RHIT Domain 3

On October 1st, a hurricane hit a small coastal community, which has a community hospital licensed for 50 beds. Hospital staff set up 10 additional beds around the facility and used three labor room beds and two treatment room beds in order to help take care of patients. Which of the following would be the denominator used to determine the percentage of occupancy for October 1st? a. 50 b. 60 c. 63 d. 65

a A bed count, also called an inpatient bed count, is the number of available hospital inpatient beds, both occupied and vacant, on any given day. Temporary beds are not included in the bed count for percentage of occupancy (Horton 2016a, 54).

The hospital-acquired infection rate for our hospital is 0.2%, whereas the rate at a similar hospital across town is 0.3%. This is an example of a: a. Benchmark b. Check sheet c. Data abstract d. Run chart

a A benchmark is a systematic comparison of one organization's measurement characteristics to those of another similar organization. When an organization compares its current performance to its own internal historical data, or uses data from similar external organizations, it helps establish an organization benchmark (Foltz et al. 2016, 465).

In the community clinic Dr. Simpson, an interventional cardiologist, saw 270 patients last quarter. Of those, he performed stent procedures on 182 patients and angioplasty procedures on 88 patients. What is the proportion of Dr. Simpson's patients who have had stent procedures? a. 0.67 b. 0.45 c. 0.33 d. Unable to determine

a A proportion is a type of ratio in which x is a portion of the whole (x + y ). In a proportion, the numerator is always included in the denominator. 182 / 270 = 0.67 (Horton 2016a, 23).

A family practitioner in your local physician's clinic saw 150 adults in one week for their annual physical examinations. Sixty-seven received the flu vaccine and three patients received the pneumococcal pneumonia vaccine. What is the rate of the flu vaccine administration for this physician? a. 44.7% b. 67.0% c. 20.0% d. 447%

a A rate is a ratio in which there is a distinct relationship between the numerator and denominator and the denominator often implies a large base population. (67/150) × 100 = 44.66 = 44.7% (Horton 2016a, 23).

What format problem is in the following table? Community Hospital Admissions by Sex, 20XX Male 3,546 42.4 Female 4,825 57.6 Total 8,371 100 a. Column headings are missing b. Title of the table is missing c. Column totals are inaccurate d. Variable names are missing

a A table is an orderly arrangement of values that groups data into rows and columns. Almost any type of quantitative information can be organized into tables. Tables are useful for demonstrating patterns and other kinds of relationships. Tables need headings for columns and rows, and they need to be specific and understandable (Watzlaf 2016, 347).

Which unit of measure is used to indicate the services received by one inpatient in a 24-hour period? a. Inpatient service day b. Volume of services c. Average occupancy charges d. Length of services provided

a A unit of measure that reflects the services received by one inpatient during a 24-hour period is an inpatient service day (IPSD). 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 (Horton 2016b, 386).

To use a data element for aggregation and reporting, that data element must be: a. Abstracted or indexed b. Searched c. Subject to case finding d. Registered

a Abstracting is the process of extracting elements of data from a source document and entering them into an automated system. The purpose of this endeavor is to make those data elements available for later use. After a data element is captured in electronic form, it can be aggregated into a group of data elements to provide information needed by the user (Sayles 2016b, 74).

Which of the following is a technique for graphically depicting the structure of a computer database? a. Data model b. Data flow diagram c. Foreign key d. Primary key

a Data models provide a contextual framework and graphical representation that aid in the definition of data elements (Amatayakul 2016, 301).

A health data analyst has been asked to abstract patient demographic information into an electronic database. Which of the following would the analyst include in the database? a. Patient date of birth b. Name of attending physician c. Patient room number d. Admitting diagnosis

a Demographics is the study of the statistical characteristics of human populations. In the context of healthcare, demographic information includes the following elements: patient's full name; patient's facility identification or account number; patient's address; patient's telephone number; patient's date and place of birth; patient's gender; patient's race or ethnic origin; patient's marital status; name and address of patient's next of kin; date and time of admission; hospital's name, address, and telephone number (Sayles 2016b, 56-57).

Certificates, such as those for births and fetal-deaths, are reported by hospitals to the individual state registrars and maintained permanently. State vital statistics registrars then compile the data and report them to which of the following: a. National Center for Health Statistics b. Agency for Healthcare Research and Quality c. Health Services Research d. National Statistics Research

a Healthcare facilities are interested in births and deaths, fetal deaths, and induced terminations of pregnancy; facilities generally are responsible for completing certificates for births, fetal deaths, abortions, and occasionally, deaths. All states have laws that require this data. The certificates are reported to the individual state registrars and maintained permanently. State vital statistics registrars compile the data and report them to the NCHS (Horton 2016a, 4).

