPAA. Because of their knowledge of coding, health information managers can help review, revise, and maintain the hospital's chargemaster. Hospitals receive Medicare reimbursement for ambulatory care through an outpatient prospective payment system (OPPS) based on DRGs.
Hospitals receive Medicare reimbursement for ambulatory care through an outpatient prospective payment system (OPPS) based on DRGs.
Any happening that is not consistent with routine operations
Incident
The ___________________________________ is a written plan developed by the client's treatment team that is used to identify the type and frequency of services needed by the client. It includes measurable goals and objectives that address the problems identified in the clinical assessment and should be updated periodically (usually every six months) as the client's treatment needs change.
Individualized Treatment Plan
The major tool in the care and services rendered to the individual, consisting of a comprehensive individualized assessment, list of goals and objectives, and plans to attain those goals
Individualized program plan
In addition to medical care and substance abuse treatment, clients in ____________ substance abuse facilities require nursing care.
Inpatient
A(n) ____________________________ is a facility that provides care and training for persons with intellectual disabilities in order to increase their adaptive skills, such as self-care skills, language skills, social skills, vocational skills, and so on.
Intermediate Care Facility for Individuals with Intellectual Disabilities
Which of the following is NOT a factor in determining the case-mix group? (CMG)
International Classification of Functioning, Disability and Health (ICF) codes
The ______________________________ is a standardized assessment instrument that can be used for program planning and is also used in several states as a data collection tool for case mix reimbursement to ICF/IID organizations.
Inventory for Client and Agency Planning
The ______________________is a standardized assessment instrument that can be used for program planning and is also used in several states as a data collection tool for case mix reimbursement to ICF/IID organizations. American Association on Intellectual Disability Assessment (AAIDA) Inventory for Client and Agency Planning (ICAP) Annual Staffing Process (ASP) Home and Community Based Services (HCBS) Assessment
Inventory for Client and Agency Planning (ICAP)
A listing of all known public and private substance abuse treatment facilities in the United States and its territories
Inventory of Substance Abuse Treatment Services (I-SATS)
___________________________________ is a legal process by which individuals who are deemed to be a danger to themselves or to others may be admitted to a substance abuse (or mental health) treatment program even though they refuse or cannot consent to the treatment.
Involuntary Commitment
______________________ is a legal process by which individuals who are deemed to be a danger to themselves or to others may be admitted to a treatment program even though they refuse or cannot consent to the treatment. Detention Incarceration Voluntary admission Involuntary commitment
Involuntary commitment
_________________________ is a legal process by which individuals who are deemed to be a danger to themselves or to others may be admitted to an inpatient facility even though they refuse or cannot consent to the treatment.
Involuntary commitment
Which of the following statements is TRUE regarding health care in jails? The provision of health services in jails is the responsibility of the state legislature. Medical examinations are not performed at jails. Most jails have on-site medical facilities. Jails may screen and continuously monitor intoxicated persons throughout the detoxification period.
Jails may screen and continuously monitor intoxicated persons throughout the detoxification period.
Medicare payments to long-term acute-care hospitals (LTACHs) are based on ___________. LTC-DRGs PIP-DCGs DRGs RUGs
LTC-DRGs
Physical presence in the long-term care facility is limited
Licensed Physicians
Predominant licensed caregivers in the long term care setting
Licensed practical nurses
An early initiative to create a nationwide data system for uniform reporting of mental health data
MHSIP
______________________ is a common acronym for programs for persons dually diagnosed with mental illness and chemical/alcohol addiction. (This abbreviation is not considered correct when used to refer to individuals or to indicate a population.)
MICA
Which of the following is NOT a step in the development of action plans? Determine all steps necessary to attain each goal. Maintain confidentiality of each goal. Assign responsibility for each step. Set deadlines for each goal.
Maintain confidentiality of each goal.
Which of the following is a recommended practice in health information management in correctional facilities? Use inmates to supplement staffing in the health information area. Maintain inmate health records separately from confinement records. Permit correctional officers to access the health record as needed. Avoid developing written policies, as failure to adhere to them may be damaging during litigation.
Maintain inmate health records separately from confinement records.
The primary source of funding for an ICF/IID is from _______________. private donations government grants Medicare Medicaid
Medicaid
Help patients and family members cope with a patient's disease process through placement and involvement with community services; help find appropriate resources and make suggestions for long-range planning
Medical social services
________________________________________ treatment programs for substance abuse provide a planned regimen of 24-hour medically directed evaluation, care, and treatment of mental and substance related disorders in acute care inpatient settings, which are staffed by designated addiction-credentialed physicians, including psychiatrists.
Medically Managed Intensive Inpatient
As required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, CMS has replaced past claims processing contractors known as fiscal intermediaries and Medicare carriers with ________________________. Medicare Payment Processors (MPPs) Medicare Evaluation Boards (MEBs) Medicare Administrative Contractors (MACs) Medicare Revenue Exchanges (MREs)
Medicare Administrative Contractors (MACs)
In long-term care, CPT codes are used most commonly to bill for:
Medicare Part B Services
The method for physician reimbursement currently in place based on relative value units is the ____________________. Medicare Physician Fee Schedule Diagnosis Related Group System Uniform Ambulatory Care Data Set Ambulatory Payment Classification System
Medicare Physician Fee Schedule
A managed care organization (MCO) that undergoes evaluation of its ability to perform as an insurance provider will request accreditation from _______________. CMS NCQA AAAHC The Joint Commission
NCQA
This program was developed by The Joint Commission to help accredited health care institutions focus upon specific patient safety concerns. National Quality Forum (NQF) Quality Improvement Organization (QIO) National Patient Safety Goals (NPSG) Patient Safety Organization (PSO)
National Patient Safety Goals (NPSG)
An online searchable database of treatments and interventions that have been demonstrated to be effective for substance abuse and mental health treatment and prevention programs
National Registry of Evidence-based Programs and Practices (NREPP)
An annual survey of all substance abuse treatment facilities that collects facility-specific information on location, characteristics, services offered, and utilization.
National Survey of Substance Abuse Treatment Services (N-SSATS)
Provide daily care needs to long term care residents
Nursing Assistants
Which of the following is a facility in which the majority of patients are regarded as permanent residents?
Nursing Facility
Data set required of home health care agencies
OASIS
_______ is a data set that is a requirement under Medicare for home health
OASIS-1
Assist the patient to become independent with person care duties such as dressing, bathing and other normal activities of daily living.
Occupational therapists
Often independent contractors rather than employees
Occupational therapists
Which of the following is charged with protecting the integrity of the Medicare and Medicaid programs? Office of Civil Rights (OCR) Internal Revenue Service (IRS) Office of the Inspector General (OIG) Reimbursement Integrity Contractors (RICs)
Office of the Inspector General (OIG)
This federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information was mandated. in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. Office of the National Coordinator for Health Information Technology (ONC) Nationwide Health Information Network (NHIN) Centers for Medicare and Medicaid Services (CMS) Institute of Medicine
Office of the National Coordinator for Health Information Technology (ONC)
Which of the following is NOT a characteristic of urgent care centers? Generally no appointment system Extended hours or days of operation Often "not for profit," charging reduced fees Provide routine care or treat minor emergencies
Often "not for profit," charging reduced fees
Which audit initiative resulted in many teaching hospitals having to repay millions of dollars to the Medicare program because they lacked documentation to substantiate Medicare payments to faculty physicians who supervised residents? PATH EMTALA MAC HOPPS
PATH
Which of the following is NOT one of the administrative simplification provisions of HIPAA? EDI Privacy Security PPS
PPS
Clinical measures taken to reduce the intensity of disease symptoms, rather than providing a cure for the disease are called
Palliative care
A comprehensive outpatient rehabilitation facility receives reimbursement from Medicare under __________.
Part A
This part of Medicare is also known as Medicare Advantage. Part A Part B Part C Part D None of the above
Part C
This part of Medicare is optional insurance coverage available to all Medicare beneficiaries designed to lower prescription drug costs. Part B Part A None of the above Part D Part C
Part D
This law, passed in 2010, expanded Medicaid eligibility requirements. American Recovery and Reinvestment Act (ARRA) Patient Protection and Affordable Care Act (PPACA) Hill-Burton Act Health Information Technology for Economic and Clinical Health Act (HITECH)
Patient Protection and Affordable Care Act (PPACA)
Which of the following is a document prepared by the interdisciplinary team that evaluates the patient in at least thirteen required areas? Patient assessment Plan of care Interdisciplinary progress notes Clinical performance measures
Patient assessment
Where is the majority of hospice care provided?
