Mock RHIA part 2
144. A child's prescription drug is not on the healthcare plan's formulary. The pharmacist states that the drug's cost is $113.45. Using the information provided on the patient's prescription coverage, how much should the guarantor expect to pay for the prescription? Prescription Drug Copayment per Prescription for 34-Day Supply Tier 1: Generic $10 Tier 2: Formulary without Generic $25 Tier 3: Formulary with Generic $35 Tier 4: Non-Formulary $40
$40 The copayment is a fixed dollar amount or flat fee. The fixed amount may vary by type of service, such as a visit or a prescription. In this situation, the child's prescription is not on the healthcare plan's formulary (list of preferred drugs), so it would fall to the Tier 4 rate of $40 for the copayment.
Using the information provided, if a participating physician accepts the assignment then what is the patient's liability to the physician? Physician's normal charge = $340 Medicare Fee Schedule = $300 Patient has met his deductible
$60 Nonparticipating providers (nonPARs) do not sign a participation agreement with Medicare and may or may not accept assignment. If the nonPAR physician elects to accept assignment, he or she is paid 95% (5% less than participating physicians) of the Medicare Fee Schedule (MFS). For example, if the MFS amount is $200 then the PAR provider receives $160 (80% of $200) and the nonPAR provider receives only $152 (95% of $160). In this case, the physician is participating so he or she will receive 80% of the MFS, or 80% of 300, which is $240. Medicare will reimburse the physician $240 and the patient's liability is $60.
Urban Clinic is establishing a new Women's Breast Center at an initial investment cost of $2,000,000. Monthly operating expenses are expected to be $100,000, and the center is expected to generate $20,000 in profits each month. What is the estimated return on investment of this project for one year?
12% Return on investment (ROI) measures the increase in value of an asset. Return on investment for one year can be calculated for the acquisition of the Women's Breast Center in this manner: $20,000 × 12 = $240,000; $240,000 / $2,000,000 × 100 = 12%; Return on investment: earnings (after taxes)/total assets.
Community Hospital had 250 patients in the hospital at midnight on May 1. The hospital admitted 30 patients on May 2. The hospital discharged 40 patients, including deaths, on May 2. Two patients were both admitted and discharged on May 2. What was the total number of inpatient service days for May 2?
242 The calculation for this scenario is [(250 + 30) - 40] + 2 = 242. A unit of measure that reflects the services received by one inpatient during a 24-hour period is called an inpatient service day. The number of inpatient service days for a 24-hour period is equal to the daily inpatient census; that is, one service day for each patient treated.
During the month of June, Community Hospital had 149 discharges and 47 patients had consultations from specialty physicians. What was the consultation rate for June?
31.5% The consultation rate calculation for this scenario is (47 × 100) / 149 or 4,700 / 149 = 31.5%. A consultation occurs when two or more physicians collaborate on a particular patient's diagnosis or treatment. The attending physician requests the consultation and explains the reason for doing so. The consultant then examines the patient and the patient's health record and makes recommendations in a written report. The formula for calculating the consultation rate is: Total number of patients receiving consultations for a given period / Total number of discharges and deaths for the same period × 100.
All the patients who present to the emergency department with a suspected acute myocardial infarction (AMI) are expected to receive an EKG within 10 minutes of their arrival. Of the 56 patients who had a suspected AMI during the last quarter, 32 had an EKG within the specified time frame. What was the rate of compliance?
57.1 A rate is type of ratio where the two numbers represent different things. For example, a rate may compare the number of patients and the number of days in a time period, or the number of patients and the number of patients who have a certain disease. To calculate a rate, there is a formula that is important to remember: the number of times something happened divided by the number of times it could have happened, times 100. In this case, the calculation is 32 / 56 × 100 = 57.1.
Which of the following purchases would most likely be considered a capital budget item?
A cost of more than $1,000 with a life expectancy of 3 years Capital budget items are large dollar purchases, as defined by facility budget policies and procedures. Capital budget items usually have a useful life in excess of one fiscal year, making them long-term assets, and a dollar value in excess of a predetermined amount, often $500 or $1,000.
Coding accuracy is best determined by:
A predefined audit process Coders should be evaluated at least quarterly with appropriate training needs identified, facilitated, and reassessed over time. Only through this continuous process of evaluation can data quality and integrity be accurately measured and ensured. Accuracy of coding is best determined by a predefined audit process
In its payment notice (remittance advice), the healthcare plan lists that the payment for an individual laboratory test is $39. The bill that the pathologist's office submitted for the laboratory test was $45. What does the amount of $39 represent?
