MEDA 260 FINAL
A proactive strategy.
A plan to prevent or diminish the opportunity for harm is known as: A. A reactive strategy. B. Objective protection. C. A proactive strategy. D. A risk analysis.
Stark.
A federal law that prohibits a physician from making referrals to any facility in which the physician has a financial interest is known as: A. Hill-Burton. B. HIPAA. C. Affordable Care. D. Stark.
Anti-kickback law.
A federal law that prohibits facilities from paying referral fees to physicians is the: A. False claims act. B. Stark law. C. Affordable Care Act. D. Anti-kickback law.
Doctrine of Corporate Negligence.
A law that holds hospitals liable for the competence of their staff is the: A. HIPAA. B. Equal Employment Opportunity Act. C. Doctrine of Corporate Negligence. D. Hill-Burton Act.
Occult problem.
A non-compliant event that is deeply hidden and cannot be identified without an in-depth investigation is known as a/n: A. Overt problem. B. Covert problem. C. Occult problem. D. All of the above.
Covert problem
A non-compliant event that is not obvious or easily seen is known as a/n: A. Internal problem. B. Overt problem. C. Covert problem. D. Extrapolation.
A deontological approach.
A perspective of ethical decision making that focuses on the obligation of one's oath or duty to care is known as: A. A deontological approach. B. A teleological approach. C. A professional approach. D. An ortho-doctrine approach.
With the intent to get someone fired.
A reporting system should permit individuals to bring violations to the attention of the administrator: A. With the intent to get someone fired. B. To avoid suspicion. C. Without fear of repercussion. D. To get on your good side.
Hotline phone number.
A reporting system to permit staff to report an alleged violation might include: A. Voluntary DNA tests. B. Hotline phone number. C. A "tattler" t-shirt. D. All of the above.
Identification of the harm that could be caused.
A risk assessment begins with the first step of: A. Increasing the facility's liability insurance. B. Evaluating the individual(s) proposing the project. C. Identification of the harm that could be caused. D. Determining the budget.
Denied.
A thorough analysis must also include data on the cost to the organization if the project is: A. Mistaken. B. Lost in committee. C. Denied. D. Set aside.
Patient safety practice
A type of process that reduces the probability of adverse events is known as: A. Evidence-informed care management. B. Evidenced-based quality. C. Patient safety practice. D. Do/Do Not Do/Don't Know
Determination of the scope of the audit.
A valid internal audit will include all of the following steps except: A. Determination of the scope of the audit. B. Letting the audit team take as much time as they want. C. Not requiring a written report. D. All of the above
National Practitioner Data Bank (NPDB)
All applicant physicians should be checked on the ________ before hiring or granting privileges to treat patients in your facility. A. Physician Quality Reporting System (PQRS) B. American Medical Association website C. National Practitioner Data Bank (NPDB) D. medical school website
Patient's reason for the encounter.
All clinicians are required by law to accurately document the complete details of every patient encounter and patient-related encounter, including: A. Patient's education level. B. Patient's reason for the encounter. C. Patient's salary. D. Patient's complete health history.
consequences
All compliance plans should include a clear explanation of the ________ for failing to follow the policies of the organization. A. guidelines B. support available C. consequences D. benefits
Timely and effective care for patients with AMI
All of the following are measured for quality of care by Hospital Compare, except: A. Timely and effective care for patients with AMI. B. Use of surgical techniques. C. Number of Medicaid patients. D. Spending per hospital patient with Medicaid.
Only complete process once and then move on
All of the following are steps to initiate effective benchmarking EXCEPT: A. Identify what you want to measure and improve and how you will obtain measurements B. Decide what improvements can be made to improve your processes C. Only complete process once and then move on D. Repeat-determine if your goals are accomplished and identify continual opportunities for improvement.
I, II and IV
An Accountable Care Organization (ACOs): I. Relies on a risk adjustment reimbursement methodology called Hierarchical Categories (HCCs) II. Is paid a fixed dollar to care for a patient III. Is paid fee for service IV. Must decide on the most efficient way to allocate treatment resources to manage a patient's condition(s). V. Must include preventure medicine as the primary goal. A. I, III, and V B. I, II, and V C. I, II and IV D. I, III, and IV
Mitigation.
An action that will lessen the severity of harm is known as: A. Aversion. B. An alibi. C. Mitigation. D. Complication.
Any of the above.
An appropriate consequence for breaching a policy may be: A. Verbal warning. B. Written warning. C. Additional training/education. D. Any of the above.
Sampling audit.