Patient's place of residence
Under this care model, the primary care physician acts as a "gatekeeper" to coordinate the patient care across providers by addressing preventive, acute, and chronic care needs and by providing the patient with access to electronic tools. Health information exchange organization Patient-centered medical home model Pay-for-performance (P4P) Patient safety organization (PSO)
Patient-centered medical home model
Under this type of program, reimbursement may be rewarded or penalized based upon the provider's ability to meet pre-established targets for delivery of health care services. Pay-for-performance (P4P) Zone Program Integrity Contractors (ZPICs) Quality improvement organization (QIO). Clinical documentation improvement (CDI)
Pay-for-performance (P4P)
Residents who need constant oversight and supervision in activities of daily living
Permanent residents receiving non skilled care
Residents receive frequent skilled care from licensed professionals
Permanent residents, skilled care
Designed to care for residents diagnosed with conditions such as Alzheimer's
Permanent residents, special care
A process that focuses on the preferences of the individual receiving services in planning the type of future life that individual wishes to live
Person-centered planning
Establish a home exercise and maintenance program for the patient, assisting with exercise routines and ambulating devices
Physical therapists
May treat clients under the supervision of a physician, although in some states they may practice more independently
Physician assistants and nurse practitioners
Monitor or manage any treatment plan that requires a medical intervention, such as prescription medications or detoxification services
Physicians
The ____ provides care to the hospice patient in the patient's place of residence (such as giving medications, dressing changes, reporting changes in patient's condition) when hospice staff are not there
Primary caregiver
_______________________________ is a mode of treatment for serious mental illness that focuses on provision of an array of community support services (e.g., development of job skills, if needed) for persons with mental illness, sufficient to allow them to live in the least restrictive environment possible outside an institution.
Psychosocial Rehabilitation
______________________________ medications are designed to reduce psychotic symptoms by altering the chemical processes within the brain.
Psychotropic
The ____________________________________ agreement provides an exception to the federal confidentiality of alcohol and drug abuse rules by permitting disclosure of patient record information to an organization providing services to the substance abuse program, such as laboratory, data processing, bill collecting, dosage preparation, legal, medical, or accounting services.
Qualified Service Organization
The Conditions of Coverage require that each dialysis facility implement a data-driven performance improvement program that utilizes indicators or performance measures associated with improved health outcomes and with the identification and reduction of medical errors. This program is known as_______________________________. Clinical Performance Measures (CPM) Project Renal Management Information System (REMIS) Quality Assessment and Performance Improvement (QAPI) Consolidated Renal Operations in a Web-enabled Network (CROWNWeb)
Quality Assessment and Performance Improvement (QAPI)
An organization serving individuals with intellectual disabilities might voluntarily seek accreditation from the Council on _______________.
Quality and Leadership
CMS provides free software for entering and transmitting MDS assessment data. This software is called ____
RAVEN
A program designed by CMS to recover improper Medicare payments is named _______________. Recovery Audit Contractor (RAC) Pay-for-performance (P4P) Quality improvement organization (QIO) Clinical documentation improvement (CDI)
Recovery Audit Contractor (RAC)
In long-term inpatient and residential treatment programs, may develop programs for residents such as games, exercise programs, or outdoor activities
Recreational Therapists
Coordinate long term daily care and hold supervisory positions
Registered Nurses
Substance abuse ______________________ treatment services are staffed by designated addiction treatment and mental health personnel who provide a planned regimen of care in a 24-hour live-in setting where patients can reside safely and where mutual and self-help group meetings generally are available on site.
Residential Inpatient
Teach techniques to increase efficiency in the lungs, such as pursed-lip breathing, and safety precautions when using oxygen equipment in the home.
Respiratory therapists
A patient receives care un a approved facility in a short-term basis (not more than 5 days at a time)
Respite care
Short stay to provide relief to primary caregivers of the frail elderly
Respite care
The ______________ involves all of the activities from pricing to selling of health care services and then collecting what is owed from the purchaser for those services. APC System Revenue Cycle HIPAA Program Utilization Review Plan
Revenue Cycle
An agreement between the HMO and CMS to provide services to Medicare beneficiaries under which the health plan receives a monthly payment for enrolled Medicare members and must then provide all services needed is called a(n) ______
Risk Contract
A patient is at his or her place of residence and is receiving non-problematic care
Routine home care
A federal agency whose purpose is to reduce the impact of substance abuse and mental illness on America's communities
SAMHSA
Which of the following is a coding system commonly used in veterinary medicine? CPT SNDO ICD-9-CM SNOMED CT
SNOMED CT
Residents length of stay is less than 100 days
Short-term patients
In hospice, coding additional ______ helps build a diagnosis database that can be used to evaluate not only the quality of care give, but also the components of various diagnosis groups.
Signs and symptoms
Make arrangements for adaptive equipment, clothing, and financial assistance
Social Services
Which of the following statements is TRUE regarding programs for terminally ill inmates? Prisons do not limit prescribing of narcotics to inmates. Hospice programs are prohibited in prisons. Terminally ill inmates cannot be segregated into separate units. Some facilities allow for compassionate release.
Some facilities allow for compassionate release.
A _______ is a record organized in sections according to patient care departments and/or disciplines
Source-oriented record
Assist patients who suffer from strokes or adverse effects of feeding tubes or endotracheal tubes; teach proper swallowing techniques and so on
Speech-language pathologists
Informal term for a meeting of the interdisciplinary team during which the individual program plan is reviewed and revised
Staffing
The Joint Commission would accredit an ICF/IID using its ________________________. Hospital Accreditation Standards Standards for Behavioral Health Care Standards for Home Health Standards for Long-Term Care
Standards for Behavioral Health Care
Which of the following would initiate a complaint investigation in response to a hotline call concerning alleged abuse or neglect?
State licensing agency
Financial support for persons with mental illness who have not been able to establish a work history is available through ______________________. Supplemental Security Income (SSI) Social Security Disability Income (SSDI) the Substance Abuse and Mental Health Services Administration (SAMHSA) the Center for Mental Health Services (CMHS)
Supplemental Security Income (SSI)
Which of the following is NOT one of the payment mechanisms created by Medicare to discourage the transfer of patients between the LTCH and other facilities for financial rather than clinical reasons? The "Interrupted Stay" Rule The "5 Percent" Rule The "10 Day" Rule The "25 Percent" Rule
The "10 Day" Rule
Which of the following is a list of organizations that have deeming authority for home health care with regard to Medicare certification and the Condition of Participation?
The Accreditation for Commission for Health Care (ACHC) The community Health Accreditation program (CHAP) and the Joint Commission
Which of the following focuses on developing and circulating standards for companion animal hospitals? The joint Commission The American Animal Hospital Association The American Veterinary Medical Association The Veterinary Hospital Managers Association
The American Animal Hospital Association
What certification can any health professional working in corrections receive, and through which organization is the program administered? The CCHP certification from the National Commission on Correctional Health Care The RCHCP certification from the American Correctional Health Services Association The RHIA-C from the American Health Information Management Association The CCP from the American Correctional Association
The CCHP certification from the National Commission on Correctional Health Care
How is reimbursement to the ICF/IID handled in most states? The ICF/IID receives a DRG payment for each episode of care. The ICF/IID receives a capitation payment for each individual in its geographic region. The ICF/IID receives a per diem payment for each day of service to each individual resident. The ICF/IID receives payment for each item of service provided according to a statewide fee schedule.
The ICF/IID receives a per diem payment for each day of service to each individual resident.
Which of the following organizations provides the most comprehensive, measurable health care standards that take into account the size and complexity of the institution and that are specific to correctional facilities? The Joint Commission The American Correctional Association The National Commission on Correctional Health Care The American Correctional Health Services Association
The National Commission on Correctional Health Care
Select the TRUE statement below with regard to Medicare hospital outpatient reimbursement. The hospital may be paid for only one RBRVS per day per patient The hospital may be paid for only one APC per day per patient The hospital may be paid for only one APC per patient per 72 hours The hospital may be paid for more than one APC per patient visit
The hospital may be paid for more than one APC per patient visit
Who determines how long-term care facilities are reimbursed under the Medicaid program?
The individual state agency through state legislation
Which of the following statements is FALSE in relation to documentation requirements specific to patients receiving urgent or immediate care? When emergency, urgent, or immediate care is provided, the time and means of arrival are also documented in the medical record. The medical record notes how long a patient receiving emergency, urgent, or immediate care had to wait for treatment. The medical record of a patient receiving emergency, urgent, or immediate care notes the conclusions at termination of treatment including final disposition, condition at discharge, and instructions for follow -up care. The medical record contains a copy of the information made available to practitioners or organizations providing follow-up care.
The medical record notes how long a patient receiving emergency, urgent, or immediate care had to wait for treatment
Which of the following applies with regard to co-morbidity adjustments in the Medicare prospective payment system for dialysis facilities? There are only a few (less than 20) categories of conditions that qualify as co-morbidities. There are a significant number (over 100) of categories of conditions that qualify as co-morbidities. There are numerous (more than 1,000) categories of conditions that qualify a co-morbidities. There are no co-morbidity adjustments in the Medicare prospective payment system for dialysis facilities.