The following data were derived from a comparative discharge database for hip and femur procedures: Comparative Data on Hip and Femur Procedures for Current Year Hospital A Hospital B Hospital C Hospital D Hip procedures 2,300 1,467 2,567 1,100 Femur procedures 988 1,245 1,067 678 a. Aggregate b. Identifiable c. Patient specific d. Primary

a Secondary data are considered aggregate data. Aggregate data include data on groups of people or patients without identifying any particular patient individually. Examples of aggregate data are statistics on the average length of stay (ALOS) for patients discharged within a particular diagnosis-related group (DRG) (Sharp 2016, 173).

Secondary data is used for multiple reasons including: a. Assisting researchers in determining effectiveness of treatments b. Assisting physicians and other healthcare providers in providing patient care c. Billing for services provided to the patient d. Coding diagnoses and procedures treated

a Secondary data is used in research. Data taken from health records and entered into disease-oriented databases can help researchers determine the effectiveness of alternate treatment methods. They also can quickly demonstrate survival rates at different stages of diseases (Sharp 2016, 173).

To be reliable, statistical data must: a. Have some consistency b. Be applicable to what is being measured c. Be collected from one source only d. Have multiple meanings

a The data used in the statistics must be valid and reliable. Validity answers the question of whether one measured what one intended to measure, and reliability means that there is some consistency of results (Horton 2016a, 3).

Given the numbers 47, 20, 11, 33, 30, 30, 35, and 50, what is the mode? a. 30 b. 32 c. 32.5 d. 35

a The mode is the simplest measure of central tendency. It is used to indicate the most frequent observation in a frequency distribution. The most frequent observation is 30 (Watzlaf 2016, 359).

At Community Hospital, each full-time employee is required to work 2,080 hours annually. The table below shows the amount of time that five employees were absent from work over the past year. Community Hospital Health Information Management Department Coding Section Absentee Report Annual Statistics, 20XX Employee Name Vacation Hours Used Sick Leave Hours Used A 40 6 B 22 16 C 36 8 D 80 32 E 16 40 a. 0.29% b. 0.98% c. 1.29% d. 1.54%

b A rate is a ratio in which there is a distinct relationship between the numerator and denominator and the denominator often implies a large base population. Add each employee's sick leave hours together to get a total of 102. Multiplying 2,080 (full time equivalent) by 5 (number of employees) equals 10,400. Take the total sick leave hours (102) and multiply by 100, then divide it by the total hours for the 5 full time employees (10,400). Calculations: (6 + 16 + 8 + 32 + 40) = 102 hours total sick leave time; (2,080 × 5) = 10,400 total hours for the 5 coders; (102 × 100) / 10,400 = 10,200 / 10,400 = 0.98% total sick leave rate (Horton 2016a, 23).

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? a. 240 b. 242 c. 280 d. 320

b 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. The calculation is: [(250 + 30) − 40] + 2 = 242 (Horton 2016b, 386).

Which rate describes the probability or risk of illness in a population over a period of time? a. Mortality b. Incidence c. Morbidity d. Prevalence

b An incidence rate is used to compare the frequency of disease in different populations. Populations are compared using rates instead of raw numbers because rates adjust for differences in population size. The incidence rate is the probability or risk of illness in a population over a period of time (Horton 2016b, 413).

The number of inpatients present in a healthcare facility at any given time is called a ________. a. Survey b. Census c. Sample d. Enumeration

b Healthcare facilities have a census, which is the count of patients present at a specific time and in a particular place (Horton 2016a, 5).

The type of statistics that makes a best guess about a larger group of data by drawing conclusions from a smaller group of data is called: a. Descriptive statistics b. Inferential statistics c. Generalized statistics d. Mathematical statistics

b Inferential statistics help make inferences or guesses about a larger group of data by drawing conclusions from a small group of data (Horton 2016a, 3-4).

Why is the MEDPAR file limited in terms of being used for research purposes? a. It only provides demographic data about patients b. It only contains Medicare patients c. It uses ICD-10-CM diagnoses and procedure codes d. It breaks charges down by specific type of service

b The MEDPAR file is frequently used for research on topics such as charges for particular types of care and MS-DRGs. The limitation of the MEDPAR data for research purposes is that the file contains only Medicare patients (Sharp 2016, 185).

Why is the MEDPAR file limited in terms of being used for research purposes? a. It only provides demographic data about patients. b. It only contains Medicare patients. c. It uses diagnoses and procedure codes. d. It breaks charges down by specific types of service.

b The Medicare Provider Analysis and Review (MEDPAR) file is made up of acute care hospital and skilled nursing facility (SNF) claims data for all Medicare claims. The MEDPAR file is frequently used for research on topics such as charges for particular types of care and MSDRGs. The limitation of the MEDPAR data for research purposes is that the file contains only Medicare patients (Sharp 2016, 185).

The HIM professional reported to the quality improvement committee at Community Hospital that there were 58 patients with influenza discharged from the hospital in January. Of those, 3 died. What is the case fatality rate for influenza for January? a. 1.60% b. 5.17% c. 0.10% d. 94.8%

b The case fatality rate is the total number of deaths due to a specific illness during a given time period divided by the total number of cases during the same period. (3 ×100) / 58 = 300 / 58 = 5.17% (Horton 2016a, 93).

