Final Quiz 12.1 (RHIA & RHIT)

A plaintiff must establish which burden of proof to recover damages for medical negligence or malpractice?1. a breach of the duty to care by the defendant2. damages or injury resulted from the defendant's negligence3. a duty of care relationship between the defendant and patient4. causation existed for harm to the plaintiff from the defendant's conduct only 1 1, 2, 3, and 4 1 and 3 2 and 4

1, 2, 3, and 4 -- All four elements are required for a lawsuit of negligence.

Year 2019 Month Patients with UnacceptableWaiting Time (%) January 5 February4 March3 April5 May3 June10 July5 August2 September1 October2 November1 December3 Use the information shown in the table above. Calculate the average percentage of patients for the entire year who waited longer than an acceptable amount of waiting time. (The sample size for each month's data is 100.) 3.7% 3.6% 4.0% 3.1%

3.7% --- (5 + 4 + 3 + 5 + 3 + 10 + 5 + 2 + 1 + 2 + 1 + 3) / 12 = 3.66 = 3.7.

The Six Sigma methodology differs from other quality improvement models by defining improvement opportunities using scientific management. brainstorming. nonvalue activities/processes. critical-to-quality tree.

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

Which data bank is a result of HIPAA legislation? Agency for Healthcare Research and Quality Privacy Information Breach Data Bank Fraud and Abuse Data Bank Healthcare Integrity and Protection Data Bank

Healthcare Integrity and Protection Data Bank -- Healthcare Integrity and Protection Data Bank (HIPDB) was established by the Health Insurance Portability and Accountability Act of 1996

A website, available to the general public, permits anyone to review specific measures of quality care for a particular hospital, is called ___________ Hospital Compare National Quality Measures Clearinghouse Agency for Healthcare Research and Quality WebMD

Hospital Compare -- Hospital Compare is a website created by the CMS that presents statistics on specific measures of quality care for specific hospitals, available to the general public

You are the quality coordinator for the medical staff. Analyze the chart above and determine the steps to be taken next. Close the case because this all happened last year. Change the data point for December because it is obviously a typo in data entry. Investigate why the numbers of C sections for January through November are so low. Investigate the anomaly shown for December.

Investigate why the numbers of C sections for January through November are so low. Investigate the anomaly shown for December. --- An investigation must ensue to determine whether the anomaly shown for December is an error in data entry, unusual patient conditions, or the specific cause of these unusual numbers.

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

MIPS --- MIPS is the Merit-based Incentive Payment System, created under the Quality Payment Program by the CMS. This was initiated in 2017 to take the place of PQRS. --- -NCQA is the National Committee for Quality Assurance, an independent nonprofit organization that works to improve healthcare quality through the administration of evidence-based standards, measures, programs, and accreditation. This is the correct answer. -OIG is the Office of the Inspector General, the enforcement agency for the federal government. -PQRS is the Physician Quality Reporting System, used by the CMS to monitor quality care. This program ended in 2016

An accreditation agency counterpart to the Joint Commission for managed care organizations is the IOM. AHCPR. AHRQ. NCQA.

NCQA. -- NCQA is the National Committee for Quality Assurance, an independent nonprofit organization that works to improve healthcare quality through the administration of evidence-based standards, measures, programs, and accreditation. ----------- --IOM is the Institute of Medicine, an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. --AHCPR is the Agency for Health Care Policy and Research, created to support and conduct research that improves the outcomes, quality, access to, and cost and utilization of healthcare services. --AHRQ is the Agency for Healthcare Research and Quality, part of the Federal government.

The Institute of Medicine (IOM) published report titled "To Err Is Human: Building a Safer Health System," heightened concern by the U.S. government and accrediting agencies. This led the Joint Commission to place emphasis on improving patient safety and sentinel event occurrences through its safety program, known as National Patient Safety Goals (NPSG). Health Plan Employer Data & Information (HEDIS). Health Care Quality Improvement Program (HCQIP). ORYX Initiative Set.

National Patient Safety Goals (NPSG). --- The publication of "To Err Is Human: Building a Safer Health System" led the Joint Commission to place emphasis on improving patient safety and sentinel event occurrences through its safety program, known as National Patient Safety Goals

The health information reception desk is experiencing a huge influx of phone calls on Monday, Tuesday, and Wednesday mornings. This is creating a problem in getting requested patient information out within an acceptable time frame. The reception staff work group has agreed to start recording the reason for the phone calls for the next 4 weeks. They want to focus on solving the response-time problem by reducing the turnaround time for the largest category of phone calls. Which QI tool best supports this goal? scatter diagram run chart control chart Pareto chart