Allowable charge In a fee-for-service environment, third-party payers establish a fee schedule. A fee schedule is a predetermined list of fees that the third-party payer allows for payment for all healthcare services. The allowable charge represents the average or maximum amount the third-party payer will reimburse providers for the service
It is important to evaluate a health information system implementation. All of the following are recommended as measures to determine appropriate performance except for the:
Amount of electricity used The implementation committee for a new information system should establish a formal process to collect data regarding all reported problems to identify patterns, trends, and opportunities to improve the system. The percentage of downtime, unintended consequences, and number of alerts trigged would all be appropriate measures to monitor the performance of the new system. The amount of electricity used should not impact users or patients and does not need to be monitored
In a typical acute-care setting, which revenue cycle area uses an internal auditing system (scrubber) to ensure that error-free claims (clean claims) are submitted to third-party payers?
Claims processing The claims processing area uses an internal auditing system to ensure claims are error free. Once all data have been posted to a patient's account, the claim can be reviewed for accuracy and completeness. Many facilities have internal auditing systems known as scrubbers. The auditing system runs each claim through a set of edits specifically designed for the third-party payer, identifies data that has failed the edits, and flags the claim for correction.
In a recent coding audit, the coding manager discovered the following issue: A skin lesion was removed from a patient's cheek in the dermatologist's office. The dermatologist documented skin lesion, probable basal cell carcinoma. Which of the following actions should the coding professional take in order to correctly code this encounter?
Code skin lesion In the outpatient setting, do not code a diagnosis documented as "probable." Rather, code the conditions to the highest degree of certainty for the encounter.
The Joint Commission measures that are standardized metric tools that provide an indication of an organization's performance are called:
Core Performance Measures Core measures are defined as standardized sets of valid, reliable, and evidenced-based measures implemented by the Joint Commission. The hospital quality measures currently utilized by the Joint Commission and CMS are acute myocardial infarction; heart failure; pneumonia; asthma care for children; and surgical infection prevention or the Surgical Care Improvement Project.
Detailed procedures should be able to:
Create consistent outcomes for tasks done A procedure describes how work is to be done and how policies are to be carried out. Procedures are instructions that ensure high-quality consistent outcomes for tasks especially when more than one person is involved.
The HIM manager is conducting a study that compares the ICD-9-CM and ICD-10-CM diabetes mellitus codes and documents variations in order to assess the impact on the organization. This process creates a:
Data map A data map describes the connections, or paths, between classifications and vocabularies. To help the HIM manager ensure study validity and integrity, the manager will rely on the data map, or crosswalk, that "connects" the ICD-9-CM codes across the span of the study to ensure that an ICD-9-CM code has, in essence, the same meaning as the ICD-10-CM code it is mapped or cross-walked to.
Extracting data from a data set to determine trends and identify patterns is referred to as _____.
Data mining In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set. Those trends and patterns are then used in business planning or process.
Which of the following is the process of probing and extracting business data and information from a data warehouse and then quantifying and filtering the data for analysis purposes?
Data mining In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set. Those trends and patterns are then used in business planning or process.
A drug interaction alert would be a typical function of a _____.
Decision support system The clinical decision support may be active, which means that it has alerts or reminders the user must address, or passive, which means the user may choose to utilize or ignore the alerts. Alerts may notify the care provider of patient allergies, contraindications for the medication, or other treatment. It may notify the user that the drug being ordered is off-formulary.
When the Medicare Recovery Audit Contractor (RAC) has determined that incorrect payment has been made to an organization what document is sent to the provider notifying them of this determination?
Demand letter The provider will be notified of RAC or MAC determination in a demand letter, which includes the providers identification, reason for the review, list of claims, reasons for any denials, and amount of the overpayment for each claim. The demand letter is the equivalent of a denial letter.
The most important information to include in an informed consent in biomedical research is the:
Description of risk Federal regulations require that certain information be provided to each human subject in a research study. The subjects must be given a description of reasonably foreseeable risks or discomforts. The description must be accurate and reasonable, and subjects must be informed of previously reported adverse events.
What information might be displayed on a histogram?