An assessment conducted on a statistically valid portion of the entire body of data is known as a: A. Retrospective audit. B. Sampling audit. C. Covert audit. D. Concurrent audit.
External audit.
An assessment to determine compliance performed by an authorized agency or organization is known as a/n: A. Retrospective audit. B. Internal audit. C. Trend analysis. D. External audit.
Retrospective audit.
An audit was performed using data from the last 3 years, current year not included. This is known as a: A. Concurrent audit. B. Common sampling audit. C. Comprehensive audit. D. Retrospective audit.
Sampling audit
An audit was planned to review a small percentage of a facility's files by randomly choosing which records to analyze. This is known as a: A. Sampling audit. B. Concurrent audit. C. Retrospective audit. D. Comprehensive audit.
10% to 50%
An element of 'medium risk' means there is a ________ probability of harm. A. 0% to 25% B. 50% to 85% C. 10% to 50% D. 25% to 70%
Medical assistants gossiping about patients.
An example of an overt problem is: A. A nurse stealing drugs. B. A physician who is a functioning alcoholic. C. Medical assistants gossiping about patients. D. Upcoding on claim forms.
All of these.
An external audit of your facility may be initiated by: A. Random selection. B. A prescheduled annual event. C. An alert of specific activity. D. All of these.
An audit.
An investigation focused on analyzing and evaluating certain amounts of data is known as: A. An audit. B. A scope document. C. An internal investigation. D. An evaluation.
An adverse outcome
An unexpected reaction to a procedure or treatment is known as: A. An adverse outcome. B. An anomaly. C. A misadventure. D. An accident.
Both A and B
As an administrator, you will need to assess the: A. Cost of new technology. B. True need for new equipment. C. Both A and B D. Neither A or B
Hospital Compare
As part of the Hospital Quality Initiative, CMS created: A. Hospital Compare. B. A toll-free hotline. C. EMTALA. D. HIPAA.
2020
By _______, the health system will move from predominantly paper-based records to digital information controlled by the patient. A. 2018 B. 2020 C. 2025 D. 2030
The total number of patients who died due to a specific condition
Case fatality percentage can be determined by dividing which of the following by the total number of patients who have been diagnosed with that same condition within a specific period of time? A. The total number of patients found to have a genetic potential for a specific condition B. The total number of patients who have a family history of a specific condition C. The total number of patients who were treated for a specific condition D. The total number of patients who died due to a specific condition
audits
Conducting regularly scheduled ________ will reveal any violations relating to billing and claims. A. interrogations B. searches of desks C. department meetings D. audits
Teleological approach.
Ethical decision making based on the outcome of that decision is known as the: A. Deontological approach. B. Ortho-doctrine approach. C. Professional approach. D. Teleological approach.
Comprehensive audit
Every employee in the Pediatrics Department is directed to submit to a drug test. This is an example of a: A. Retrospective audit. B. Comprehensive audit. C. Sampling audit. D. Concurrent audit.
Decrease the number of RACs and ZPICs
Examples of programs initiatives created to reduce waste, fraud, and abuse include all of the following EXCEPT: A. Mandatory repayment of overpayment within 60 days B. Enforce violations of the Anti-Kickback statute as also violations of the False Claims Act. C. Decrease the number of RACs and ZPICs D. Establish compliance and ethics programs for Medicare and Medicaid providers
Patient Protection and Affordable Care Act (ACA)
Expanding health coverage, controlling healthcare costs, and modernizing the healthcare delivery system are the three main objectives of which healthcare legislation? A. American Healthcare Act B. Patient Protection and Affordable Care Act (ACA) C. Health Innovations Expansion Law D. Accountable Care Organization
Expand the roles and scopes of services for nonphysician providers.
Expansion of Medicaid and insurance mandates will have the following affect: A. Reduce the national debt by increasing the financial responsibility of healthcare consumers. B. Increase the supply and therefore the accessibility of health care consumers C. Expand the roles and scopes of services for nonphysician providers. D. Decrease the role of pharmacies in providing health care
Are initiated by a regulating authority.
External audits: A. Evaluate air quality control. B. Are initiated by a regulating authority. C. Investigate the physical environment around the facility. D. Are initiated by the facility administration.
70%
Federal sentencing Guidelines may reduce fines and penalties by as much as ________ when a compliance plan has been created and implemented using the seven elements guidance. A. 55% B. 10% C. 70% D. 25%
Acted upon.
For an audit to have value, the results must be: A. Publicized. B. Kept confidential. C. Acted upon. D. Copied to the Attorney General of your state.