In May, 270 women were admitted to the obstetrics service. Of these, 263 women delivered; 33 deliveries were by C-section. What is the denominator for calculating the C-section rate? a. 33 b. 263 c. 270 d. 296

b The denominator (the number of times an event could have occurred) in this case would be 263 as 263 women delivered (Horton 2016b, 384).

Given the numbers 47, 20, 11, 33, 30, 30, 35, and 50, what is the median? a. 30 b. 31.5 c. 32 d. 35

b The median is the midpoint of a frequency distribution. It is the point at which 50 percent of observations fall above and 50 percent fall below. If an even number of observations is in the frequency distribution, the median is the midpoint between the two middle observations. It is found by averaging the two middle scores, (x + y) / 2. In the example, the median is 31.5: ([30 + 33] / 2) (Watzlaf 2016, 359).

In a frequency distribution, the lowest value is 5, and the highest value is 20. What is the range? a. 5 to 20 b. 15 c. 7.5 d. 20 to 5

b The range is the simplest measure of spread. It is the difference between the smallest and largest values in a frequency distribution (Watzlaf 2016, 360).

One of the pediatricians at Community Physician's Clinic worked with a software vendor to get a display of the patients she currently has in the hospital on her smart phone that lets her know current information such as lab results, vital signs, medications given. This is called a ________. a. Big data b. Descriptive analytics screen c. Dashboard d. Descriptive tablet

c A dashboard is a visual display of the most important information that a physician would need to see about his patients. These can usually be customized by facility or an individual (Horton 2016a, 326).

Suppose that 6 males and 14 females are in a class of 20 students with the data reported as 3/1. What term could be used to describe the comparison? a. Average b. Percentage c. Proportion d. Rate

c A proportion is a particular type of ratio in which x is a portion of the whole (x + y ) (Horton 2016b, 383).

What is (are) the format problem(s) with the following table? Community Hospital Discharges by Sex Sex Number Percentage Male 3,000 37.5% Female 5,000 62.5% Unknown — — Total 8,000 100% a. The title is missing. b. Variable names are missing. c. There are blank cells. d. Row totals are inaccurate.

c A table should contain all the information the user needs to understand the data in it. A table should not have blank cells. When no information is available for a particular cell, the cell should contain a zero (Watzlaf 2016, 347).

After the types of cases to be included in a trauma registry have been determined, what is the next step in data acquisition? a. Registering b. Defining c. Abstracting d. Finding

c After the cases have been identified, information is abstracted from the health records of the injured patients and entered into the trauma registry database. The data elements collected in the abstracting process vary from registry to registry but usually include: demographic information on the patient; information on the injury; care the patient received before hospitalization (such as care at another transferring hospital or care from an emergency medical technician who provided care at the scene of the accident or in transport from the accident site to the hospital); status of the patient at the time of admission; patient's course in the hospital; and diagnosis and procedure codes (Sharp 2016, 178).

Using the information in the table below, calculate the C-section rate at University Hospital for the semiannual period. University Hospital Obstetrics Service Semiannual Statistics July-December, 20XX Admissions 672 Discharges and Deaths: Delivered 504 Not Delivered 147 Aborted 21 Vaginal deliveries 403 C-sections 101 a. 15.03% b. 19.24% c. 20.04% d. 25.06%

c C-section rate: (101 × 100) / 504 = 10,100 / 504 = 20.039 = 20.04% (Horton 2016a, 155).

Data elements collected on large populations of individuals and stored in databases are referred to as: a. Statistics b. Information c. Aggregate data d. Standard

c Data about patients can be extracted from individual health records and combined as aggregate data. Aggregate data are used to develop information about groups of patients. For example, data about all patients who suffered an acute myocardial infarction during a specific time period could be collected in a database (Sharp 2016, 173).

What do the wedges or divisions in a pie graph represent? a. Frequency groups b. Various data c. Percentages d. Classes

c Pie charts are best to use when you want to show each category's percentage of the total. They do not show changes over time. A circle is divided into sections such as wedges or slices. These represent percentages of the total (100 percent) (Horton 2016a, 258).

This type of analytics allows users to prescribe a number of different possible actions: a. Descriptive analytics b. Predictive analytics c. Prescriptive analytics d. Real-time analysis

c Prescriptive analytics is a relatively new field of analytics that allows users to prescribe a number of different possible actions. This type of analytics predicts what will happen, but also provides recommendations that will take advantage of the predictions (Horton 2016a, 325).