Discharges by age A histogram is used to display a frequency distribution. It is different from a bar graph in that a bar graph is used to display data that fall into groups or categories (nominal or ordinal data). The other categories are non-continuous or discrete. Histograms are used to illustrate frequency distributions of continuous variables such as age
The amount of money owed a healthcare facility when claims are pending is called:
Dollars in accounts receivable The accounts receivable department manages the amounts owed to a facility by customers who received services but whose payments will be made at a later date by the patient or a third-party payer
When managing the master patient index (MPI) which of the following would be the biggest concern for the health information professional?
Duplicate record numbers A duplicate medical record number results in the creation of a new medical record for the patient. This duplicate number and the associated records results in a patient having medical information in disparate medical records that could impede proper care. Proper management of the MPI is critical to reduce or eliminate the assignment of duplicate medical record numbers.
If a physician coerces a patient into undergoing experimental treatments, the contract between them may be void based on which defense for nonperformance?
Duress Duress is when unlawful threats or pressure are used to force a party to execute the contract. In this situation the physician placed undue pressure on the patient to undergo the experimental treatment so the contract may be voided based on this
Allowing employees to solve problems within the scope of their job is a characteristic of:
Empowerment Empowerment is the concept of providing employees with the tools and resources to solve problems themselves. Employees obtain power over their work situation by assuming responsibility.
The distinguishing feature of a results management application is that it:
Enables results of a diagnostic study to be compared and displayed with other data The result management application enables the results of diagnostic studies to be compared and displayed with other data.
A hospital is reviewing the quantity and type of resources being used in the provision of chemotherapy treatments. This is an example of:
FOCUS-PDCA review Like other continuous quality improvement (CQI) models, FOCUS-PDCA applies to the Plan, Do, Check, Act process, which is a cycle of trial, measurement, and learning.
At the end of March, the HIM department has a year to date (YTD) payroll budget of $100,000. The actual YTD amount paid is $95,000 because a coder resigned in February. For the past two months, the position has been filled through outsourcing. Therefore, the actual YTD amount for consulting services is $5,000, although no money was budgeted for consulting services. The reporting threshold for variances is 4%. The fiscal year-end is December. What is the best description of the payroll variance for this year?
Favorable, permanent The money that is in the payroll budget may not be spent by the end of the fiscal year; therefore, it is a permanent variance ($100,000 - $95,000 = $5,000). The payroll budget is the positive amount, so it is favorable.
Medical identity theft includes all of the following except use of another person's:
Financial information to purchase expensive handbags Medical identity theft occurs when a patient uses another person's name and insurance information to receive healthcare benefits. Most often this is done so a person can receive medical care with an insurance benefit and pay less or nothing for the care received
The medical transcription improvement team wants to identify the cause of poor transcription quality. Which tool could help them accomplish this objective?
Fishbone diagram When a team first identifies a problem, it may use a fishbone diagram, also known as a cause-and-effect diagram, to help determine the root causes of the problem. The problem is placed in a box on the right side of the paper. A horizontal line is drawn, somewhat like a backbone, with diagonal bones, like ribs, pointing to the boxes above and below the backbone. Each box contains a category. The categories may be names that represent broad classifications of problem areas (for example, people, methods, equipment, materials, policies and procedures, environment, measurement, and so on).
The HIM manager at Anywhere Hospital has contracted with an outside vendor to handle the complete cancer registry function for the facility. This type of contract for services would be considered:
Full service In this situation, contracting for staffing to handle a complete function (cancer registry) within the HIM department would be considered a full service contract.
What project management tool focuses on the percentage completion of a task but does not show a link between one or more tasks?
Gantt Scheduling the project is commonly planned and managed through a Gantt chart. The Gantt chart captures each of the work packages identified in the work breakdown structure (WBS) as tasks for the project team, assigns each task to a project team member, identifies the dates when the work begins and when it will be completed, and identifies any scheduling dependencies. The Gantt chart can be used to display the schedule in a hierarchical form similar to the WBS. The resulting Gantt chart is used to communicate the schedule and to monitor the progress of the project during execution
A patient who was admitted for treatment of an intervertebral disk injury developed a urinary tract infection and fever several days after undergoing surgery. In this situation the urinary tract infection would be classified as:
Healthcare-associated infection A healthcare-associated infection is one that occurs in a patient in a hospital or healthcare setting in whom it was not present or incubating at the time of the admission nor is it the remainder of an infection acquired during previous admission
Which of the following basic services provided by an HIE organization provides authentication?