An overview of the entire project
Good project management skills begin with: A. Delegation of work tasks. B. Creation of a timeline. C. Establishing quality standards. D. An overview of the entire project.
Security Rule.
HIPAA has two essential parts: the Privacy Rule and the: A. Confidentiality Rule. B. False Claims Rule. C. Referral Rule. D. Security Rule.
prevent
Health care laws and ethical codes demand that you do everything possible to________ negligence. A. ignore B. abate C. prevent D. ensure
Altered.
Healthcare records are deemed legal documents and therefore cannot be: A. Altered. B. Abbreviated. C. Evidence. D. Shared.
50%
High-risk is described by a probability of harm over: A. 70%. B. 30%. C. 15%. D. 50%.
2015
In _____ providers who have not implemented an EHR will begin to see a reduction in Medicare reimbursement. A. 2012 B. 2013 C. 2015 D. 2017
Malpractice.
In legal terms, professional negligence is known as: A. Discompensation. B. Malpractice. C. Respondeat superior. D. Battery.
All of these
Included in the audit process, a review of all applicable ________ must be done. A. laws B. regulations C. guidance D. All of these
respect
It is a sign of ________ to explain the foundations of the policies to your staff. A. contempt B. weakness C. submissiveness D. respect
Increase
Mobile technology is rapidly being integrated into healthcare to monitor patients, improve outcomes and reduce the need for face-to-face visits. The amount of data and real-time patient information that will become available will ________. A. Increase B. Decrease C. Remain the same D. Initially increase and then decrease
All of these
Multiple agencies from ___ have the authority to audit your facility. A. private insurance companies B. state government C. federal government D. All of these
Determine the cause of the breach.
Once a breach is identified, you will need to: A. Determine the cause of the breach. B. Ensure everyone is sworn to secrecy. C. Hide the documentation. D. Fire everyone on the spot.
Take patient complaints seriously
One method for identifying overt problems is to: A. Ask around the cafeteria. B. Interrogate all staff members. C. Take patient complaints seriously. D. Complete a staff survey.
Perform an internal audit
One of the best ways to prepare for an external audit is to: A. Hire a good attorney. B. Perform an internal audit. C. Erase all applicable files from the server. D. All of the above
Medical necessity.
One of the first determinations required to support performing a test or procedure on a patient is called: A. Cause and effect. B. Medical necessity. C. Catalyst. D. Probable cause.
Lost productivity during implementation.
One of the hidden costs of a project or program might be: A. High cost of purchase. B. Lost productivity during implementation. C. Cost of staff training. D. All of the above.
Ongoing repetition of the same error.
One of the reasons that many external audits are done retrospectively is that they go beyond finding errors; they look at the: A. Ongoing repetition of the same error. B. Education levels of all staff. C. Names and religion of all staff. D. Gender of all staff.
EMTALA
Only Medicare-participating hospitals must comply with the terms of: A. The federal false claims act. B. The HIPAA Privacy Rule. C. EMTALA. D. The HIPAA Security Rule.
Solid direction for compliance.
Organizational policies and procedures should provide your staff with: A. Nothing about compliance. B. Ways around compliance. C. Solid direction for compliance. D. Questions to ask about compliance.
A quality cycle and QI method that systematically impacts a process of a system.
Plan-Do-Check-Act is defined as: A. A quality plan to manage and promote quality improvement at all levels. B. A quality cycle and QI method that systematically impacts a process of a system. C. A quality cycle focused on developing methods to fix processes D. A quality cycle developed to ensure a system is functioning well at an enterprise level
All of these.
Projects that may pose risk include: A. New equipment. B. Expansion of population services. C. Telemedicine. D. All of these.
A system of technical activities that measures against a criteria or standard.
Quality control is defined as: A. An integrated system ensuring that a process is needed and expected. B. A system of technical activities that measures against a criteria or standard. C. A strategy of continuously refining processes D. A system measuring the performance of a process to optimize levels of quality.
Routine measurement of performance
Quality improvement focuses on: A. Individual clinicians or system users B. Routine measurement of performance C. Information technology issues D. Constant training
All of the above.
Quality improvement strategies, as listed by AHRQ, include: A. Physician reminder systems. B. Patient education services. C. Internal audits. D. All of the above.
b and c only.
Realistic objective monitoring devices might include: A. Cameras in every corner of the office. B. RFID chips in paper records. C. An EHR log of who opens patient records. D. b and c only.
Teleological ethical approach.