In the relational database shown here, the patient table and the visit table are related by: Patient Table Patient # Patient Last Name Patient First Name Date of Birth 021234 Smith Donna 03/21/1944 022366 Jones William 04/09/1960 034457 Collins Mary 08/21/1977 Visit Table Visit # Date of Visit Practitioner # Patient # 0045678 11/12/2008 456 021234 0045679 11/12/2008 997 021234 0045680 11/12/2008 456 034457 a. Visit number b. Date of visit c. Patient number d. Practitioner number

c Relations are established in a relational database by the primary key of one table becoming a foreign key in another table. In this case, the patient number is the primary key in the patient table and used as the foreign key in the visit table (Johns 2015, 127-128).

Community Hospital wants to compare its hospital-acquired urinary tract infection (UTI) rate for Medicare patients with the national average. The hospital is using the MEDPAR database for its comparison. The MEDPAR database contains 13,000,000 discharges. Of these individuals, 200,000 were admitted with a principal diagnosis of UTI; another 300,000 were admitted with a principal diagnosis of infectious disease, and 700,000 had a diagnosis of hypertension. Given this information, which of the following would provide the best comparison data for Community Hospital? a. All individuals in the MEDPAR database b. All individuals in the MEDPAR database except those admitted with a principal diagnosis of UTI c. All individuals in the MEDPAR database except those admitted with a principal diagnosis of UTI or infectious disease d. All individuals in the MEDPAR database except those admitted with a diagnosis of hypertension

c The Medicare Provider Analysis and Review (MEDPAR) file is made up of acute care hospital and skilled nursing facility (SNF) claims data for all Medicare claims. The MEDPAR file is frequently used for research on topics such as charges for particular types of care and DRGs. The limitation of the MEDPAR data for research purposes is that the file contains only Medicare patients. Community Hospital is excluding MEDPAR data of those patients with a principal diagnosis of UTI or infectious disease because these would not represent a hospital acquired condition (HAC) because the patients were admitted with those diagnoses. Community Hospital is looking for comparative secondary diagnosis data of Medicare patients from the MEDPAR file to compare their HAC rate for UTIs to the national average from the MEDPAR data (Gordon and Gordon 2016a, 437; Sharp 2016, 185).

Community Hospital had 25 inpatient deaths, including newborns, for the month of June. The hospital performed five autopsies for the same period. What was the gross autopsy rate for the hospital for June? a. 0.02% b. 5% c. 20% d. 200%

c The gross autopsy rate is the proportion or percentage of deaths that are followed by the performance of autopsy. In this case, (5 / 25) × 100 = 20% (Horton 2016b, 395-396).

Community Memorial Hospital had 25 inpatient deaths, including newborns, during the month of June. The hospital had a total of 500 discharges for the same period, including deaths of adults, children, and newborns. The hospital's gross death rate for the month of June was: a. 0.05% b. 2% c. 5% d. 20%

c The gross death rate is the proportion of all hospital discharges that ended in death. It is the basic indicator of mortality in a healthcare facility. The gross death rate is calculated by dividing the total number of deaths occurring in a given time period by the total number of discharges, including deaths, for the same time period: 25/500 = 0.05 × 100 = 5% (Horton 2016b, 392-393).

The HIM department at Community Hospital has three full time coders. One is considered the lead coder and his salary is $20.35 per hour. One coder is a new graduate who makes $15.50 per hour and the third coder is an experienced employee who earns $18.90 per hour. The lead coder codes four records per hour; the new coder codes three records per hour and their experienced coder codes six records per hour. Using a 7.5-hour productive day, what is the unit cost for the lead coder? a. $3.36 per record b. $4.49 per record c. $5.43 per record d. $5.51 per record

c The lead coder's annual salary is $20.35 × 2,080 (hours per year) = $42,328. The lead coder's productivity is 7.5 hours per day × 4 records per hour = 30 records per day. 30 records per day × 5 days per week × 52 weeks per year = 7,800 records per year. Yearly salary of $42,328 / 7,800 records per year = $2.556 = $5.43 per record (Horton 2016a, 174-175).

What is the mean for the following frequency distribution: 10, 15, 20, 25, 25? a. 47.5 b. 20 c. 19 d. 95

c The mean is the arithmetic average of frequency distribution. Put simply, it is the sum of all the values in a frequency distribution divided by the frequency: (10 + 15 + 20 + 25 + 25) / 5 = 19 (Watzlaf 2016, 359).

What is the official count of inpatients taken at midnight called? a. Average daily census b. Census c. Daily inpatient census d. Inpatient service days

c The result of the official count taken at midnight is the daily inpatient census (Horton 2016b, 386).

Based on the payment percentages provided in this table, which payer contributes most to the hospital's overall payments? Payer Charges Payments Adjustment Charges Payments Adjustments BC/BS $450,000 $360,000 $90,000 23% 31% 12% Commercial $250,000 $200,000 $50,000 13% 17% 6% Medicaid $350,000 $75,000 $275,000 18% 6% 36% Medicare $750,000 $495,000 $255,000 39% 42% 33% TRICARE $150,000 $50,000 $100,000 7% 4% 13% Total $1,950,000 $1,180,000 $770,000 100% 100% 100% a. BC/BS b. Commercial c. TRICARE d. Medicare

d In the "Payments" column, Medicare has the highest payment percentage (42 percent) of any of the payers; therefore, Medicare contributes more to the hospital's overall payments (Watzlaf 2016, 347).