Identity management Identity management is a process that operates to ensure that individuals who have been identified are who they say they are, that they have authority to do what they want to do, and that their actions are tracked. This process is essentially the typical security functions of authorization, authentication, access control, and audit control
Consumer education about the PHR must include which of the following items in order for consumers to embrace it?
Information about security and confidentiality Personal health records (PHRs) are popular outside of patients and physicians. The Office of the National Coordinator for Health Information Technology includes PHRs as part of its strategy for implementing EHRs and the National Health Information Network (NHIN). Vendors have introduced a proliferation of PHR products. For consumers to embrace PHRs, the healthcare industry must provide education on their proper use—including security and confidentiality—and the technical standards that facilitate the exchange of PHR information.
Providers should be queried regarding information in the health record for all of the following except:
Insignificant information Queries are not necessary for every discrepancy or unaddressed issue in physician documentation. Healthcare entities should develop policies and procedures that clarify which clinical conditions and documentation situations warrant a request for physician clarification. Insignificant or irrelevant findings may not warrant a query regarding the assignment of an additional diagnosis code for example. Entities must balance the value of collecting marginal data against the administrative burden of obtaining the additional documentation
Which term describes the ability of one information system to exchange data with another information system?
Interoperable Many healthcare organizations have used a closed-system approach to designing healthcare information systems (ISs) that has resulted in a lack of interoperability among systems. Interoperability refers to the capability of one IS to exchange data with another
If the agreement rate on retrospective queries for a physician is 100 percent, this could be a sign of:
Leading queries It is important to collect the agreement rate, because if it is too high or too low, this may represent a systemic problem with the documentation process. For example, if the agreement rate is 100%, the physician is agreeing with the CDI specialist on all queries. This may be evidence of either leading queries or physicians who did not receive proper training in clinical documentation practices
Which of the following is a solution to the problem of staff recruitment for coding and transcription?
Telecommuting Alternative staffing structures (flextime, telecommuting, and job sharing) offer flexibility in hours, location, and job responsibilities as a method to attract and retain employees.
A hospital's utilization review committee would like to see data that show the monthly admissions to five different units over the past year. Which of the following techniques for data display would work best?
Line chart A line chart or plot may be used to display time trends. The x-axis shows the unit of time from left to right, and the y-axis measures the values of the variables being plotted.
Which of the following is the key to the identification and location of a patient's health record in a numerical filing system?
Master patient index The master patient index (MPI) functions as the primary guide to locating pertinent demographic data about the patient and his or her health record number. Without the information contained in the MPI, it would be almost impossible to locate a patient's health record in most organizations that use a numeric filing system. The MPI is the permanent record of every patient ever seen in the healthcare entity
A transcription manager is assigned to a project team that is implementing a voice-recognition system. He reports to the director of health information services for regular job functions and to the project manager for tasks related to the project. This is an example of which type of project management structure?
Matrixed The matrixed organization maintains the functional organization. Team members report to a functional manager and remain employees of that department. The team members receive their project assignments from the project manager
The Joint Commission requires a varying number of safety functions and plans depending on the license or services provided by an organization. The standards require the assessment of safety features for patients, staff, and visitors. Which of the following lists are required safety standard plans for the environment of care?
Medical equipment management, life safety management, and emergency management The seven written safety standards or plans for the environment of care cover the following areas: safety management, security management, hazardous materials and waste management, emergency management, life or fire safety management, medical equipment management, and utilities management.
Compliance with the Conditions of Participation allows a hospital to achieve:
Medicare certification The regulations for health record content and documentation were originally established in the Conditions of Participation. CMS is responsible for developing and enforcing regulations regarding the participation of healthcare providers in the Medicare program.
Which one of the following healthcare information systems is most likely to use barcoding technology for patient safety purposes?
Medication administration The bar code symbol was standardized for the healthcare industry, making it easier to adopt bar-coding technology and to realize its potential. Since then, bar-coding applications have been adopted for labels; patient wristbands; specimen containers; business, employee, and patient records; library reference materials; medication packages; dietary items; paper documents; and more.
How does mentoring differ from coaching as a career development practice?
Most often performed by a senior employee Mentoring is a form of coaching. A mentor is a senior employee who works with employees early in their careers, giving them advice on developing skills and career options.