Refusal to perform surgery on a patient when the procedure has a 91% chance of leaving the patient with irreversible brain damage represents making this decision with a: A. Clinical approach. B. Hippocratic approach. C. Teleological ethical approach. D. Deontological ethical approach.
Wage and hour.
Regulations that govern how much you pay your staff members and how that amount is calculated are commonly referred to as: A. ADA. B. EEO. C. FMLA. D. Wage and hour.
Evidence-based medicine (EBM).
Research studies provide statistical evidence as to which services, procedures, treatments, and policies work best. This is known as: A. National Guideline Clearinghouse (NGC). B. Interventions and Practices Considered (IPC). C. Quality Practices and Procedures (QPP). D. Evidence-based medicine (EBM).
Autonomy
Respecting an individual's right to make decisions for himself is known as: A. Justice. B. Autonomy. C. Malevolence. D. Beneficence.
Care beyond the traditional physician office.
Retail Clinics, internet-based visits and remote patient monitoring are all examples of: A. Care beyond the traditional physician office. B. Patients moving towards home based holistic medicine C. Patients moving towards self-care instead of traditional office visits D. Care in a hospital or facility
investigating the origin of the incident
Reviewing complete incident reports and ________ will support improvement efforts. A. investigating the origin of the incident B. phoning the police C. terminating all staff involved D. making the staff member pay restitution
deontological
The 'duty to care' guidance to do whatever possible for the patient, regardless of the outcomes, is the ___ perspective. A. deontological B. ethical C. Hippocratic D. teleological
Physician Self-Referral Act.
The Stark law is also known as the: A. Hill-Burton Act. B. Physician Self-Referral Act. C. Anti-kickback law. D. Affordable Care Act.
Non-maleficence.
The absence of harm is known as: A. Beneficence. B. Non-maleficence. C. Teleologic. D. Autonomy.
Justice.
The belief that all people should be treated fairly and equally is the definition of: A. Autonomy. B. Justice. C. Maleficence. D. Beneficence.
Extrapolation.
The determination of results by projecting existing experience or known data is known as: A. Sampling. B. Upcoding. C. Extrapolation. D. Statistical assessment.
HIPAA.
The federal law that protects patient confidentiality is known by the acronym: A. EEO. B. Stark. C. HIPAA. D. FMLA
Affordable Care Act.
The federal law that provides stronger protections for patients when getting health insurance is known as the: A. EMTALA. B. False Claims Act. C. Comprehensive Primary Care Initiative. D. Affordable Care Act.
OSHA.
The federal law that requires employers to ensure a safe and healthy place to work is known by the acronym: A. EMTALA. B. OSHA. C. EEO. D. ADA.
Electronically.
The first few phases of an external audit are completed: A. Electronically. B. In person at the investigator's office. C. In person at your office. D. Over the telephone.
Battery.
The illegal intentional touching of another person without consent is known as: A. Examination. B. Fraud. C. Battery. D. Malpractice.
EEO.
The law that bars employers from discriminating against a potential employee is known by the acronym: A. EEO. B. OSHA. C. SSA. D. FMLA.
OSHA
The law that requires safety protocols to protect employees at work, including providing protective gloves, sharps boxes, and antibacterial wipes is known by the acronym: A. FMLA B. OSHA C. EEO D. EMTALA
Requires health plans to spend 75% or more of the premium dollars on medically related services.
The new health legislation enacts several provisions on insurance companies that are aimed at improving customer safeguards. Which provision is NOT included in the health reform? A. Adult children up to age 26 will be allowed to stay on their patient's policy B. Provides first dollar coverage for preventative health services. C. Removes caps on lifetime limits on the dollar amount of the coverage for which insurance companies will pay. D. Requires health plans to spend 75% or more of the premium dollars on medically related services.
a and c only.
The obligation to provide quality of care for patients is guided by: A. Ethical correctness. B. Clinical opinion. C. Legal correctness. D. a and c only.
CMS-participating hospitals.
The only healthcare facilities that must comply with EMTALA are: A. CMS-participating hospitals. B. Walk-in clinics. C. Board-certified physicians. D. Skilled nursing facilities.
Trend analysis
The review and assessment of data taken over a period of time with the intention of identifying patterns is known as performing a/n: A. Sampling audit. B. Trend analysis. C. Retrospective audit. D. Internal audit.
I, III, and IV
The roles of physicians will be changing with healthcare reform. Which of the following are TRUE of changes to come? I. The roles and scope of services for non-physician providers will be expanded due to the increased demand for healthcare. II. Physicians will focus primarily on preventative care III. Non-physician providers will play a larger role in caring for routine problems. IV. Pharmacists will play a greater role in providing comprehensive care. V. Chronic conditions will be monitored by home visits. A. II and III B. I, III, and V C. II, III, and V D. I, III, and IV
Beneficence.