There are only a few (less than 20) categories of conditions that qualify as co-morbidities.
A ___________________is a single outcome expected to be achieved by the individual within one year, as a result of training. Measurable outcome, criteria for measuring progress, and projected completion date should be specified relative to strengths, needs, and established goals.
Training Objective
A means to collect uniform data from states that is client specific, but not client identifiable, including demographic and substance abuse characteristics.
Treatment Episode Data Set (TEDS)
A dually diagnosed substance abuse client has both a substance-related disorder and a chronic mental illness. True False
True
A hallucination is a false sensory perception, such as seeing, hearing, smelling, or feeling things that are not real. True False
True
A life-care plan lists the items required over a lifetime for the individual, their cost, and the frequency of replacement and serves as a medical legal document that may guide court decisions regarding a settlement.
True
A mental health program could be accredited by the Joint Commission, CARF, or NCQA. True False
True
A qualified developmental disabilities professional (QDDP) is responsible for coordinating and monitoring each individual's True False
True
Clients with acute problems may be seen in a medically managed intensive inpatient treatment program, such as that found in an acute care general hospital. True False
True
DSM-5 recognizes four degrees of severity of intellectual disabilities: mild, moderate, severe, and profound. True False
True
Federal law mandates strict confidentiality guidelines for substance abuse facilities. True False
True
Habilitation is a process by which a person is assisted to acquire and maintain life skills that enable him or her to cope more effectively with personal and environmental demands and to raise the level of physical, mental, and social efficiency. True False
True
ICF/IID client records are often divided into three sections—administrative, health, and habilitation/training sections. True False
True
Intensive outpatient treatment requires a minimum of nine treatment hours per week within a structured program. True False
True
Interdisciplinary team meetings may be informally referred to as staffing's. True False
True
Involuntary commitment is a legal process by which individuals who are deemed to be a danger to themselves or to others may be admitted to a facility even though they refuse or cannot consent to the treatment. True False
True
It is generally thought that persons with serious mental illness who are in stable mental states do not benefit greatly from traditional talk therapy, and that in fact it may sometimes produce negative effects by increasing stress when discussion turns to unhappy events. True False
True
Many substance abuse agencies and treatment facilities have established employee assistance programs to serve working adults and their employers. True False
True
Medicaid (Title XIX) provides most funding for ICF/IIDs. True False
True
Medicare will only pay for home health care services for persons who are homebound.
True
T/F: National databases maintained on spinal cord and traumatic brain injuries facilitate research in rehabilitation and promote uniform treatment, leading to improved functional outcomes.
True
T/F: The Joint Commission and CARF are the nationally recognized agencies that review care provided in rehabilitation facilities for accreditation purposes.
True
T/F: The admission history and physical performed on a rehabilitation patient includes a functional history, which covers the patient's functional status prior to the onset of illness or injury.
True
The Addiction Severity Index calculates a severity rating, or score, that can be used as an outcomes measure in research studies. True False
True
The American Society of Addiction Medicine identified two levels of outpatient care and two levels of inpatient care in substance abuse treatment settings. True False
True
The Child and Adolescent Service System Program (CASSP) began as a federal initiative in the 1980s to create a comprehensive network of services for emotionally disturbed children and adolescents, now known as systems of care. True False
True
The Council on Quality and Leadership publishes its accreditation standards for facilities for individuals with intellectual disabilities in a document called Personal Outcome Measures. True False
True
The IMPACT Act of 2014 requires post-acute care providers to report standardized assessment data across post-acute settings for the purposes of patient assessment, quality comparisons, resource use measurement, and payment reform.
True
The Inventory for Client and Agency Planning (ICAP) is an assessment instrument used by some states that provides service scores that can be used to adjust payments to providers. True False
True
The Joint Commission has a separate accreditation program for behavioral health care programs like non-hospital substance abuse facilities. True False
True
The Rancho Los Amigos Scale is beneficial in communicating to other members of the rehabilitation team the level of recovery of a patient with traumatic brain injury.
True
The Uniform Reporting System (URS) is a system by which each State Mental Health Authority (SMHA) reports aggregate data to SAMHSA Question 25 options: True False
True
The United States Supreme Court has ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities. True False
True
The individualized treatment plan (ITP) includes both proposed treatment processes and treatment goals and objectives. True False
True
The individualized treatment plan must be based on the client s comprehensive clinical assessment. True False
True
The principal sources of funding for CMHCs are client fees, Medicaid, Medicare, and block grant funding for special projects. True False
True
True or False: A care area may be triggered by data entered on the minimum data set (MDS) and, if so, the interdisciplinary team must document the outcome of their assessment process for that care area
True
True or False: A home care agency that opts to be surveyed for Medicare certification by the Joint Commission would be deemed to be in compliance with the Conditions of Participation upon accreditation by the Joint Commission
True
True or False: A home health care agency's payer mix is the ratio of various insurers and third party payers, such as government programs and commercial insurers
True
True or False: A hospice program is licensed by the state in which its located
True
True or False: HIM home care positions require knowledge of finance, quality improvement, utilization review, and information systems.
True
True or False: Home Health Resource Groups (HHRGs) are based on assessment data in three areas --- Clinical, Functional, and Service Utilization
True
True or False: Home health care is a service provided to recovering, disabled, or chronically ill patients who receive their treatment in their homes.
True
True or False: Hospice and home care tend to be high-pressure, high-burnout working environments for clinical staff, with staff turnover high in some areas.
True
True or False: Hospice services require little out of pocket expense and paper work on the part of the patient and/or family
True
True or False: In addition to clinical staff, the interdisciplinary team includes a pastoral and other counselor who offers spiritual support and comfort
True
True or False: Long term care patients are commonly called residents
True
True or False: Many hospice patients are unable to consent for themselves and have appointed personal representatives.
True
True or False: Risk management, in general terms, is a program that monitors the liability and accountability of home care services delivered to customers.
True
True or False: Standard surveys of long-term care facilities are unannounced and conducted at least every fifteen months
True
True or False: Substantial noncompliance and substandard quality of care findings at a long term care facility can result in fines up to $10,000 per day
True
True or False: The Accreditation Commission for Health Care (ACHC) has deeming authority for Medicare in home health, hospice, and DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies)
True
True or False: The Outcome and Assessment Information Set (OASIS) is a data set that is used by Medicare for both payment and quality improvement purposes
True
True or False: The primary caregiver is the person designated to provide care for the hospice patient when hospice staff is not available
True
True or False: Under Medicare regulations, both the attending physician and the hospice medical director must certify that the patient is terminally ill
True
True or False: When the state agency receives notification of a complaint about a long-term care facility, the result is an investigation of the facility
True
The standard form for submitting information to third-party payers when filing claims for hospital services is the ______________. UB-04 CMS 1500 DRG 919 APC 8000
UB-04
The __________ specifies definitions and rules for selecting the principal diagnosis, other diagnoses, principal procedure, and several other elements that are critical in DRG assignment and payment for hospital-based care. UHDDS UACDS DEED NCVHS
UHDDS
The _______________________ is a system by which each State Mental Health Authority (SMHA) reports aggregate data to SAMHSA.
Uniform Reporting System
The best source of data on kidney transplants is available from the ______________. CROWNWeb reporting system Forum of ESRD Networks Centers for Disease Control United Network for Organ Sharing
United Network for Organ Sharing
When coding, which would be more useful to hospice staff for internal evaluation of the quality of care provided to the terminally ill?
Urinary tract infection
Which of the following uses of electronic systems can enhance patient safety? Use of computerized provider order entry (CPOE) for orders directly entered by authorizing provider Record smoking status for patients 13 years old or older Check insurance eligibility electronically from public and private payers Use of voice recognition systems in radiology
Use of computerized provider order entry (CPOE) for orders directly entered by authorizing provider
In the ICF/IID, caring for each individual in the most appropriate setting and managing resources efficiently are the goals of _______________________.
Utilization Management
________________ is a national database containing data abstracted from animals treated in veterinary teaching hospitals and used extensively for research. ISIS OFA VMDB SNOMED
VMDB
Which of the following statements is true concerning Medicare regulations regarding volunteers in hospice?