The hospital's Performance Improvement Council has compiled the following data on the volume of procedures performed. Given this data, which procedures should the council scrutinize in evaluating performance? (graph unable to be added) a. Procedures 1, 4 b. Procedures 2, 3, 5 c. Procedures 6, 7 d. Procedures 1, 4, 6, 7

d Performance measurement in healthcare provides an indication of an organization's performance in relation to a specified process or outcome. Healthcare performance improvement philosophies most often focus on measuring performance in the areas of systems, processes, and outcomes. Outcomes should be scrutinized whether they are positive and appropriate or negative and diminishing (Shaw and Carter 2015, 44-47).

The HIM department at Community Hospital has three full time coders. One is considered the lead coder and his salary is $20.35 per hour. One coder is a new graduate who makes $15.50 per hour and the third coder is an experienced employee who earns $18.90 per hour. The lead coder codes four records per hour; the new coder codes three records per hour and their experienced coder codes six records per hour. Using a 7.5-hour productive day, what is the unit cost for the new graduate coder? a. $3.36 per record b. $4.49 per record c. $5.43 per record d. $5.51 per record

d The new graduate coder's salary is $15.50 × 2,080 (hours per year) = $32,240. Productivity is 7.5 hours per day × 3 records per hour = 22.5 records per day. 22.5 records × 5 days per week × 52 weeks per year = 5,850 records per year. $32,240 / 5,850 = $5.51 per record (Horton 2016a, 174-175).

Using the information in the table below, calculate the vaginal delivery rate at University Hospital for the semiannual period. University Hospital Obstetrics Service Semiannual Statistics July-December, 20XX Admissions 672 Discharges and Deaths: Delivered 504 Not Delivered 147 Aborted 21 Vaginal deliveries 403 C-sections 101 a. 20.04% b. 59.97% c. 84.13% d. 79.96%

d Vaginal delivery rate: (403 × 100) / 504 = 40,300 / 504 = 79.96% (Horton 2016a, 155-157).

What number is assigned to a case when it is first entered in a cancer registry? a. Accession number b. Patient number c. Health record number d. Medical record number

a Accession number is a number assigned to each case as it is entered in a cancer registry (Sharp 2016, 175).

Which of the following best represents the definition of the term data? a. Patient's laboratory value is 50. b. Patient's SGOT is higher than 50 and outside of normal limits. c. Patient's resting heartbeat is 70, which is within normal range. d. Patient's laboratory value is consistent with liver disease.

a Although sometimes used interchangeably, the terms data and information do not mean the same thing. Data represent the basic facts about people, processes, measurements, conditions, and so on. They can be collected in the form of dates, numerical measurements and statistics, textual descriptions, checklists, images, and symbols. After data have been collected and analyzed, they are converted into a form that can be used for a specific purpose. This useful form is called information. In other words, data represent facts and information represents meaning (Sayles 2016b, 52).

The Medical Staff Executive Committee has requested a report that identifies all medical staff members who have been suspended in the last six months due to delinquent health records. This is an example of what type of report? a. Ad hoc or demand b. Annual report c. Exception d. Periodic scheduled

a As opposed to periodic and exception reports, demand reports, also known as ad hoc reports, are produced as needed, whenever a manager demands or asks for it. Usually, demand reports are produced through report generators or database query languages and are customized by the manager (Johns 2015, 236).

Case finding is a method used to: a. Identify patients who have been seen or treated in a facility for a particular disease or condition for inclusion in a registry b. Define which cases are to be included in a registry c. Identify trends and changes in the incidence of disease d. Identify facility-based trends

a Case finding is a method used to identify the patients who have been seen or treated in the facility for the particular disease or condition of interest to the registry. After cases have been identified, extensive information is abstracted from the patients' paper-based health records into the registry database or extracted from other databases and automatically entered into the registry database (Sharp 2016, 176).

Your administrator has asked you to generate a report that gives the number of hypertension patients last year. This is an example of ________. a. Descriptive analytics b. Predictive analytics c. Prescriptive analytics d. Real-time analysis

a Data analytics is the science of examining raw data with the purpose of drawing conclusions about that information. Analytics can be descriptive, predictive, or prescriptive. Descriptive analytics is just the summarization of data (Horton 2016a, 322).

The process of extracting and analyzing large volumes of data from a database for the purpose of identifying hidden and sometimes subtle relationships or patterns and using those relationships to predict behaviors is called: a. Data mining b. Data warehouse c. Data searching d. Big data

a Data mining is the process of extracting and analyzing large volumes of data from a database for the purpose of identifying hidden and sometimes subtle relationships or patterns and using those relationships to predict behaviors (Giannangelo 2016b, 324).