Which work design tool uses an office layout to visualize the interaction of various work procedures?
Movement diagram A movement diagram is a visual depiction of the layout of the workspace with all the furniture, equipment, doorways, and other elements sketched in. Superimposed on the layout are the movements of either individuals or things (for example, documents, files, and such).The movement diagram can be used to evaluate the workflow and to redesign one that is more efficient
The primary goals of which of the following groups are to enable health information to follow the consumer, to make health information available for clinical decision making, and to support appropriate use of healthcare information beyond direct patient care?
National Health Information Network The National Health Information Network's (NHIN) efforts play a major role in the future of health information exchange. The NHIN provides the framework for the exchange of health information across the country. Some goals of the NHIN are to enable health information to follow the consumer, to make health information available for clinical decision making, and to support appropriate use of healthcare information beyond direct patient care.
The technology that allows a healthcare organization to logically (or conceptually) link multiple physical data repositories is:
OLTP Online or real-time transaction processing (OLTP) is a technology that allows an organization to logically link their physical data repositories. The data are entered into the repositories by the organizations' various "feeder" applications, and the users must be able to manipulate, update, retrieve, and otherwise act on the data in real time while the data are stored in the repositories. This requires data repositories to include tools like OLTP, which are designed to perform intricate data searches and retrievals.
Coding compliance programs focus on preventing accusations of fraud and abuse in healthcare. Which organization from the Department of Health and Human Services provides guidance for healthcare organizations in developing compliance programs?
Office of the Inspector General (OIG) The Office of the Inspector General (OIG) continues to issue compliance program guidance for various types of healthcare organizations. The goal of the compliance programs is to prevent accusations of fraud and abuse, make operations run more smoothly, improve services, and contain costs
Which of the following describe the EHR product's data architecture, analytical processes supported, necessary interfaces, reliability and security features, system capacity, expansion capabilities, response time, downtime, and other issues associated with system maintenance?
Operational requirements The operational requirements elicit information on the EHR product's data architecture, analytical processes supported, necessary interfaces, reliability and security features, system capacity, expansion capabilities, response time, downtime, and other issues associated with system maintenance.
A hospital has experienced an increase in third-party payer denials for lack of pre-authorization for certain services. Which of the following departments should hospital administration scrutinize to ensure that proper procedures are in place?
Patient registration The patient registration department or admitting encompasses all of the front-end processes including obtaining information before the patient arrives at the facility for services. Insurance verification is essential to determine whether the patient actually has insurance coverage, whether the insurance covers the services the patient will have, and whether the patient must pay a deductible or co-payment. Nonverification of some or all of this information can result in claims either being sent to an insurance company that will not pay then being returned to staff in the patient accounts department to try to determine the actual insurance or claims reverting to the patient for payment
This EHR implementation strategy identifies the sequence of implementing the EHR with regard to various inpatient units, departments, physicians, or other categories of users or sites.
Phased rollout Implementation of an EHR component, or functions of a component, in one or a few organizational units at a time with a plan to follow with full rollout in the same manner is called a phased rollout.
Electronic prescribing is used in:
Physician's office prescription writing Electronic prescribing (e-Rx) is the protocol used for a physician's office to send prescriptions electronically to a retail pharmacy.
This type of data display tool is used to show the relationship of each part to the whole.
Pie charts A pie chart is an easily understood chart in which the sizes of the slices of the pie show the proportional contribution of each part. Pie charts can be used to show the component parts of a single group or variable and are intended for interval or ratio data
What application of data mining is used to identify potential fraudulent Medicare claims?
Predictive modeling Predictive modeling applies statistical techniques to determine the likelihood of certain events occurring together. Statistical methods are applied to historical data to learn the patterns in the data. These patterns are used to create models of what is most likely to occur. CMS uses predictive modeling to identify potential fraudulent Medicare claims.
Allowing patterns of retrospective documentation, hiding or ignoring negative quality review outcomes, and hiding incomplete health records from accreditation surveyors are unethical behaviors for which of the following Code of Ethics principle?
Put service before self-interest The ethical obligations of the health information management (HIM) professional include placing service before self-interest. The HIM professional must ensure the honor of the profession before personal advantage as well as the health and welfare of patients before all other interests
The performance standard to "Deliver the record to the requester of a STAT request within 10 minutes of receiving the request" is an example of a:
Quality standard Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions. In the scenario, delivery of the record to the requester of a STAT request within 10 minutes of receiving the request is identifying the quality or how well the work is being performed rather than how much work is being performed, so it is a quality standard.