Volunteer hours must equal at least 5% of the patient care hours of paid employees and contract staff
Medicare Advantage (formerly Medicare + Choice) is _________________. a Medicare managed care program the use of supplemental insurance to pay for medical expenses not covered under Medicare a program for physicians that allows them to choose to participate in Medicare or not a federal health care program created by the Patient Protection and Affordable Care Act (PPACA) to replace and expand traditional Medicare
a Medicare managed care program
Select the best answer or combination of answers: A dialysis facility is an entity that _________________. provides outpatient maintenance dialysis services provides home dialysis training and support services performs kidney transplants a and b, but not c a, b, and c
a and b, but not c
The State Children's Health Insurance Program (SCHIP or CHIP) is _________________. a private health insurance program with variable coverage from state-to-state a Medicare Part A program for uninsured children a Medicare Part D program for uninsured children a joint state-federal program providing insurance for lower income children not covered by Medicaid
a joint state-federal program providing insurance for lower income children not covered by Medicaid
In the hospital setting, the term "resident" is primarily applied to ______. a licensed physician participating in an approved graduate medical education program an outpatient evaluated and treated in the observation area of the hospital a computer program that resides in RAM, used to diagnose emergency patients quickly patients enrolled in the hospital's long-term ambulatory care program
a licensed physician participating in an approved graduate medical education program
Select the best answer or combination of answers: Renal replacement therapy (RRT) includes ______________. peritoneal dialysis hemodialysis kidney transplant a and b, but not c a, b, and c
a, b, and c
An inpatient facility that provides acute medical care
acute care hospital
Individual records at an ICF/IID facility are often divided into sections, as follows: history, examination, and medical decision-making administrative, health, and habilitation/training medical, nursing, and ancillary past, present, and future
administrative, health, and habilitation/training
Under HIPAA, it is permissible to use or disclose PHI without a specific written authorization when it is necessary for ____________________. treatment payment health care operations all of the above none of the above
all of the above
Which of the following are ways cancer is treated? surgical procedures radiation chemotherapy all of the above
all of the above
Environmental control units (ECUs) __________.
allow a person who has limited mobility to perform many everyday functions in the home, at work, or school
Devices that provide stability and support for individuals who have trouble walking are __________.
ambulation aids
What is a program for the performance of elective surgical procedures on patients who are classified as outpatients and typically are released from the surgery center on the day of surgery, thus avoiding an overnight stay in the health care facility? ambulatory surgery partial hospitalization adult day care surgery clinic
ambulatory surgery
The effect of the Olmstead ruling on services for individuals with intellectual disabilities has been _________________________. an increase in community-based services an increase in institutional-based services a decrease in services available to individuals a decrease in individuals requiring services
an increase in community-based services
What is Alcoholics Anonymous? a regulation described in 42 CFR, Part 2, Confidentiality of Drug and Alcohol Abuse Records an employee assistance program offered by most large companies in the United States a recovery program sponsored by the American Society of Addition Medicine an organization of self-help recovery groups that utilizes a twelve-step program
an organization of self-help recovery groups that utilizes a twelve-step program
Adjuvant therapy includes all of the following EXCEPT: chemotherapy antibiotic therapy radiation therapy hormone therapy
antibiotic therapy
The Palliative Performance Scale ______
assesses the patient's physical, functional, and mental status
_____________________ is the process of identifying an individual's functional level, strengths, needs, causes of disabilities, and conditions hindering development.
assessment
Which of the following was NOT a factor in the 2005 implementation of the inpatient psychiatric facility prospective payment system (IPF PPS)? assessment scores comorbidities patient age MS-DRG
assessment scores
What is the role of a case manager in substance abuse treatment settings? ensures that all documentation requirements are met assists the client with non-treatment activities designs therapeutic recreational activities oversees all treatment activities
assists the client with non-treatment activities
Amy Williams is the HIPAA Compliance Officer for Wayne County Hospital. In her role she will be expected to _________________. audit records against codes submitted purchase supplies for the operating room suite ensure insurance information is obtained upon patient admission track patient disposition after discharge
audit records against codes submitted
In a hospice situation, the _____ period ordinarily lasts about one year
bereavement
A form of mental illness in which a person alternates between states of ecstatic mania and severe depression
bipolar disorder
An appointment scheduling method in which all patients are assigned in a large block for the same appointment time (e.g., 9 a.m. for all morning appointments) then seen on a first-come, first-served basis is called a ______________. standard scheduling system walk-in scheduling system block appointment system capitation appointment system
block appointment system
Hospice care focuses on the needs of _____
both patient and the family
A person who is not a member of the covered entity's workforce, but performs work on behalf of the covered entity that involves the use or disclosure of protected health information is a(n) ___________________. client employer employee business associate
business associate
The days of care reimbursed by Medicare at an inpatient rate (either general inpatient or respite) ______
can be no more than 20% of the total days of hospice care
Clinically relevant information about an individual that identifies specific problems and forms the basis for individual care planning
care area triggers
Tooth decay is called ____________. caries plaque calculus composite
caries
Which of the following individuals would be responsible for referral to needed services, coordination among service providers, and monitoring for escalation of psychotic symptoms, but would not provide treatment? psychiatrist psychologist recreation therapist case manager
case manager
A computer file that contains a list of the Healthcare Common Procedural Coding System (HCPCS) codes and associated charges for the services provided to hospital patients is referred to as a ______________________. fiscal intermediary revenue code chargemaster status indicator
chargemaster
In recent years, mental health services have placed emphasis on __________. psychosurgery functional deficits client strengths placement in the most restrictive environment
client strengths
A mental illness appearing as a deep feeling of melancholy and futility that is not situational in nature
clinical depression
HCPCS "Level II" or national codes refer to ______. CPT codes ICD-9-CM codes APC codes codes that CMS developed
codes that CMS developed
The 20 percent expense that is the responsibility of the insured under an indemnity insurance policy is called _______________. coinsurance copayment self-indemnity point-of-service fee
coinsurance
Which of the following is NOT recommended by the American Academy of Pediatrics in an adolescent substance abuse treatment program? knowledge of the clinicians about adolescent behavior and development in addition to chemical dependency treatment low staff-to-patient ratio combining adolescents and adults in the same treatment unit availability of academic and vocational activities
combining adolescents and adults in the same treatment unit
A ___________________________ is a plan for ensuring that a facility or practice is following all laws and regulations, including those pertaining to reimbursement under Medicare and Medicaid. public health plan strategic plan follow-up plan compliance plan
compliance plan
Verifying medical necessity of tests and procedures ordered during an inpatient hospitalization is called _______________. concurrent review coinsurance gatekeeping credentialing
concurrent review
The term by which persons with mental illness who are living in the community prefer to be called is _________________. consumer client patient resident
consumer
In ______________________________ the patient is able to perform his or her own dialysis almost anywhere because very little special equipment is required, and the patient dialyzes three or four times a day at home or at work. hemodialysis self-hemodialysis continuous cycling peritoneal dialysis (CCPD) continuous ambulatory peritoneal dialysis (CAPD)
continuous ambulatory peritoneal dialysis (CAPD)
A focus on customer involvement in planning services and obtaining feedback as to satisfaction with service delivery is a component of _____________________. utilization management continuous quality improvement continuity of care commitment
continuous quality improvement
Determining which insurance is the primary payer and assuring that no more than 100 percent of the charges are paid to the provider and or reimbursed to the patient is called ______________. capitation coinsurance gatekeeping coordination of benefits
coordination of benefits
The practice of requiring inmates to pay a (small) fee for predetermined, nonemergency medical treatments is called inmate _____________. coordination of benefits self-insurance deductible copayment
copayment
The process of review to approve a provider, such as a physician, who applies to participate in a health plan is ______________. evaluation regulation credentialing accreditation
credentialing
A person-centered philosophy that creates a more home-like environment for residents of a nursing facility
culture change movement
The amount of medical expenses that insureds must pay each year from their own pockets before the plan will reimburse them is called the ______________. coinsurance deductible copayment per annum
deductible
A form of disordered thinking in which a person holds unrealistic beliefs (e.g., that they are receiving communications from aliens in outer space or that their food is being poisoned)
delusion
The spouse or child of the primary recipient of the managed care insurance benefit within a managed care organization is referred to as a _____________. contract dependent subscriber beneficiary
dependent
The term for a person held in custody awaiting trial, not yet convicted is _____________. inmate prisoner detainee custodian
detainee
Which of the following types of caregivers would be most likely to see the in-center dialysis patient at every treatment? social worker dietitian physician dialysis technician
dialysis technician
_______________________ are personnel whose daily responsibility is to manage, supervise, and provide direct care to individuals in their residential living units.
direct care staff
A restriction or inability to perform an activity in the manner or within the range considered to be normal for a human being is a(n) __________.
disability
Physical therapy, occupational therapy, speech-language pathology, medical social services and respiratory therapy are all examples of various _____ that may provide services to home health patients.
disciplines
A wheelchair or hospital bed is an example of ______
durable medical equipment
Ensuring that a provider is not underutilizing services and compromising the health of managed care members or over-utilizing services and creating unnecessary expense is ________________. service regulation financial supervision enrollment management economic credentialing
economic credentialing
The determination as to whether a person is allowed to receive care under a managed care organization contract is called ____________. eligibility enrollment entitlement case management
eligibility
Substance abuse assessment and treatment programs established through a contractual arrangement between an organization and a substance abuse treatment facility to serve the employees within the organization are known as __________________________________.