Pareto chart -- Pareto chart provides focus on those concerns or problem areas that have the greatest potential for improvement --- --Scatter diagram visualizes the relationships between variables. --Run chart enables the illustration of trends or patterns over a specific length of time to see, visually, if improvements have been made. -Control chart is used to monitor, control, and improve the processes used over time by enabling the visualization of variation and that source

The outpatient coding staff has been working to improve coding accuracy. The standard for the number of cases that must be coded has been raised four times in the past year. The staff said, "The more cases that must be coded, the greater the error rate will be for the corresponding time period." The department keeps statistics on both the numbers of cases coded and the corresponding error rate. What is the best QI tool for testing the coding staff's theory? control chart scatter diagram run chart Pareto chart

Pareto chart --- Pareto chart provides focus on those concerns or problem areas that have the greatest potential for improvement

The FOCUS PDCA model used in performance improvement is best known for its change strategy technique of Plan, Do, Study, Act. Business Process Engineering. Cause and Effect Diagramming. Input, Through-Put, Output.

Plan, Do, Study, Act. --- PDCA stands for Plan-Do-Check-Act, which aligns with Plan-Do-Study-Act.

An organization that reviews the facility's provision of health care services, respond to Medicare beneficiary complaints that have been filed, and take action by implementing quality of care improvements is known as a(n) ______________ Quality Improvement Organization (QIO) Total Quality Management Program HVBP program Lean Management Model

Quality Improvement Organization (QIO) --- Quality Improvement Organization (QIO) reviews the facility's provision of healthcare services, responds to Medicare beneficiary complaints that have been filed, and takes action by implementing quality of care improvements

What quality indicator would identify improvement needs in hospital electronic transmission of health care claims and remittances to allow interoperability with ICD-10 codes? denied requests for medical record copies for continued care an increase in hospital-acquired infections an increase in 5010 rejections an increase in requests for operative reports

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

The comparing of one facility's outcomes to another, similar facility, or to national standards is known as ______________ benchmarking control charting nominal group technique value-based

benchmarking --- Benchmarking is the process of comparing one facility's outcomes to another, similar facility or to national standards --- --Control chart is used to monitor, control, and improve the processes used over time by enabling the visualization of variation and that source. --Nominal Group Technique (NGT) enables a committee to rank the importance of issues and concerns using an individualized ranking process aligned to the priorities of that committee. --Value-based evaluation is used to determine the benefit of something to the facility.

The Joint Commission on-site survey process incorporates tracer methodology, which emphasizes surveyor review by means of patient tracers. policy and procedure manual reviews. system tracers. both system tracers and patient tracers.

both system tracers and patient tracers. ---- The Joint Commission is responsible for both system quality and patient care quality.

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

business office --- Business office would have access to patient's financial information and therefore be the best source of information on rejected claims not related to coding. --- -Admissions has access to those patients who have been admitted. --- -Health information would have the expertise regarding coding errors. --- -Medical staff office would be the source for information on appointments and reappointments.

The board of directors of a 400-bed women's hospital receives a report of key quality indicator results on a periodic basis. The report always includes the quarterly cesarean section rate. This reporting period, they see a rise in the rate and want to know if it is a significant increase. What is the best QI tool for this purpose? control chart Pareto chart run chart scatter diagram

control chart -- Control chart is used to monitor, control, and improve the processes used over time by enabling the visualization of variation and that source --- --Pareto chart provides focus on those concerns or problem areas that have the greatest potential for improvement. --Run chart enables the illustration of trends or patterns over a specific length of time to see, visually, if improvements have been made. --Scatter diagram visualizes the relationships between variables.

What is the best tool for differentiating between common cause variation and special cause variation? Pareto chart run chart control chart scatter diagram

control chart -- Control chart is used to monitor, control, and improve the processes used over time by enabling the visualization of variation and that source.

Adding the UCL (upper control limit) and LCL (lower control limit) to the chart above creates a variation graph. control chart. run chart. frequency distribution.

control chart.

Jane believes new equipment will make her staff more efficient. The board has asked for an analysis of the cost of the equipment to be compared with the benefit to the facility. This mathematical process is known as a ________ force field analysis performance improvement plan cost-benefit analysis Pareto

cost-benefit analysis --- Cost-benefit analysis is the evaluation to determine whether the value of something is greater than the cost of that item, or not

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

credentialing. -- Credentialing is the process of confirming a professional's licenses, malpractice history, education, and other legal background.

There are times when good staff members can burn out. As a manager, a _________ program can help the organization retain these quality workers while providing the staff member with something new to do. rewards reactive strategy intellectual capital cross-training

cross-training -- Cross-training teaches staff members to do more than one job

The U.S. federal government's CMS substitutes compliance of its Conditions of Participation requirements to hospitals that already have accreditation awarded by various other agencies that include the Joint Commission, CARF, AOA, or AAAHC. This is known as deemed status. due process. waiver status. contingent statutory.

deemed status -- This means that the CMS has provided validity for the qualifications deemed by the other respected organizations

All of the following are among the Joint Commission's initial core measure sets for hospitals EXCEPT surgical infection prevention. pneumonia. acute myocardial infarction. diabetes.

diabetes. -- is not on the list of core measures.