Recently, a local professional athlete was admitted to your facility for a procedure. During this patient's hospital stay, access logs may need to be checked daily in order to determine: a. Whether all access by workforce is appropriate b. If the patient is satisfied with their stay c. If it is necessary to order prescriptions for the patient d. Whether the care to the patient meets quality standards

a In order to maintain patient privacy certain audits may need to be completed daily. If a high profile patient is currently in a facility, for example, access logs may need to be checked daily to determine whether all access to this patient's information by workforce is appropriate (Thomason 2013, 173).

Which events must occur in order to maintain patient identity data integrity? a. The data must be accurately queried b. The data must be accurately analyzed c. The data must be accurately normalized d. The data must be accurately coded

a Maintenance of data integrity is a key aspect of data quality management. When it comes to patient identity and HIE, integrity is of prime importance to linking the patient to the correct information. Three events must occur in order to maintain patient identity data integrity. The data must be accurately collected, entered, and queried (Giannangelo 2016b, 338).

Which of the following types of data does not have a natural order? a. Nominal b. Ordinal c. Ratio d. Interval

a Qualitative data are divided into the nominal scale and ordinal scale. Nominal data observations are organized into categories in which there is no recognition of order, and ordinal data are types of data where the values are in ordered categories and the order of the numbers is meaningful, but not the numbers themselves (Horton 2016a, 322-323).

A coding supervisor wants to use a fixed percentage random sample of work output to determine coding quality for each coder. Given the work output for each of the four coders shown here, how many total records will be needed for the audit if a 5 percent random sample is used? Fixed Percentage Random Sample Audit Example Coder Work Output Records for 5% Audit A 500 B 480 C 300 D 360 a. 82 b. 156 c. 820 d. 1,550

a Sampling is the recording of a smaller subset of observations of the characteristic or parameter, making certain, however, that a sufficient number of observations have been made to predict the overall configuration of the data. In this case, 82 records would be a sufficient number to review for coding quality. The calculation is: (500 × 0.05) + (480 × 0.05) + (300 × 0. 05) + (360 × 0.05) = 82 records (Shaw and Carter 2015, 78).

The Joint Commission and CMS have identified sets of patient care characteristics that they have determined reflect the quality of care an organization can provide for important diagnoses. These sets are called: a. Core measures b. Conditions for coverage c. Case mix d. Cost outliers

a Sets of patient care characteristics that the Joint Commission and CMS have determined to reflect the quality of care an organization can provide for important diagnoses are core measures (Shaw and Carter 2015, 497).

Suppose that five patients stayed in the hospital for a total of 27 days. Which term would be used to describe the result of the calculation 27 divided by 5? a. Average length of stay b. Total length of stay c. Patient length of stay d. Average patient census

a The average length of stay (ALOS) is calculated from the total length of stay (LOS). The total LOS divided by the number of patients discharged is the ALOS (Horton 2016b, 390).

Which of the following is not a component of the data analytics process? a. Software testing b. Dissemination c. Data extraction d. Data preparation

a The components of data analytics are: data extraction, data preparation, descriptive statistics, statistical analyses, dissemination (Kellogg 2016a, 34).

Which of the following is the first step in analyzing data? a. Know your objectives or purpose of the data analysis b. Start with basic types of data analysis and work up to more sophisticated analysis c. Utilize a statistician to analyze the data d. Present your findings to administration

a The first step in analyzing data is to know your objective or the purpose of the data analysis (Watzlaf 2016, 363-364).

Given the information here, which of the following statements is correct? MS DRG MDC Type MS-DRG Title Weight Discharges Geometric Mean Arithmetic Mean 191 04 MED Chronic obstructive pulmonary disease w CC 0.9184 10 3.3 4.0 192 04 MED Chronic obstructive pulmonary disease w/o CC/MCC 0.7234 20 2.7 3.2 193 04 MED Simple pneumonia & pleurisy w MCC 1.3860 10 4.6 5.7 194 04 MED Simple pneumonia & pleurisy w CC 0.9469 20 3.6 4.3 195 04 MED Simple pneumonia & pleurisy w/o CC/MCC 0.7028 10 2.8 3.3 a. In each MS-DRG, the geometric mean is lower than the arithmetic mean. b. In each MS-DRG, the arithmetic mean is lower than the geometric mean. c. The higher the number of patients in each MS-DRG, the greater the geometric mean for that MS-DRG. d. The geometric means are lower in MS-DRGs that are associated with a CC or MCC.

a The geometric mean LOS is defined as the total days of service, excluding any outliers or transfers, divided by the total number of patients. Given the examples, the geometric means are lower than the arithmetic means (Casto and Forrestal 2015, 116).

A record is considered a primary data source when it: a. Contains data about a patient and has been documented by the professionals who provided care to the patient b. Contains data abstracted from a patient record c. Includes data stored in a computer system d. Contains data that are entered into a disease-oriented database

a The health record is considered a primary data source because it contains data about a patient that has been documented by the professionals who provided care or services to that patient. Data taken from the primary health record and entered into registries and databases are considered a secondary data source (Sharp 2016, 172).