Carolyn works as a coder in a hospital inpatient department. She sees a lab report in a patient's health record that is positive for staph infection. However, there is no mention of staph in the physician's documentation. What should Carolyn do?
Query the physician As a result of the disparity in documentation practices by providers, querying has become a common communication and educational method to advocate proper documentation practices. Queries may be made in situations in which there are clinical indicators of a diagnosis but no documentation of the condition
An 80-year-old female is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." How should the coder proceed to code this case?
Query the physician to ask if the patient has septicemia because of the symptomatology. As a result of the disparity in documentation practices by providers, querying has become a common communication and educational method to advocate proper documentation practices. Queries can be made in situations when there is clinical evidence for a higher degree of specificity or severity. In this case, a diagnosis of urosepsis is ambiguous and needs to be clarified by the physician for correct coding
An analyst was testing the hypothesis that there is an association between physician gender (M/F) and the willingness to use or not use CPOE. The value of the chi-square test statistic is 7.23. If the acceptable level of type I error was set to 0.01, what is the conclusion of the hypothesis test?
Reject the null hypothesis In testing a hypothesis using statistical inference, the decision is to reject or not reject the null hypothesis at the present alpha level. If the test statistic value is greater than the cutoff, reject the null hypothesis. In this scenario, the chi-square test statistic is 7.23 and is greater than the type I error rate of 0.01 so the null hypothesis would be rejected.
The charge description master relieves the HIM department of ________ that does not require documentation analysis.
Repetitive coding The principal purpose of the charge description master (CDM) is to allow the healthcare facility to efficiently and accurately charge repetitive services and routine supplies to the patient's bill. Through the process of order entry, services located in the CDM are "charges" that are hard coded to the patient's account
The process of prescreening vendors before detailed vendor proposals are requested is called:
Request for information A request for information (RFI) is generally sent to a list of vendors that are known to offer products or systems that meet the organization's needs. The RFI is used to obtain general product information and to prescreen vendors.
Which of the following would likely head the list of important performance measures for evaluating the results of strategic change?
Results compared to performance targets Any time strategic change is undertaken, the measures by which its success will be judged should be made part of the performance measures data set.
Which of the following is a continuous quality improvement (CQI) tool frequently used to display data?
Scatter diagram A scatter diagram is a data analysis tool used to plot points of two variables suspected of being related to each other in some way.
An HIM director wants to conduct research to learn about the physicians' view of the department's image. What type of scale should be used to collect data?
Semantic differential scale Researchers, marketers, and others use a semantic differential scale to ascertain a group's perspective or image of a product, healthcare organization, or program
Disciplinary action:
Should be documented at each step in the process Regardless of the counseling and disciplinary actions mandated by the organization, managers should take some key steps of their own such as documenting the steps taken to improve performance.
Site surveyors always look for evidence of three trigger issues including very high percentages of patients suffering from dehydration, decubitus ulcers in low-risk residents, and fecal impaction within which type of healthcare setting?
Skilled nursing facility Long-term care site surveyors always look for evidence of three trigger issues: very high percentages of patients suffering from dehydration, decubitus ulcers in low-risk residents, and fecal impaction. Current federal regulations mandate the primary importance of these issues in a long-term care setting. Whether the facility has very high percentages is determined on the basis of the Facility Quality Indicator Survey.
A leader who was using path-goal theory and determined that a worker was not performing well because of a lack of self-confidence would most likely use which of the following leadership behaviors to correct the situation?
Supportive leadership Path-goal theory identifies four different situations, each requiring a different facilitative response from leadership. When workers lack self-confidence, leaders provide support by being friendly, approachable, concerned about needs, and equitable. This increases the workers' confidence to achieve the work outcome.
The health information manager is conducting a patient satisfaction survey in an outpatient clinic. Because the clinic typically sees about 300 people per day, the manager decides to have the interviewers administer the questionnaire on every tenth patient. This is an example of what type of sampling:
Systematic sampling A systematic random sample is a simple random sample that may be generated by selecting every fifth or every tenth member of the sampling framework
Emphasis on group rather than individual achievement is stressed in the training topic called:
Team-building Team-building training helps employees learn to work in groups that have the authority to make decisions. Emphasis is on the group rather than individual achievement
What factor is medical necessity based on?