A retrospective review as part of quality improvement activities is conducted after the patient has been admitted. discharged. cleared for surgery. released from the surgical recovery room.

discharged -- Discharged is the point where a retrospective review would be conducted, because the treatments and care of the patient is now in the past.

When a decision is made to restrict or deny clinical privileges during the recredentialing or reappointment process to a medical staff member, _______________ must be offered. revocation of license privilege suspension crisis intervention due process

due process -- Due process refers to fair treatment through the normal judicial system, especially as a citizen's entitlement. This is the correct answer. The candidate must be provided with complete and accurate explanation for the restriction or denial to ensure fairness. --------- --Revocation of license would only be necessary if the individual was found to be dangerous and deemed incapable to properly provide care to patients. --- Privilege suspension is the temporary cancellation of permission for a physician to treat patients at a specific facility. --Crisis intervention is a process to help an individual going through a crisis.

The high cost of staff turnover is eating away at the department's budget, so Thomas is creating a(n) __________ program to increase staff satisfaction. marketing monitoring continuing education employee retention

employee retention -- Employee retention programs are used to ensure that high-quality staff members will continue to stay at the organization

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

error-based penalties --- Error-based penalties are negative-oriented actions. Quality improvement strategies use positive reinforcement and support to increase productivity and accuracy

Integration of decision support systems and best practices in medicine is known as the practice of subjective determination. outcome measures. case management. evidence-based medicine.

evidence-based medicine --- Evidence-based medicine is the availability, provided by Clinical Decision Support Systems (CDSS) linking access to the most recent, credible evidence -- -Subjective determination is opinion-based, not fact-based. --- -Outcome measures are the analysis of the conclusion of patient care --- -Case management is the coordination of a patient's care by an individual, monitoring interactions with multiple providers

Historic accomplishments impacting quality in medical care include all EXCEPT ensuring competent practitioners. medical education reform (Flexner report findings). implementation of NDC. Darling v. Charleston Community Hospital.

implementation of NDC. -- NDC stands for National Drug Codes. Ensuring competent practitioners, Darling v. Charleston Community Hospital, and medical education reform such as the Flexner report findings impact quality in medical care, but NDC codes do not

Sally wants to motivate her staff members to earn and submit their required continuing education credits by the deadline, so she is offering a $25 gift card to the first one to complete their requirements. Sally is using _____ motivation techniques. extrinsic intellectual capital cross training intrinsic

extrinsic ---- Extrinsic motivators are those that offer a reward or an acknowledgement from an outside source --- --Intellectual capital refers to the assets of the company that come from its staff members' knowledge. --Intrinsic motivators are those that meet personal goals and satisfaction; goals that are not necessarily known to others. --Cross training teaches staff members to do more than one job.

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

fishbone diagram -- Fishbone diagram, also known as cause-and-effect diagram, enables the identification of all potential causes to a specific problem. --------- --Flowchart enables the illustration of a process, showing the sequence of tasks or steps. --Matrix diagram, also known as a decision matrix, enables the systematic identification, analysis, and rating of the strengths of relationships between two or more sets of data. --Histogram graphically represents data collected over a period of time

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

focuses attention on process variation over a time period -- Control chart is used to monitor, control, and improve the processes used over time by enabling the visualization of variation and that source.

Dashboards are a method used in health care that illustrate the marketing plan. graphically display a performance improvement project conducted. serve as a documentation format in patient records. serve as a teaching tool for third-party auditors.

graphically display a performance improvement project conducted --- A dashboard can provide a graphic overview of an entire project.

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

health information --- Health information would have the expertise regarding DRG validations --- -Business office would have access to patient's financial information. -Health information would have the expertise regarding DRG validations. -Medical staff office would be the source for information on appointments and reappointments and all other materials

Dr. Jeremy is establishing a clinical trial research study for his patients with lung cancer wishing to participate in a chemotherapy clinical trial. As assistant director, you are responsible for clinical abstract of data and advise him to first seek approval of research involving human subjects through the office of national coordinator (ONC). governing board. institutional review board (IRB). medical staff.

institutional review board (IRB) --- Institutional Review Board (IRB) is an appropriately constituted group that has been formally designated to review and monitor biomedical research involving human subjects ---------- --Office of the National Coordinator (ONC) is charged with building an interoperable, private and secure nationwide health information system and supporting the widespread, meaningful use of health information technology. --Governing board also known as the Board of Directors (BOD) has the definitive responsibility for the successful operation of that facility. --Medical staff are the clinicians who are authorized to work in the facility.