employee assistance programs
A freestanding ambulatory care facility generates which of the following at the conclusion of a patient's visit? UB-04 incident report chargemaster encounter form
encounter form
A period of time during which a variety of services (inpatient and/or outpatient) are provided to a mental health consumer for a given occurrence of illness is known as a(n)______________. hospitalization involuntary commitment episode of care relapse
episode of care
Estelle v. Gamble is a U.S. Supreme Court case that ________________________. upheld the privatization of prison systems established a right to health care for inmates gave inmates the right to bring a lawsuit against a prison system made inmates eligible for Medicare and Medicaid benefits
established a right to health care for inmates
Under Medicare, approximately how often must a physician certify that home care is needed?
every 60 days
In a ______________ system the health care provider charges and is paid for each item of service provided. prospective payment fee-for-service capitation per diem
fee-for-service
Prisons are for the confinement of persons convicted of a __________________. felony whose sentence exceeds one year felony whose sentence is less than one year misdemeanor whose sentence exceeds one year misdemeanor whose sentence is less than one year
felony whose sentence exceeds one year
Psychosocial rehabilitation services _____________________. include aggressive consistent implementation of specialized and generic training, treatment, health services, and related services on a 24-hour daily schedule in an institutional setting refer to a meeting of the interdisciplinary team during which the individual program plan is reviewed and revised focus on provision of an array of community support services for persons with mental illness sufficient to allow them to live in the least restrictive environment represent the predominant method of mental health service delivery to children with emotional disturbances and their families, utilizing professional services tailored to meet the specific needs of the child and family, often including the home and/or school settings
focus on provision of an array of community support services for persons with mental illness sufficient to allow them to live in the least restrictive environment
A center for rehabilitation that is not physically part of another facility
freestanding rehabilitation center
The managed care primary care provider (PCP) who coordinates all patient health care needs and decides what, if any, additional care or testing is required is acting as a(n) ______________. coinsurer network gatekeeper indemnifier
gatekeeper
A hospice patient is admitted to a hospital for pain and symptom management. The hospice will be reimbursed for ______
general inpatient care
Which term describes a formal, administrative procedure whereby inmates may file complaints against a correctional facility for review by a panel? malpractice litigation grievance process risk management utilization management
grievance process
A form of disordered thinking in which a person reports sensory experience that is not valid, such as seeing, hearing, smelling, or feeling things that are not real
hallucination
By definition, a ___________ limits or prevents the fulfillment of one or several roles that are regarded as normal (depending on age, sex, social, and cultural factors) for a given individual.
handicap
Having a statewide Health Services Director (HSD) in correctional health care can be helpful because the HSD ______________________. has both clinical and administrative experience provides more local control with less state-level control can supervise both health care operations and overall prison operations reports to the warden, which is an arrangement that provides consistency between health care and prison policies
has both clinical and administrative experience
The National Hospice and Palliative Care Organizations (NHCPCO) _________
has staff available to answer questions or concerns regarding interpretation of NHPCO standards
In ___________, the patient's blood circulates outside his or her body through an artificial kidney that removes metabolic wastes and helps to maintain homeostasis. artificial renal function hemodialysis CAPD CCPD
hemodialysis
Computers that control environments and wheelchairs are __________.
high-technology assistive devices
Rehabilitation services provided to patients in the home by an agency
home health rehabilitation
One of the criteria for receiving Medicare payment for home care is that the patient being served must be _____
homebound
In an ICF/IID, the most active portion of the individual's record is ___________________. housed in the HIM department. housed on the living unit. microfilmed or imaged weekly maintained in original form for 21 years past the statute of limitations
housed on the living unit
Which of the following is NOT a major factor in determining the fee charged by a consultant? costs to provide services fees charged by other consultants the reputation and experience of the consultant household operational costs
household operational costs
A(n) __________ is any temporary or permanent loss or abnormality of a body structure or function, whether physiological or psychological.
impairment
Acute rehabilitation programs are generally offered _____.
in a hospital
Which dialysis modality is the most prevalent in the United States? in-center hemodialysis home hemodialysis continuous ambulatory peritoneal dialysis continuous cycling peritoneal dialysis
in-center hemodialysis
The Diagnostic and Statistical Manual of Mental Disorders __________________. was developed by the American Medical Association includes diagnostic criteria and descriptive text for various mental disorders is a coding system is based on SNOMED has not been updated since 1978
includes diagnostic criteria and descriptive text for various mental disorders
The most common form of outpatient treatment for substance abuse disorders is _________________. group therapy family therapy individual therapy drug therapy
individual therapy
A summary of the goals and the objectives that the staff will assist the individual to attain during the coming year, this document outlines how the program will guide the individual toward achieving the set goals. standing orders training schedule core team summary sheet individualized program plan
individualized program plan
Developed by the substance abuse client's treatment team, this document is used to identify the type and frequency of services needed by the client. It includes measurable goals and objectives that address the problems identified in the clinical assessment and should be updated periodically. individualized treatment plan (ITP) addiction severity index (ASI) history and physical (H&P) progress notes (SOAP)
individualized treatment plan (ITP)
A record format in which the documentation is maintained in chronological order regardless of the type or author of the documentation is _______________. problem oriented source oriented sequential integrated
integrated
The preferred term for significant limitations in both intellectual functioning and adaptive behavior expressed in conceptual, social, and practical adaptive skills and age of onset before the age of 18 is _____________________. intellectual disability mental retardation cognitively challenged special needs
intellectual disability
In an ICF/IID, the individualized program plan is developed by the ___________________. qualified developmental disability professional individual receiving services interdisciplinary team health information manager
interdisciplinary team
A system of care _____________________________________________. involves collaboration across agencies, families, and youth for the purpose of improving access and expanding community-based services and supports for children and youth with a serious emotional disturbance and their families is a program of federal benefits paid to persons with disabilities such as mental illness who have worked a sufficient length of time to qualify to receive Social Security benefits is a program in the federal block grant program that supplements the revenue of the community mental health centers to provide services to adults in inpatient psychiatric crisis facilities is a program in the federal block grant program that supplements the revenue of State Mental Health Authorities to fund both inpatient psychiatric hospitals and community mental health centers
involves collaboration across agencies, families, and youth for the purpose of improving access and expanding community-based services and supports for children and youth with a serious emotional disturbance and their families
Which is a governmental process that requires a facility to comply with state laws and standards to operate? authorization accreditation attestation licensure
licensure
Jails are operated by _____________________. international governments federal governments state governments local governments
local governments
An arrangement by which one physician temporarily works in place of another physician is ____________________. LMRP locum tenens OIG program transmittal
locum tenens
Provide inpatient rehabilitation services for patients with acute illness superimposed on chronic disability or for medically complicated patients.
long term acute care hospitals
_______ is a charitable organization that provides food services for those unable to leave the home:
meals on wheels
Without documented information on the diagnoses or symptoms that prompted a physician to order a test, the hospital lacks the information needed to demonstrate that the test was _____________________. performed in a timely manner professionally administered medically necessary critically assessed
medically necessary
The ______ (is/are) a core set of screening and assessment elements, including common definitions and coding categories forming the foundation of the comprehensive resident assessment of residents in a long-term care facilities, such as skilled nursing facilities (SNF)
minimum data set
Wheeled chairs that assist those for whose ambulation is difficult or not possible are __________.
mobility devices
Unstable dialysis patients should be reassessed by the interdisciplinary team at least ________. daily weekly monthly annually
monthly
When a hospital provides services to a Medicare patient as an outpatient within 72 hours before a related inpatient admission, charges for those outpatient services __________________________. must be billed separately from the inpatient bill must not be billed separately from the inpatient bill must be written off as "uncollectable" expenses must be billed prior to the inpatient admission
must not be billed separately from the inpatient bill
Under EMTALA, hospitals that offer emergency services ___________________. are free to refuse emergency services to patients who do not show proof of insurance can refuse emergency services to patients as long as another hospital agrees to accept the patient as a transfer must screen and stabilize, if necessary, any patient who arrives in the emergency department must provide emergency services free of charge to a certain number of individuals to meet the EMTALAcharity obligations
must screen and stabilize, if necessary, any patient who arrives in the emergency department
ICD-O is used to code what? neoplasm topography and morphology emergency room records surgery charts diagnostic labs
neoplasm topography and morphology
Automatic patient recall notices generated by practice management software ________________. notify patients about the need for periodic dental checkups and teeth cleanings remind patients about outstanding balances due by generating individual statements track patient referrals according to which dentist in the practice generated the referral identify patients who have received treatment, but for whom claims have not been filed
notify patients about the need for periodic dental checkups and teeth cleanings
In the veterinary setting, the total number of times all patients were treated by the facility in a given time period is represented by a data item called the ___________________________________. total patients discharged inpatient services days number of accessions census
number of accessions
A __________ is a registered nurse who has had additional training in areas such a family or pediatric care and has credentials for limited independent practice. physician assistant nurse practitioner chiropractor podiatrist
nurse practitioner
Mid-level providers are often used in managed care to provide illness-related services to patients; they include ____________. physicians case managers health educators nurse practitioners
nurse practitioners
Teaches patients activities of daily living, such as dressing, bathing, grooming, etc
occupational therapist
When a dialysis patient is transferred to another facility, federal regulations require that all requested medical record information be transmitted to the receiving facility within __________. one working day five working days two weeks one month
one working day
For certain categories of encounter-based hospital outpatient services, "Composite APCs" result in _______________________. only a single payment for certain common combination services provided on the same day of service individual payments for each service provided during the outpatient visit additional payments for hospital supplies and technical assistance zero payments due to the fact that these services are not covered by Medicare
only a single payment for certain common combination services provided on the same day of service
External appliances that supplement an extremity's function or improve stability and positioning are __________.