The state of producing good acts is known as: A. Non-maleficence. B. Autonomy. C. Beneficence. D. Maleficence.
Covert problems.
The three categories of problems that need to be uncovered and addressed include: A. Covert problems. B. Restitution. C. Uncovering excuses. D. Safety protocols.
Payment Reforms
What aimed at reducing growth in Medicare spending and developing alternative payment models to promote more efficient use of healthcare resources and higher quality of care? A. Recovery Adult Contractors (RACs) B. Payment Reforms C. Zone Program Integrity Contractors (ZPICs) D. OIG compliance guidance
Verify from whom the request has come.
What is the first thing the administrator should do after receiving notification of an external audit? A. Contact the facility's attorney. B. Pull the requested files. C. Verify from whom the request has come. D. Call a Board of Directors meeting.
Information and documentation required for the appeals process.
When going through an external audit, before receiving the auditor's determinations, you should be certain to prepare: A. Your r�sum�. B. A company check for the fines and penalties. C. An alibi. D. Information and documentation required for the appeals process.
organization
When making an ethical decision, as the administrator, you must include the ________ as an entity affected by this decision. A. media B. organization C. federal government D. applicable resources
a and b only
Where can important risk information be found regarding new equipment? A. User manual B. MSDS C. Online 'likes' D. a and b only
I, II, III and IV
Which of the following are key trends in healthcare reform? I. Focus on fraud and abuse II. Shift from acute care to prevention and wellness III. Care delivery expanding beyond the traditional physician office IV. Coordination fo Care A. I and III only B. I and II only C. I, II and III only D. I, II, III and IV
Volume
Which of the following is NOT measured in a hospital that is paid based on performance? A. Volume B. Efficiency C. Patient Satisfaction D. Quality of Care
The focus of care will shift from acute care to preventative care and wellness.
Which of the following is a trend in health care that can be expected with health care reform? A. Providers will receive a financial incentive to limit the number of tests needed to diagnosis patients. B. The focus of care will shift from acute care to preventative care and wellness. C. Providers will be required to accept all types of insurance D. The focus of care will shift from preventive and wellness to acute care.
An internal audit of billing procedures to verify compliance with federal and state regulations.
Which of the following is an example of a practice monitoring quality assurance? A. An internal audit of billing procedures to verify compliance with federal and state regulations. B. Weekly inspection of the sterilization machine used for surgical instruments. C. Determine the time it takes a medical assistant to prepare for a physical. D. Develop a budget to make sure cash is available to purchase equipment.
Lab equipment calibration
Which of the following is the best example of quality control? A. Lab equipment calibration B. Front desk audits to verify demographic information is collected properly C. Verifying that policies are up to date and being adhered to D. IT assessment to verify three are enough computers
A 5% increase in reimbursement for mental health services starting in 2010
Which of the following preventative services has been improved with the new legislation? A. A 5% increase in reimbursement for mental health services starting in 2010 B. A rebate on patients' insurance premiums when they present for a yearly physical. C. A waive of the patient's deductible when they have tests for pancreatic cancer. D. Preventive services can be reimbursed for all provider types.
All of the above
Which of the following processes will make quality improvement meaningful and reduce medical errors? A. Using computerized provider order entry (CPOE) of medications (e-prescribing) B. Medication Reconciliation C. Using computerization to track, report and measure quality D. All of the above
Allows sharing of IRS data to identify fraudulent providers or providers with tax debts.
Which of the following provisions of the PPACA will help reduce fraud and abuse? A. Increases the monetary reward of qui tam to encourage the reporting of fraud. B. Allows sharing of IRS data to identify fraudulent providers or providers with tax debts. C. Requires all providers to attend fraud and abuse training and yearly audits of claims D. Mandates that overpayment be returned within 90 days or provider will pay a penalty
Comparing measurements to other organizations or industries to improve performance
Which of the following statements correctly describe external quality benchmarking? A. Measuring data over time in the practice to make improvements. B. Comparing measurements to other organizations or industries to improve performance C. Hiring an outside consultant to manage your QI initiatives D. Reviewing data from lower performing organizations to identify what is being done well
There are 50 questions in the CMS survey.
Which of the following statements regarding the Patient Experience of Care survey is false? A. A facility may add questions to the original questions. B. Patients are asked about the cleanliness of the hospital. C. There are 50 questions in the CMS survey. D. The survey asks about communication with physicians.