In this experimental study, blood pressure is taken before and after an experimental medication is used as the intervention in a sample of participants that were previously unable to control their blood pressure with other medications. In this example, the independent variable is the ________ and the dependent variable is the________. a. Experimental medication; blood pressure b. Blood pressure; experimental medication c. Blood pressure; heart disease d. Experimental medication; heart disease

a The independent variable in this example is the intervention used (medication) and the dependent variable is the disease that is being assessed (blood pressure) (Watzlaf 2016, 366).

If an employee produces 2,080 hours of work in the course of one year, how many employees will be required for the coding area if the coding time on average for one record is 30 minutes and there are 12,500 records that must be coded each year? a. 3 b. 6 c. 36 d. 69

a The number of records per FTE is 2 (number of records per hour) × 2,080 = 4,160. Therefore, three employees per year are required: 12,500 / 4,160 = 3.0 (Prater 2016, 585).

The Information Services Department has requested information about the electronic signature system being used in your facility. They would like to know the locations where physicians are accessing the system. Review the information in the table below. What is the percentage of physicians not using the electronic signature system? Community Hospital Electronic Signature System 500 Physicians on Staff; 489 Using the System Site No. of Physicians Using the System at This Site % of Physicians Using the System at This Site Medicine, 2 West 54 11.04% Medicine, 2 East 62 12.68% Pediatrics, 3 West 42 8.59% Obstetrics, 1 West 12 2.45% Physician's lounge 87 17.79% HIM department 65 13.29% Personal mobile device 92 18.81% Physician home 75 15.34% a. 2.2% b. 2.45% c. 18.81% d. 99.99%

a The ratio of a part to the whole is often expressed as a percentage. Percentages are a useful way to make fair comparisons. The percentage of physicians not using the system is 2.2%. (11 physicians not using the system × 100) / 500 = 1,100 / 500 = 2.2% (Horton 2016a, 18).

Within the context of the inpatient prospective payment system, how is the case-mix index calculated? a. The sum of all relative weights divided by the total number of discharges b. The total number of inpatient service days divided by the total number of discharges c. The sum of all MDCs divided by the total number of discharges d. The total number of inpatient beds divided by the total number of discharges

a To determine the case-mix index, take the sum of all relative weights and divide by the total number of discharges. The formula for computing case-mix is: The sum of the weights of MS-DRGs for patients discharged during a given period divided by the total number of patients discharged (Horton 2016a, 204).

An employee views a patient's electronic health record. It is a trigger event if: a. The employee and patient have the same last name b. The patient was admitted through the emergency room c. The patient is over 89 years old d. A dietitian views a patient's nutrition care plan

a With appropriate policies and procedures in place, it is the responsibility of the organization and its managers, directors, CSO, and employees with audit responsibilities to review access logs, audit trails, failed logins, and other reports. One type of event that would be a trigger event would include employees viewing records of patients with the same last name or address of the employee (Rinehart-Thompson 2016c, 275).

Which autopsy rate compares the number of autopsies performed on hospital inpatients to the total number of inpatient deaths for the same period of time? a. Net b. Gross c. Hospital d. Average

b A gross autopsy rate is the proportion or percentage of deaths that are followed by the performance of autopsy (Horton 2016b, 395-396).

Community Hospital has compared its admission-type patient-profile data for two consecutive years. From a performance improvement standpoint, which admission types should the hospital examine for possible changes in capacity handling? a. Elective b. Emergency c. Newborn d. Urgent

b A pie chart is used to show the relationship of each part to the whole, in other words, how each part contributes to the total product or process. The 360 degrees of the circle, or pie, represent the total, or 100 percent. The pie is divided into "slices" proportionate to each component's percentage of the whole. Review of the pie chart shows that the emergency department has had significant patient growth over the five-year period. By using this patient profile data for performance improvement, the hospital should examine capacity changes for this department (Shaw and Carter 2015, 91).

Which tool is used to display performance data over time? a. Status process control chart b. Run chart c. Benchmark d. Time ladder

b A run chart displays data points over a period of time to provide information about performance. The measured points of a process are plotted on a graph at regular time intervals to help team members see whether there are substantial changes in the numbers over time (Carter and Palmer 2016, 509-510).