The beneficial effects of a service for the patient's physical needs and quality of life Part of utilization review is to determine the medical necessity of services provided to or planned for an individual patient. Determination of medical necessity is based on whether the services can be expected to have a reasonably beneficial effect on the patient's physical needs and quality of life.
130. Use the following custom revenue production report to determine which of the following evaluations is apparent to the practice coding manager about the consultation codes (99241-99245). Revenue Production Report Small Multispecialty Group Month: January Code Qty Fee Projected Revenue Actual Insurance Revenue 99201 0 $50 $0 $0.00 99202 3 $75 $225 $164.10 99203 4 $90 $360 $267.94 99204 0 $120 $0 $0.00 99205 0 $150 $0 $.00 99211 703 $28 $19,684 $14,988.32 99212 489 $47 $22,983 $18,092.65 99213 1853 $63 $116,739 $92,890.38 99214 41 $89 $3,649 $2,799.11 99215 7 $135 $945 $722.87 99241 3 $100 $300 $52.50 99242 9 $125 $1,125 $156.23 99243 27 $150 $4,050 $610.45 99244 10 $175 $1,750 $124.32 99245 1 $200$200 $53.10
The charges are not being paid appropriately. The projected revenue is considerably higher than the actual revenue for consultations in the report, which indicates the practice group is not being paid what they are expecting for their consultation services. A revenue production report contains the total revenue produced by CPT or HCPCS code and the average reimbursement rate for that code. This report is sorted by the amount of revenue produced. Usually 80% of revenue is produced by 20% of the CPT codes used by the practice
In project management terminology, what is the definition of variance?
The difference between the original project plan (in terms of work, cost, and schedule estimates) and the actual progress or revised estimates After updating the project schedule with the task progress, the project manager compares the task start date, expected finish date, estimated work effort, estimated cost, and estimated duration to what was originally planned. All projects do not progress as originally planned. The project manager must concentrate on those variances that are substantially affecting the project's timeline, budget, and objectives.
Which of the following is not an element of the external environmental assessment that should be part of a manager's routine scanning?
The opinions of employees Knowledge of the internal and external environment is essential to vision and strategy formulation. Elements of an external environmental assessment include: the opinions of industry experts, changes in healthcare policy and regulation, and what is happening in similar organizations in the community. The opinions of employees would not be considered an external assessment of the environment.
Key to the implementation of an effective performance improvement program is a written plan that systematically describes the structure and approach the organization will follow in the continuous assessment and improvement of its important systems, processes, and outcomes of care. Which of the following activities should be included in this plan?
The organization sets priorities for performance improvement, ensuring that the scope of care, treatment, and services are represented across all disciplines. The Joint Commission recommends that a healthcare organization's performance improvement plan include the following activities: the organization's leaders decide the scope and focus of performance monitoring and data collection activities, including factors that contribute to unanticipated adverse events or outcomes, that are planned, systematic, and organization-wide; the organization sets priorities for performance improvement, ensuring that the scope of care, treatment, and services are represented across all disciplines; data are systematically collected, aggregated, and analyzed on an ongoing basis; and improvement opportunities are identified and changes are made that will lead to and sustain improvement
Which of the following statements most accurately characterizes the primary reason why today's managers must be able to think and act strategically?
The pace of change has compressed organizational response times. Strategic planning was developed to prevent organizations from "crisis planning" when they realized that their competitors outpaced them in innovation and they quickly had to develop reactive strategies to keep this from happening again.
A patient was admitted to the hospital for treatment of a myocardial infarction (heart attack) and the MS-DRG assigned was 236 Coronary bypass without cardiac cath without MCC. During the patient's admission a bypass procedure was performed on day 2. On day 4, the patient was diagnosed with sepsis that was not present on admission. Sepsis is a major complication. This case was identified as coded incorrectly in a recent audit by the coding manager. What error was made by the coder?
The sepsis was not coded and so an MCC was missed. Complications and comorbidities (CCs) and major complications and comorbidities (MCCs) also play a part in determining the MS-DRG. CCs and MCCs are additional, or secondary, diagnoses that ordinarily extend the length of stay. A complication is a secondary condition that arises during hospitalization; a comorbidity is one that exists at the time of admission. CCs affect many but not all MS-DRG categories. MS-DRGs are often found in sets of two or three depending on whether CCs or MCCs affect the DRG assignment. In such groupings, a case with a CC would represent a higher severity level and would result in a higher payment than a case without a CC. A case with an MCC would be an even higher level of severity and would pay more than a case with a CC.