Focuses on prevention of issues.
Which option is FALSE regarding Quality Assurance (QA)? A. It is an integrated system of management involving planning, training, quality control, assessment, data review, reporting, and quality improvement to ensure a process, item or service is of expected type and quality. B. Focuses on inspection C. Sets policy and controls to ensure the usability of the product. D. Focuses on prevention of issues.
Deliver specified documents to the court.
You have just received a subpoena ducestecum. This means you must: A. Be available to the court for 30 days. B. Deliver specified documents to the court. C. Serve on a jury. D. Testify in court.
Internal audit.
You instruct your assistant to review the records of all employees who work in the clinic to ensure all vaccinations are up-to-date. This is an example of: A. External audit. B. Internal audit. C. Manufactured audit. D. Abuse of power.
Reactive strategy.
"If a patient slips on a wet floor, staff members are directed to immediately help the patient up, perform a physical exam to determine harm, send the patient for x-rays to ensure no fractures were caused, and complete and submit an incident report." From its content, you can tell this statement is a: A. Cost-benefit analysis. B. Proactive strategy. C. Risk assessment. D. Reactive strategy.
MGMA Surveys
A physician's office with 2 full-time nurse practitioners currently has two coders on staff to perform all of the coding for the practice. The coder's state they need additional help to stay current and the physician state they should be able to keep up with the current staff. Where would you look to find benchmark information on how many coders should be on staff? A. MGMA Surveys B. OSHA compliance manual C. OIG compliance Plan D. EMR Statistics
Reactive strategy
A plan that specifies what actions staff members should take after an adverse outcome has occurred is known as a: A. Mitigation strategy B. Reactive strategy C. Defensive strategy D. Proactive strategy
current or former employee
A Qui Tam lawsuit is filed by a/n________ against the accused institution on behalf of the government. A. current or former patient B. county prosecutor C. FBI agent D. current or former employee
American Board of Medical Specialties
A claim that a physician is board-certified should be confirmed with the: A. National Quality Measures Clearinghouse. B. American Board of Medical Specialties. C. American Medical Association. D. National Medical Specialists Association.
A cost-benefit analysis.
A mathematical process by which to evaluate whether something has a value equal to or greater than the amount paid is known as: A. A proactive strategy. B. Risk management. C. Mitigation. D. A cost-benefit analysis.
Partially excuses a wrong
A migrating circumstance is one that: A. Magnifies the consequences of a wrong. B. Partially excuses a wrong. C. Prevents wrong-doing. D. Is cause for immediate termination.
M.D.
A physician's credential may be: A. M.D. B. RN. C. PT. D. Ph.D.
Program Evaluation and Review Technique.
A project management chart may be helpful, such as the PERT, which stands for A. Program Effectiveness and Routine Tasks. B. Project Evaluation and Routine Timeline. C. Program Evaluation and Review Technique. D. Project Efficiency and Report Timeline.
Use only standard terminology.
According to the DHHS-published list of suggestions for developing risk management strategies, to avoid miscommunications, you should: A. Accept verbal consent for non-emergency procedures. B. Only summarize in chart documentation. C. Never document patient non-compliance. D. Use only standard terminology.
MGMA Annual Survey
As the practice manager, you notice that charges are not being coded as quickly as you believe they should. When you speak to coders, they complain that there are too many doctors and not enough coders to code all the changes in the timeframe you have requested. What resource could you use to find benchmark information to indicate how many coders you should employ in your practice? A. MGMA Annual Survey B. Quality Improvement Organizations C. CMS website D. Ask the practice next door how many coders they have
Proven quality indicators (QI)
Better, more effective care to patients can be supported by: A. Providing more benefits to staff. B. Paying clinicians higher salaries. C. Having staff work only 4 days a week. D. Proven quality indicators (QI).
Total Quality Management (TQM)
CMS identifies one private organization in each state to review the provision of health care services and to respond to complaints. These organizations are called: A. Healthcare Quality Indicators (HQI). B. Total Quality Management (TQM). C. Quality Improvement Organizations (QIO). D. Healthy People 2020.
FDA website.
Important approvals, recalls, and communications regarding medical devices can be found on the: A. Manufacturer's Facebook page. B. FDA website. C. Amazon. D. None of the above
Quantify it.
In order to accurately assess the level of risk of a procedure or using new equipment, you will need to: A. Qualify it. B. Visit the manufacturer's factory. C. Quantify it. D. Interview previous users.