orthotic devices
End result or consequence; the patient's health and functional status after a period of treatment
outcome
Rehabilitation therapy provided to patients who do not stay overnight
outpatient rehabilitation
The hospital outpatient prospective payment system (OPPS) allows for additional payments to be made to cover the costs of innovative medical devices, drugs, and biologicals. These payments are referred to as __________________. disproportionate share hospital payments experimental incentives research and development incentives pass-through payments
pass-through payments
The Joint Commission requires that the medical record contain a summary list for each patient that should include all of the following EXCEPT ____________________. significant medical diagnoses and conditions significant operative and invasive procedures adverse and allergic drug reactions past insurance and billing accounts with significant balances
past insurance and billing accounts with significant balances
One effect that the quality incentive program could have on Medicare payments to dialysis facilities is that ______________________. payments to high-performing facilities may be increased by as much as 5% payments to facilities that do not meet performance standards may be reduced by as much as 2% payments to facilities significantly below performance standards may be denied all of the above
payments to facilities that do not meet performance standards may be reduced by as much as 2%
Medicare reimburses hospice care on a _______ basis
per diem
The fundamental payment in Medicare's reimbursement system for dialysis facilities is made on a _______________. per diem basis per treatment basis monthly capitation basis diagnosis related group basis
per treatment basis
The ____________-centered approach to habilitation has been instrumental in improving the services rendered to individuals with intellectual disabilities and identifying the least restrictive program alternative.
person
Physical medicine/rehabilitation physician specialist who heads the rehabilitation team
physiatrist
________________________ involves mechanical or personal restriction that immobilizes or reduces the ability of an individual to move his or her arms, legs, or head freely.
physical restraint
Which are considered the main caregivers in ambulatory care? physicians physical therapists nurse practitioners physician assistants
physicians
Federal regulations explicitly state that the patient or designee must sign one of the following documents or the document should explain the reason that the signature was not provided. To which of the following documents does this regulation apply? history and physical discharge summary progress notes plan of care
plan of care
Risk management departments protect health care organizations from financial loss that could occur as a result of ____________________. meaningful use activities potentially compensable events disagreements between staff members ICU patients who are transferred to LTACHs
potentially compensable events
One aspect of Medicare managed care is that _____________. premiums to HMOs are risk-adjusted based on patient diagnoses Medicare pays physicians directly through fee-for-service arrangements additional premiums are paid to all HMOs who employ certified wellness coordinators hospitals with Joint Commission accreditation are not deemed to meet the Conditions of Participation for Managed Care
premiums to HMOs are risk-adjusted based on patient diagnoses
Which of the following is NOT a case-mix adjustment factor in Medicare's prospective payment system for dialysis facilities for dialysis facilities? body surface area body mass index procedures age
procedures
A record format that provides for documenting multiple animals on the same record is found in ____________________. production medicine the veterinary inpatient record the source-oriented medical record the problem-oriented medical record
production medicine
With regard to progress notes in mental health records, _____________________________. accreditation surveyors often check to see that every progress note has a corresponding diagnosis in the history and physical report progress notes are important as documentation that a service was performed as a basis for reimbursement the Conditions of Participation require that physicians in psychiatric hospitals write daily progress notes progress notes are not usually included in electronic medical records for mental health and therefore are generally handwritten, even when the rest of the record is electronic
progress notes are important as documentation that a service was performed as a basis for reimbursement
A device that is designed to replace a missing extremity or partially missing extremity is a(n) ____________.
prosthesis
Devices that replace missing body parts are ___________.
prosthetics
Which of the following would NOT be appropriate to include in a consulting contract? business associate agreement providing for protection of privacy of PHI provision for payment contingent upon improving facility revenues hourly rate of payment for services description of services
provision for payment contingent upon improving facility revenues
Partial hospitalization services are paid for under Ambulatory Payment Classifications (APCs) when _____________________. received by unstable dialysis patients in a part of the hospital where patients generally do not stay overnight psychiatric or behavioral health patients receive certain services and spend part of the day or the night in the hospital an observation patient has been in the hospital for over 48 hours and the patient's condition still does not permit discharge to home an inpatient length of stay is too short for a regular diagnosis related group (DRG) payment
psychiatric or behavioral health patients receive certain services and spend part of the day or the night in the hospital
Assists the newly disabled person and family in adjusting to the disability
psychologist
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is mainly used by _____________________. psychologists and psychiatrists health information managers case managers Nurses
psychologists and psychiatrists
A(n) _________________________________ is a state of extreme disordered thinking in which a person demonstrates such symptoms of serious mental illness as hallucinations and delusions.
psychosis
The authorization to receive a specific health service from a specific health provider is called a(n) ___________. transfer referral encounter remittance
referral
The physician sends the patient to the hospital for a radiological examination. The patient returns to the physician's office for follow-up of test results. From the point of view of the hospital, what type of hospital patient is this? inpatient emergency outpatient clinic outpatient referred outpatient
referred outpatient
In most hospitals, the patient record starts with the ___________________. registration process initial evaluation by nursing staff first physician visit discharge process
registration process
Substance abuse treatment composed of "services staffed by designated addiction treatment and mental health personnel who provide a planned regimen of care in a 24-hour live-in setting...." is called _____________________. intensive outpatient treatment partial hospitalization treatment residential/inpatient treatment medically managed intensive inpatient treatment
residential/inpatient treatment
Studying incident and accident reports to identify patterns and reduce hazards is a function of ______________________. person-centered planning utilization management habilitation training risk management
risk management
___________________________ is a psychosis represented by a state of extremely disordered thinking, manifesting as a break with reality.
schizophrenia
Mr. Smith goes to the emergency room at North park Hospital complaining of chest pain. He states that he does not have health insurance and does not have the money to immediately pay for treatment. According to EMTALA, the hospital must _______________________. refuse to treat Mr. Smith if the ER physician is not willing to admit him to the hospital for full treatment explain all billing practices including collection agency policies before Mr. Smith can be treated screen and stabilize Mr. Smith before attempting to transfer him to another facility contact CMS to verify that Mr. Smith qualifies for public assistance
screen and stabilize Mr. Smith before attempting to transfer him to another facility
A condition in which a young person (from birth to age 18) has a diagnosable mental, behavioral, or emotional disorder resulting in functional impairment that substantially interferes with or limits the child's role or functioning in family, school, or community activities
serious emotional disturbance
A condition in which a person has a diagnosable mental, behavioral, or emotional disorder resulting in functional impairment that substantially interferes with or limits one or more major life activities
serious mental illness
One difference in the way that services rendered to an ICF/IID client differ from those in other settings is that in the ICF/IID setting, __________________. services must include training dietary services are rarely included services are provided during the day, but not at night dental services are excluded
services must include training
Initial health screenings of inmates. are rarely conducted. should be completed within 45 days of admission. should be completed within one week of admission. should be completed within 24 hours of admission.
should be completed within 24 hours of admission.