The Joint Commission's emphasis on improving quality of patient care for a participating facility is exemplary through the required self-assessment process tool known as real-time analytics. focused standards assessment. intracycle monitoring. total quality management (TQM).

intracycle monitoring

An area identified for needed improvement through benchmarking and continuous quality improvement is known as a key performance indicator. knowledge base. measure hierarchy. key attribute.

key performance indicator. -- Key performance indicator are defined as metrics used to measure key business processes and reflect strategic performance throughout the organization

Which department will most likely be responsible for taking corrective action regarding the following quality indicator? QUALITY INDICATOR:Ninety-five percent of physician appointments/reappointments will be completed within 90 days of receipt of all required materials. health information business office admissions medical staff office

medical staff office -- Medical staff office would be the best source for information on appointments and reappointments and all other materials. --- --Admissions has access to those patients who have been admitted. --Business office would have access to patient's financial information. --Health information would have overviews of all patient information.

A patient satisfaction survey conducted after discharge is a method of quality measurement through outcomes indicator. structure indicator. prospective indicator. process indicator.

outcomes indicator --- Patient satisfaction, or lack thereof, is a direct outcome of the patient's stay.

The following "sentinel events" must be available for Joint Commission review EXCEPT surgery on wrong patient or wrong body part. petechiae due to adverse drug reaction. rape. infant abduction.

petechiae due to adverse drug reaction --- An adverse reaction indicates that everything was done correctly, by the prescribing physician and with regard to the administration of that drug. An adverse drug reaction is not a "sentinel event" because it cannot be predicted and therefore cannot be prevented.

Traditional management functions, such as ________, must be applied to performance improvement initiatives. planning education accreditation reimbursement

planning --- Proper planning contributes heavily to productivity and efficiency, regardless of accreditation, education, or reimbursement levels.

During a risk management strategy session, the HIM director states that policies and procedures must be created to prevent specific opportunities for an adverse outcome, as well as those that will function to diminish any that might not be preventable. This type of strategy is known as a _____________ reactive strategy proactive strategy prevention quality indicator cost-benefit analysis

proactive strategy -- Proactive strategies are used for the prevention of adverse outcomes

During the Utilization Review Committee meeting, a case presented for discussion involved a surgical case resulting in unexpected loss of lower extremity below the knee due to complications requiring extended length of stay. Being a sentinel event, the committee requested that an investigation and reporting was required to identify the cause and prevention of future occurrences. This investigation and required reporting to the Joint Commission is known as a root cause analysis. medication review. report card. potential compensable event.

root cause analysis -- Root cause analysis, also known as a fishbone diagram or cause-and-effect diagram, enables the identification of all potential causes to a specific problem. This is the correct answer. Refer the Joint Commission website for more information

To properly implement performance improvement (PI), organizations should ensure that all employees participate in an integrated, continuous PI program. This is known as organizational PI. shared vision. quality management liaison group. shared leadership.

shared leadership. -- The team approach, or shared leadership, permits all members to take responsibility for the improvements that need to be made

Year 2019 Month Patients with UnacceptableWaiting Time (%) January5 February4 March3 April 5 May 3 June 10 July 5 August 2 September 1 October 2 November 1 December 3 The average percent of patients exceeding acceptable waiting time was 3.7%. The calculated UCL (upper control limit) is 9.4. When you plot the upper and lower limits, what would you suggest as the reason for the June variation? common cause variation unable to determine with the data given root cause variation special cause variation

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

The quality review process of invasive and noninvasive procedures to ensure performance of appropriate procedure, preparation of patient, monitoring and postoperative care, and education of patient describes surgical review. blood and blood component usage. infection review. universal protocol.

surgical review. -- The terms "invasive" and "noninvasive" procedures describe types of surgical procedures. Therefore, a surgical review

To accomplish the Joint Commission's safety goal to eliminate wrong-site, wrong-patient procedures, the organization can use all of these EXCEPT preoperative verification processes. available patient records. using imaging guidance on all procedures. mark the surgical site.

using imaging guidance on all procedures. --- The use of imaging guidance will not help improve wrong patient or wrong side procedures. However, preoperative verification, checking available medical records, and physically marking the surgical site with a marker have all been shown to reduce or eliminate wrong-site or wrong-patient procedures.

Resources that produce little-to-no value to the organization, such as non-utilized talent, inventory miscalculations, and staff members waiting for information so they can do their jobs, is known as _______, which must be reduced, if not eliminated, in a lean managed organization. measured improvements value benchmarking waste

waste -- Waste is the use of resources that produce little-to-no value to the organization, its staff, or patients --- --Measured improvements are the components of a quality improvement program. --Value is the determined benefit.