Emotion
In risk assessment, it is important to keep which of the following out of the decision-making process? A. Consensus B. Statistical facts C. Calculations D. Emotion
Consequences.
In those cases when an employee does not comply, policies should clearly state: A. Bonus schedule. B. Accolades. C. Consequences. D. That no one should ever mention it.
Same-day surgery center
Inpatient quality indicators from AHRQ can be used by all of the following except a/n: A. Long-term rehabilitation center. B. Acute care hospital. C. Same-day surgery center. D. Skilled nursing facility.
Providing feedback, including physician performance evaluations.
Internal audits can improve the quality of care provided in your facility by: A. Supporting implementation of salary reductions. B. They do not improve the quality of care at all. C. Finding reasons to fire employees. D. Providing feedback, including physician performance evaluations.
Internal audits.
Investigations initiated by the administration of the organization designed to identify quality as well as human error or wrong-doing are known as: A. External audits. B. Internal audits. C. Due diligence. D. Employee reviews.
An increase in the use of midlevel providers.
It is anticipated that expansion of Medicaid and mandated insurance coverage will add millions of newly insured Americans. In order to meet the demand of these patients, it is anticipated: A. Medical schools will be forced to lower the entrance requirements B. Telehealth services will be approved for all sites of service C. An increase in the use of midlevel providers. D. Training more physician specialists
alleged violations
It is important that the compliance plan includes a secure process for employees, vendors, and patients to report ________ without fear of repercussions. A. alleged violations B. technical glitches C. excellent service D. compliant activities
hospital-acquired conditions
Nosocomial conditions, also known as ________, are those illnesses and injuries that affect a patient as a direct result of the patient's stay in the hospital. A. hospital-acquired conditions B. staph infections C. genetic anomalies D. medical misadventures
buy-in
Obtaining ________ on the proposal prior to implementation will encourage a better working relationship within the facility. A. permits and licenses B. government approval C. buy-in D. corporate approval
I, II, IV and V
Several patients have presented to the office over the last three weeks complaining they have not received their lab work or received incorrect results. To improve this process, you use the Plan, Do, Check, Act method. Which options below are included in this method? I. Gather a team of the key players together to outline the plan and list steps to achieve the goal. II. Perform a small-scale testing to determine if the plan will work. III. Ask other practices if they have this same problem IV. Check to see if improvements have been made. V. Implement a plan outlined by key players pf a team. A. I, II, III, and IV B. I, II, III, and V C. I, II, IV and V D. II, III, IV and V
Public disclosure.
Since 2001, CMS has published quality initiatives with the intent of supporting quality health care through: A. Threat of imprisonment. B. Claims denial. C. Public disclosure. D. Ancillary incentives.
All applicants.
State and national criminal background checks should be performed on: A. All administrative applicants. B. All applicants. C. All physician applicants. D. All clinical applicants.
I, II, and III are correct
The Congressional Budget Office estimates health care reforms will cost an estimated $940 billion over the next 10 years, which will be paid for primarily through: I. New taxes II. New health industry fees III. Cuts in existing government health programs IV. Budgetary cuts for government staff V. Elimination of federal funding for Medicaid A. I, II, III and V are correct B. III and IV are correct C. III, IV and V are correct D. I, II, and III are correct
Federal Sentencing Guidelines.
The FSG include seven steps to ensure due diligence is done properly. In this context, FSG stands for: A. Federal Safety Guidelines. B. Financial Sentencing Governance. C. Financial Security Guidelines. D. Federal Sentencing Guidelines
Impermissible use of protected health information (PHI).
The HITECH Breach of Notification Rule requires covered entities to report: A. The results of every internal audit. B. Impermissible use of protected health information (PHI). C. All accusations of impermissible use of PHI. D. The names of security personnel.
30%
The Patient Experience of Care domain accounts for ________ of the total performance score (TPS). A. 50% B. 85% C. 65% D. 30%
Advance planning.
The key to managing a crisis effectively is: A. Advance planning. B. Never saying you're sorry. C. Immediate lock-down. D. Offering safe harbor.
Continuing education for clinicians.
The nine quality improvement strategies identified by AHRQ include: A. Continuing education for clinicians. B. Ignoring patient complaints. C. Mandating overtime to provide more patient hours. D. Financial penalties for poor performance.
Providers and hospitals to better coordinate care and improve efficiency
The objective of an ACO is to minimize incentives that promote quality of care by realigning incentives between: A. Providers and hospitals to better coordinate care and improve efficiency B. Providers and patients to better coordinate care and improve efficiency C. Providers and hospitals to decrease the number of tests required to determine a diagnosis. D. Patient and hospitals to better coordinate care and use less home health services.