Medical-surgical nursing, intravenous therapy, and restorative nursing care are ____
skilled nursing services
inpatient rehabilitation for patients who are progressing too slowly to meet criteria for standard rehabilitation programs
skilled rehabilitation programs
Hospice routinely provide ________ services as part of the hospice benefit
social work
Coordinates funding resources for the patient:
social worker
Evaluates and treats aphasia, apraxia, dysarthria, etc.
speech-language pathologist
The rule used as a basis of comparison for measuring quantitative or qualitative value is
standard
A periodic, resident-centered inspection that gathers information about the quality of service furnished in a facility to determine compliance with the requirements of participation in the Medicare and Medicaid programs
standard survey
The Scales of Independent Behavior-Revised (SIB-R), the Vineland Adaptive Behavior Scales, the AAIDD Diagnostic Adaptive Behavior Scales (DABS), and the Inventory for Client and Agency Planning (ICAP) are _________________________. standardized assessments flowsheets maintained by nursing staff electronic health record products for the ICF/IID setting used to document the services planned to achieve program goals
standardized assessments
Individuals who are the primary recipients of the managed care insurance benefit within a managed care organization are referred to as _______________. patients dependents subscribers beneficiaries
subscribers
With regard to placement of an individual in an ICF/IID setting, _____________________. the ICF/IID setting is preferable to less restrictive settings the ICF/IID is almost always the least restrictive setting for individuals with intellectual disabilities such placements should be considered permanent, unless the ICF/IID is the least restrictive setting for the individual such placements should not be considered permanent, because the goal of training is to move the individual to a less restrictive setting
such placements should not be considered permanent, because the goal of training is to move the individual to a less restrictive setting
When the consent for treatment is generated at an ambulatory surgery center, who is responsible for explaining the risks and alternatives associated with the surgery and for obtaining the patient's consent prior to the procedure? nurse surgeon admission clerk anesthesiologist
surgeon
The application of technology where a video camera, a high-speed line, and monitoring and imaging equipment are installed at a correctional facility and a medical facility, allowing videoconferencing and digital images to be transmitted and received by either site, is called ______________________. telemedicine hybrid health record certified correctional health information technology (CCHIT) ACHSA digital technology system
telemedicine
Medicare Part A and Part B beneficiary information is maintained in __________________, allowing real-time eligibility requests for coverage using a secure closed private network to communicate with a CMS data center or via the CMS Extranet. the HIPAA Eligibility Transaction System ambulatory patient groups uniform ambulatory care data sets charge description masters
the HIPAA Eligibility Transaction System
In an inpatient rehabilitation facility, the IRF-PAI differs from the UB-04 in that it requires submission of __________.
the etiological diagnosis (what caused the disability)
Under Medicare, hospice payment rates are adjusted based on _______
the geographic location of the patient
With regard to development of forms for the ICF/IID record, _____________________. each department should be encouraged to develop its own forms independently the health information director should be an active participant in the establishment of standardized forms the increase in the number of ICFs/IID with an imaging program has decreased the need for standardized forms most ICFs/IID use mandatory standardized forms developed by the Centers for Medicare & Medicaid Services
the health information director should be an active participant in the establishment of standardized forms
The phrase "private pay" in the long term care setting denotes payment by ____
the individual or family
Upon the death of the patient, the health information department may get numerous requests from insurance companies or attorneys to settle a claim or probate the patient's estate. No information should be released without proper authorization from _____
the legal representative of the estate
The resource utilization group (RUG) that applies to a given resident is based on ____
the minimum data set
When a Medicare patient revokes the election of hospice care, ________
the patient returns to standard Medicare coverage
When a care area is triggered, the long-term care interdisciplinary team documents the outcome of the assessment process for that particular care area and _____
their decision regarding care planning for a particular problem or need
In the context of mental health, "duty to warn" means that __________________. therapists must warn persons against whom clients make threatening statements, regardless of the fact that such threats are made within a privileged context clients should notify therapists when they perceive that their symptoms are becoming exacerbated so that treatment can be properly escalated family members must warn therapists when the patient makes threatening statements against caregivers mental health organizations must notify both patients and the Department of Health and Human Services when a suspected breach of confidentiality of patient records has occurred
therapists must warn persons against whom clients make threatening statements, regardless of the fact that such threats are made within a privileged context
A longitudinal patient record documents a patient's health status, conditions, and treatments _____________________________. using electronic signals to transmit clinical information from one site to another throughout the patient's life in a prospective payment system throughout the patient's residence in a particular community
throughout the patient's life
What is the purpose of the American Society of Addiction Medicine's (ASAM's) Patient Placement Criteria Manual? to establish criteria for measuring and improving the quality of substance abuse treatment services to define levels of care and the specific criteria that should be used in placing clients in the appropriate treatment setting to assist in the development of a prospective payment system using reimbursement criteria based on the level of care in which the patient is placed to assist in the development of legislation and regulations governing the placement of patients who have been involuntarily committed to substance abuse treatment
to define levels of care and the specific criteria that should be used in placing clients in the appropriate treatment setting
In health care facilities that accept Medicare patients, a(n) __________ survey would be the only type of survey conducted by a regional office of the Centers for Medicare and Medicaid Services. routine accreditation validation licensure
validation
Labor costs and transportation costs associated with home care visits are examples of _______
variable costs
MS-DRGs differ from DRGs in that MS-DRGs take into account __________________. patient demographic data such as address, insurance type, etc. various levels of patient illness using secondary diagnoses. whether the hospital is a "teaching" hospital or "nonteaching" hospital whether the patient has had any previous hospitalizations
various levels of patient illness using secondary diagnoses.
A __________________________ is a facility in which consultative, clinical, and hospital services are rendered and in which a large staff of basic and applied veterinary scientists perform significant research and conduct advanced professional educational programs. veterinary clinic veterinary medical center veterinary mobile facility veterinary emergency facility
veterinary medical center
Mr. Jones has elected the hospice benefit. Upon election of the hospice benefit, Mr. Jones ________
waives standard Medicare coverage for services related to the terminal diagnosis
A health information consultant charges $150 per hour and works the equivalent of 200 billable eight-hour days per year. Taxes, insurance, travel, and other expenses consume about 70 % of the consultant's gross revenue. What is the consultant's net annual income after taxes and other expenses? $30,000 $72,000 $168,000 $240,000
$72,000
As of 2014, the SEER Program includes 20 population-based registries and covers approximately ______% of the U.S. population? 96% 52% 28% 7%
28%
Which of the following federal laws surrounding confidentiality impact cancer registries? Privacy Act of 1974 HIPAA ARRA All of the above
All of the above
There is usually only one member per state in this organization, so the members (health information managers who are spread across the U.S. and Canada) communicate with and support each other through an Internet listserv. American Animal Hospital Association American Veterinary Medical Association Veterinary Hospital Managers Association American Veterinary Health Information Management Association
American Veterinary Health Information Management Association
___________________ refers to an aggregate of microorganisms organized into a dynamic community and collecting on the teeth and under the gums. Tartar Sealant Biofilm Impaction
Biofilm
Which of the following represent the three most prevalent types of serious mental illness? Bipolar disorder, generalized anxiety disorder, and anorexia nervosa Generalized anxiety disorder, personality disorder, and schizophrenia Personality disorder, schizophrenia, and clinical depression Bipolar disorder, schizophrenia, and clinical depression Bipolar disorder, personality disorder, and schizophrenia
Bipolar disorder, schizophrenia, and clinical depression
___________ is a title applied to more than a hundred diseases that are characterized by uncontrolled growth of cells. Large cells Cancer Regeneration Mass growths
Cancer
What is a surveillance system systematically collecting newly diagnosed cancer cases for the purposes of monitoring the disease burden, the quality of care of cancer patients, cancer survival, and disparities? Tumor List Cancer Roster Cancer Registry Tumor Roster
Cancer Registry
Which of the following would the HIM consultant be LEAST likely to research in preparing to conduct a documentation audit? federal and state regulations for the type of facility being audited accreditation guidelines HIPAA EDI standards best practices
HIPAA EDI standards
The classification system widely used in cancer registries is ___________ . HCPCS SNOMED NDC ICD-O
ICD-O
Which of the following is a true statement concerning financial considerations for the independent health information management consultant? Consultants can ordinarily expect to work at least 260 billable days per year. Consultants rarely have to wait for payment for longer than 90 days, so maintaining cash reserves is not an issue for most consultants. In addition to salary, consulting revenue should cover FICA taxes, office space, equipment, supplies, and other business expenses. Starting a health information management consulting business requires raising a large amount of funding from loans or investors prior to launching the consulting firm.
In addition to salary, consulting revenue should cover FICA taxes, office space, equipment, supplies, and other business expenses.