The management of a high-quality, error-free master patient index (MPI) requires constant maintenance. A comprehensive MPI maintenance program would include all of the following except:
Ways to find out where the patient's health information has been shared for purposes other than care The management of a high-quality, error-free master patient index (MPI) requires constant maintenance, which includes oversight, evaluation, and correction of errors. The responsibility for MPI maintenance should be centralized under the direction of a qualified professional. Employees responsible for MPI maintenance must be carefully trained, have adequate tools and procedures, and be supervised to ensure they are consistently compliant with established guidelines. A comprehensive maintenance program should include: • Ongoing processes to identify and address existing errors • Advanced person search capabilities for minimizing the creation of new errors • Mechanisms for efficiently detecting, reviewing, and resolving potential errors • Reliable links to different health record numbers and other identifiers for the same person to create an enterprise view of the person • Consideration of the types of physical merges (such as files and film) and the interfaces and correction routines to other electronic systems that are populated or updated by the MPI.
What work measurement tool uses random sample observations to obtain information about the performance of an entire department?
Work sampling Work sampling is a technique of work measurement that involves using statistical probability (determined through random sample observations) to characterize the performance of the department and its functional work units.
The period of time between discharge and claim submission, which a facility defines by policy, is called the:
bill hold Each facility has a defined number of days during the bill hold period. These are the number of days in which accounts will be held from billing so charges can be entered after the patient is discharged. Bill hold assumes that there will be a delay in accumulating the charges incurred by the patient.
Which of the following fields of informatics largely focuses on developing tools and processes to empower patients?
consumer Consumer informatics is focused on empowering patients by communicating effectively with them using a variety of methods, including health information in various formats. The communication of health information, whether in verbal or written format, relies on the ability of the individual to understand the information to achieve its desired purpose.
In this level of interoperability, the receiving computer has someinformation regarding the nature of the information being exchanged, but does not have complete and shared understanding with the sending system
functional Functional interoperability refers to sending messages between computers with a shared understanding of the structure and format of the message. With functional interoperability, the receiving computer can store information in a similar data field because the nature (con¬text) of the data being sent is understood. For example, the receiving computer could recognize that the information being sent is a lab result and store it accordingly.
116. What is the term to describe whether a person can obtain, process, and understand basic health information and services needed to make suitable health decisions?
health literacy Health literacy is the ability to understand instructions on prescription drug bottles, appointment cards, medical education brochures, doctor's directions, and consent forms; it also includes the ability to navigate complex health care systems; it requires a complex group of reading, listening, analytical, and decision-making skills and the ability to apply these skills to health situations.
Which of the following tracks patient, person, or member activity within healthcare organizations and across patient care settings?
master patient index (MPI) The MPI is a list or database created or maintained by a healthcare facility to record the name and identification number of every patient who has ever been admitted or treated in the facility
The ____ is an application within an organization's registration system that uniquely identifies the individuals who have received services.
master patient index (MPI) The master patient index (MPI) is a key application within an organization's registration system. It uniquely identifies the individuals who have received services from the organization. As such, maintaining the integrity of the MPI is critical.
In order to determine the hospital's expected MS-DRG payment, the hospital's blended rate is multiplied by the MS-DRG's ______ to determine the dollar amount paid.
relative weight Each diagnosis-related group (DRG) is assigned a relative weight (RW). The RW is a multiplier that determines reimbursement. For example, a DRG with a relative weight of 2.0000 would pay twice as much as a DRG with a RW of 1.0000.
An activity useful in diversity training that involves learners acting out a response to a hypothetical situation is known as:
role playing Role playing is an activity where learners are presented with a hypothetical situation they may encounter on the job, and they act out the response. It is useful for tasks such as interviewing, grievance handling, team problem solving, or communication difficulties
In a normal distribution, 99.7% of the observations fall within which of the following standard deviations?
±3 s.d. of the mean In the normal distribution, the standard deviation indicates how many observations fall within a certain range of the mean. The areas under the distribution curve corresponding to 1, 2, and 3 standard deviations are, respectively, 68.3%, 95.4%, and 99.7%.