Risk management.
The process by which an organization can reduce the opportunity for an adverse event to occur is known as: A. Crisis management. B. Financial management. C. Risk management. D. Strategic management.
Compliance.
The process of obeying rules, regulations, and laws is known as: A. Qui tam. B. Due diligence. C. Compliance. D. Obedience.
Stage IV pressure ulcer
The ten categories of HACs for which Medicare will not reimburse include: A. Diabetes mellitus. B. Non-catheter-associated UTI. C. Cerebrovascular accident (CVA). D. Stage IV pressure ulcer.
Readmissions.
The term used to identify those patients who must be returned to inpatient status in a hospital for the same reason as the previous admission is: A. Manifestations. B. Resubmissions. C. Readmissions. D. Secondary conditions.
Level of performance.
The terms of the Hospital Value-Based Purchasing program (HVBP) provide hospitals with incentive payments based on: A. Number of patients treated. B. Severity of illness treated. C. Level of performance. D. Credentials of physicians.
Risk assessments
To identify what bad things could happen, the administrator should perform: A. Exit interviews. B. Safety protocols. C. Industry-wide research studies. D. Risk assessments.
Practice profitability
Under MIPS, which of the following is NOT considered an improvement activity? A. Expanding practice exam B. Participation in an APM C. Patient Safety and Practice Assessment D. Practice profitability
I, II and III are correct
Value-based purchasing is a new reimbursement model that pays hospitals based on performance around the following: I. Patient satisfaction scores II. Quality of care III. Efficiency IV. Return on investment V. Number of physicians employed A. All options are correct B. A, II and V are correct C. I, III and IV are correct D. I, II and III are correct
Patient-centered care
What is providing care that is responsive to individual patient preferences, needs, and values and assuring that patient values guide all clinical decisions? A. Equitable care B. Patient-centered care C. Timely Care D. Preventive Care
Continuous Quality Improvement
What is the strategy of continuous refinement to improve quality? A. Continuous Quality Improvement B. Quality Outcome Measurements C. Quality Assurance D. Creation of policies and procedures.
Quality Control
What is the system to measure the performance of a process, item or service against a defined standard? A. Quality Assurance B. Quality Control C. Continuous Quality Improvement D. None of the above
excellence
When an attitude of ________ is proliferated throughout the organization, everyone benefits and patient care is improved. A. non-compliance B. taking shortcuts C. excellence D. individual directions
Potential benefits.
When conducting a risk assessment, the administrator should include an analysis of potential harm as well as: A. Potential benefits. B. Internal politics. C. News coverage. D. Competition.
All of these.
When performing a risk assessment, you should consider potential for: A. Physical harm. B. Psychological harm. C. Financial harm. D. All of these
Low-risk.
When the probability of any harm is low, and the harm that might occur would be minor, this is considered: A. Unsafe. B. High-risk. C. Medium-risk. D. Low-risk.
Suspension without pay.
When there is need for corrective action with an employee, but there is benefit to retaining this individual on the staff, one punishment may be: A. To ignore the event. B. To give the employee a second chance. C. Suspension without pay. D. Promotion to a different department.
I, II and III are correct
Which of the following are benefits for initiating quality efforts in a practice? I. Reduce the risk of medical law suits II. Improve patient satisfaction III. Strengthen stability of the business IV. Makes it twice as easy to recruit staff and providers A. I is correct B. II is correct C. III and IV are correct D. I, II and III are correct
I, II, and IV are correct
Which of the following are eligible providers under PQRS? I. Cardiologist II. Physical Therapist III. Outpatient surgery centers IV. Chiropractors V. Independent laboratories A. I, II, and IV are correct B. I, II, and III are correct C. I and II are correct D. I, III and V are correct
II, III and IV
Which of the following are examples of quality control (QC) processes? I. Comparing the process to other providers in the area II. Calibrating the blood pressure machines III. Testing the fire extinguishers in the clinic IV. Verifying accurate temperatures for the refrigerators containing vaccines V. Turning up the temperature of the refrigerators at night to save cost A. I, II and V B. I, III, and V C. II, III and V D. II, III and IV
Computerized order entry for radiology tests
Which of the following is an example of how IT can help reduce medical errors? A. Computerized order entry for radiology tests B. Call in a prescription to a pharmacy for a patient who is out of town C. Automated insurance verification and authorization approvals. D. Coordination of care with home health agencies.