Which of the following plans does NOT include benefits for dental care? Medicare Medicaid TRICARE Veterans Affairs
Medicare
____________________ disease is manifested by deepening pockets around the tooth, receding of the gingiva, and loss of attachment of the tooth. Neoplastic Periodontal Maxillofacial Neoplastic
Periodontal
Medical and dental care benefits are provided to families of active-duty military personnel under which program? CHIP Medicare TRICARE Veterans Affairs
TRICARE
Who certifies veterinary practice managers? The American Animal Hospital Association (AAHA) The American Veterinary Medical Association (AVMA) The Veterinary Hospital Managers Association (VHMA) The Association of American Veterinary Medical Colleges (AAVMC)
The Veterinary Hospital Managers Association (VHMA)
The first cancer registry was established where? Chicago, as a pilot project of The Joint Commission Connecticut Hospital Washington, D.C., by the National Institutes of Health Yale-New Haven Hospital
Yale-New Haven Hospital
A corporate integrity agreement is an agreement that _____________________________. a consultant reaches with the client that protects the institution from any liability arising from the misconduct of the consultant a health care provider or health plan reaches with the ONC to ensure the integrity of health care data submitted to a health information exchange a health care provider or health plan reaches with the OIG as part of a settlement agreement when allegations of improper reimbursement have been made a consultant reaches with the client to ensure that all of the necessary components of the business associate agreement are in place to protect the privacy of personal health information accessed by the consultant to fulfill the terms of the contract
a health care provider or health plan reaches with the OIG as part of a settlement agreement when allegations of improper reimbursement have been made
Which of the following is NOT of major importance to a successful HIM consulting practice? a large staff of employees relevant work experience an RHIT or RHIA credential careful research and planning
a large staff of employees
A multipurpose machine acts as _________________________. a printer, fax machine, scanner, and copier a printer, collator, and binder a computer and fax machine a computer and telephone
a printer, fax machine, scanner, and copier
Good leaders _____________________. act ethically act on self-interest have a high cognitive IQ base their power on mandated authority
act ethically
Specialty cancer registries collect cancer data for which of the following: specific facilities particular type of cancer familial cancers all of the above
all of the above
In the audit cycle, which of the following is completed after the others listed? review random sample of records to determine whether improvement occurred analyze, interpret, and present audit results research regulations and standards develop audit criteria
analyze, interpret, and present audit results
A retrospective review of selected health care records or data documents to evaluate the quality of care, services provided, documentation, or coding compared with predetermined standards is a(n) ______________________. audit contract business plan corporate integrity agreement
audit
Some zoonotic agents are being tracked as potential ______________________. blood donors bioterrorist threats tools for law enforcement sources for future medical treatments
bioterrorist threats
Obtaining consent to euthanize an animal whose life has been insured involves obtaining the consent of __________________. only the owner only the insurance company both the owner and the insurance company the owner, the insurance company, and the local animal welfare organization
both the owner and the insurance company
A formal, written document summarizing the operational and financial objectives of a business that includes the details of how the objectives are to be attained, including budgets and other financial forecasts is a(n) ___________________________. audit business plan business associate agreement corporate integrity agreement
business plan
With regard to checkups and preventive dentistry, it is common for dental insurance policies to ___________________________. apply the costs of these services to the patient's deductible cover these services at 50% cover these services at 75% cover these services at 100%
cover these services at 100%
Litigation in veterinary care is often associated with _________________________. pre-purchase examinations animal welfare advocacy wildlife management debt collection
debt collection
The __________________ is a dental professional whose training is mainly geared toward prevention of dental disease. The license of this professional usually includes the ability to perform oral and dental exams and to clean and polish teeth, but does NOT include the privilege of repairing damaged teeth. general dentist dental assistant dental hygienist oral surgeon
dental hygienist
What is NOT a piece of additional information that is included in the patient information section within a hospital cancer registry system: patient's medical record number race dietary restrictions co-morbid conditions
dietary restrictions
What is a job function that an HIM professional would NOT perform in a cancer registry? quality control for cancer records maintenance of software or other databases draw blood from patient for lab results abstracting and coding cancer incident records
draw blood from patient for lab results
Which of the following is NOT an area of regulation likely to affect HIM consultants? federal mandates for ICD coding in the veterinary setting ICD-10-CM/PCS implementation and coding meaningful use standards RAC audits
federal mandates for ICD coding in the veterinary setting
Which of the following would provide documentation of enlarged lymph nodes, bruises, or abnormal-looking growths? head, neck, and intraoral examination medical and dental history dental examination patient information
head, neck, and intraoral examination
The initial CMS Recovery Audit Contractors (RAC) program identified problems with ________________________________. workforce shortages due to the low number of health information consultants widespread lack of compliance with HIPAA privacy and security regulations incorrect coding and a failure to document medical necessity intentional filing of false claims by health care providers
incorrect coding and a failure to document medical necessity
The practice of veterinary medicine is governed by _______________________. The American Veterinary Medicine Association The Department of Health & Human Services The American Animal Hospital Association individual state veterinary practice acts
individual state veterinary practice acts
What is an item that a cancer registry will NOT collect on the last date of contact with the patient? whether the patient is alive on that date if the patient has died, the place and cause of death information needed for bereavement follow-up, in the event of death patient's current address and phone number
information needed for bereavement follow-up, in the event of death
Dental care is available to qualifying veterans at Department of Veterans Affairs medical centers where they pay _______________________________. monthly premiums for treatment (similar to a managed care program) low or no fees for treatment if obtained at the Veterans Affairs health care facility nothing because their health insurance plan reimburses the Veterans Affairs facility 100% of the fee because dental care is not covered by Veterans Affairs health benefits
low or no fees for treatment if obtained at the Veterans Affairs health care facility
An accession number is a ___________-digit number in the hospital cancer registry system that identifies the patient. 12 three six nine
nine
Judicial diversion of a person who has been certified as in need of psychiatric care to some other form of treatment that is community based with stipulations regarding behaviors such as taking medications, remaining sober, and maintaining residence in a designated place is called __________________. continuity of care outpatient commitment continuous quality improvement delusion
outpatient commitment
A written cost estimate is important in veterinary practice because _____________________. it is required by federal law it is a requirement for AAHA accreditation owners often make treatment decisions based on what they can afford to pay out-of-pocket most owners have pet health insurance policies that require cost estimates as part of the insurer's precertification programs
owners often make treatment decisions based on what they can afford to pay out-of-pocket
A radiograph taken outside the mouth that shows all the teeth on one film is called ______________. crown sealant bitewing panoramic
panoramic
Dentists, like physicians, should report dangerous and unusual medication reactions to whom? AMA DEA FDA pharmaceutical companies
pharmaceutical companies
Clients often include in the consultant's contract a requirement that the consultant maintain ___________________________. professional liability insurance coverage all equipment and resources necessary to complete the contract all protected health information necessary to complete the contract the same professional credentials that are required of the facility's permanent staff
professional liability insurance coverage
Preventive treatment, including the scaling, cleaning, and removal of calculus is called _________________. impaction prophylaxis root canal therapy orthognathic surgery
prophylaxis
Wrap around services _____________________. include aggressive consistent implementation of specialized and generic training, treatment, health services, and related services on a 24-hour daily schedule in an institutional setting refer to a meeting of the interdisciplinary team during which the individual program plan is reviewed and revised focus on provision of an array of community support services for persons with mental illness sufficient to allow them to live in the least restrictive environment represent the predominant method of mental health service delivery to children with emotional disturbances and their families, utilizing professional services tailored to meet the specific needs of the child and family, often including the home and/or school settings.
represent the predominant method of mental health service delivery to children with emotional disturbances and their families, utilizing professional services tailored to meet the specific needs of the child and family, often including the home and/or school settings.
In the audit cycle, which of the following is completed first? design audit sheet, incorporating all standards and regulations analyze, interpret, and present audit results research regulations and standards review random sample of records
research regulations and standards
Patient restraint in the veterinary health care setting is a tremendous concern in _________________________. risk management case management quality improvement utilization management
risk management
When the project for which the consultant has been hired expands beyond the contractually agreed upon services, this is referred to as ___________________ . scope creep audit expansion corporate integrity breach ergonomics
scope creep
A _____________ is formed by clear acrylic applied to the biting surface of the tooth, placed to prevent decay: cap crown bridge sealant
sealant
Which of the following is NOT a key element of a business plan? marketing strategies financial projections description of business statement of health insurance coverage
statement of health insurance coverage
In most states, dentists are legally obligated to report ______________________. social security numbers of patients using narcotics all procedures performed due to disease major procedures performed on minors suspected cases of abuse
suspected cases of abuse
When a contractor works from home, the term "container" refers to ___________________________. the terms of the contract the money provided to the contractor up front to begin work the place in which focused work is performed both physically and mentally the device in which medical documentation is transported between the facility and the contractor
the place in which focused work is performed both physically and mentally
Which of the following is NOT ordinarily a component of a health care provider's compliance program implemented to guard against fraud and abuse? internal monitoring and auditing developing compliance standards and policies designation of a compliance officer or contact training and education of the public and patients
training and education of the public and patients
Which of the following is recommended when setting up a home office? maintaining highly polished, shiny countertops and office furniture sharing one telephone line with family members and a fax machine multitasking by combining child-care duties with consulting activities using a fax machine for rapid transmission of printed documents that cannot be emailed.
using a fax machine for rapid transmission of printed documents that cannot be emailed.
A graduate of a two- or three-year AVMA-accredited associate degree or certificate program in veterinary science is a _______________________. veterinarian veterinary technician veterinary technologist veterinary practice manager
veterinary technician
With regard to emergency safety interventions, such as restraint or seclusion, _________________________. there is no recognized right to be free from the inappropriate use of restraint and seclusion CMS has rules regarding inappropriate physical restraint, but does not address chemical restraint one week after use of such emergency safety interventions, involved staff and the patient must have a face-to-face discussion and staff must document the discussion, including how such an intervention might be avoided in the future within one hour of initiation, there must be a face-to-face assessment of the psychological and physical wellbeing of the patient conducted by a physician or other professional qualified by special training in the use of emergency safety interventions
within one hour of initiation, there must be a face-to-face assessment of the psychological and physical wellbeing of the patient conducted by a physician or other professional qualified by special training in the use of emergency safety interventions