The coding department at Community Physician's Clinic developed the following report for the denials committee at the clinic. The billing report shows the following information. How many hours will it take to reconcile these denials if each denial takes 1.5 hours to review and resubmit the bill? Community Physician's Clinic Coding Department Denials - October, 20XX Payment Source Number of Claims Sent Number of Denials Percentage of Denials Medicare 460 43 9.35% Medicaid 345 35 10.14% Tricare/Military 182 14 7.69% Commercial payers 1307 83 6.35% Worker's Compensation 6 1 16.17% Total 2300 176 7.65% a. 11.46 hours b. 264 hours c. 3450 hours d. Unable to determine

b A table is an orderly arrangement of values that groups data into rows and columns. Almost any type of quantitative information can be grouped into tables. Columns allow you to read data up and down, and rows allow you to read data across. The columns and rows should be labeled. In order to determine the amount of time it will take to reconcile all of the denials the number of denials is multiplied by the amount of time it takes to complete each denial (1.5 hours). 1.5 hours × 176 denials = 264 hours (Horton 2016a, 249-250).

Review of disease indexes, pathology reports, and radiation therapy reports are parts of which function in the cancer registry? a. Case definition b. Case finding c. Follow-up d. Reporting

b Cancer registries were developed as an organized method to collect these data. Case finding is a method used to identify the patients who have been seen or treated in the facility for the particular disease or condition of interest to the registry. After cases have been identified, extensive information is abstracted from the patients' paper-based health records into the registry database or extracted from other databases and automatically entered into the registry database (Sharp 2016, 176).

What term is used for the number of inpatients present at any one time in a healthcare facility? a. Average daily census b. Census c. Inpatient service day d. Length of stay

b Even though much of the data collection process has been automated, an ongoing responsibility of the HIM professional is to verify the census data that are collected daily. The census reports patient activity for a 24-hour reporting period. Included in the census report are the number of inpatients admitted and discharged for the previous 24-hour period and the number of intrahospital transfers. An intrahospital transfer is a patient who is moved from one patient care unit (for example, the intensive care unit) to another (for example, the surgical unit). The usual 24-hour reporting period begins at 12:01 a.m. and ends at 12:00 a.m. (midnight). In the census count, adults and children are reported separately from newborns (Horton 2016b, 386).

Large population-based studies are used to identify the care processes or interventions that achieve the best healthcare outcomes in different types of medical practice. This research concept is called? a. Clinical pathway b. Evidence-based medicine c. Patient-centered care d. Morbidity indicators

b Evidence-based medicine attempts to identify the care processes or interventions that achieve the best outcomes in different types of medical practice. Researchers perform large population-based studies. Such studies are difficult to do without a well developed information infrastructure to provide data for analysis (Shaw and Carter 2015, 174).

A statewide data base is used by your performance improvement department each month to compare other facilities' readmission rates to your facility's rates. This is an example of ________. a. Internal data b. External data c. Ratio data d. Nominal data

b External data sources refers to data collected outside an organization. For example, a census, reports from the Centers for Medicare and Medicaid Services (CMS) or the Centers for Disease Control (CDC), economic databases, journals, even social media have links to outside data (Horton 2016a, 323).

The facility privacy officer receives a phone call from a patient who is concerned that her former sister-in-law who is a hospital employee has accessed her health record. The privacy officer requests an audit log of activity within the patient's health record. What part of the audit log must be analyzed to determine if this complaint has merit? a. The patient demographic information b. Which employees viewed, created, updated, or deleted information c. The ownership of the record d. Whether the patient had requested to be omitted from the facility patient directory

b It is a requirement of the HIPAA Security Rule to implement ways that document access to information systems that contain electronic PHI. One of the ways to do this is to review the individuals that have viewed, created, updated, or deleted information within a health record. In this instance, the Privacy Officer should review this information to determine if the patient complaint is valid (Thomason 2013, 177).

Which term is used to describe the number of calendar days that a patient is hospitalized? a. Average length of stay b. Length of stay c. Occupancy rate d. Level of service

b Length of stay (LOS) is calculated for each patient after he or she is discharged from the hospital. It is the number of calendar days from the day of patient admission to the day of discharge. When the patient is admitted and discharged in the same month, the LOS is determined by subtracting the date of admission from the date of discharge (Horton 2016b, 390).

City Hospital's HIM department made a decision to discontinue outsourcing its release of information (ROI) function and perform the function in house. Because of HIPAA implementation, the department wanted better control over tracking release of information. Given the graph shown here, how would you evaluate the ROI revenue growth? a. The ROI function continues to cost more than revenue generated. b. Annualized revenue for YR-7 is more than the costs. c. The ROI function costs are inversely related to revenue generated. d. The ROI costs for YR-7 are greater than the revenue.

b Line graphs are used to display time trends in data. A line graph is useful for plotting data to make observations. In analyzing the chart, the revenue exceeds the costs (Watzlaf 2016, 351).

The business office at Community Hospital is looking at software that can help them with decreasing their fraud and abuse cases. The software claims to be able to flag those patients that would most likely be involved in fraud by examining many databases at the same time and finding those patients with demographic discrepancies. This is an example of ________. a. Descriptive analytics b. Predictive analytics c. Inferential statistics d. Descriptive statistics

b Predictive analytics is a branch of data mining concerned with the prediction of future probabilities and trends, also called forecasting (Horton 2016a, 322).

A managed care organization is using a system that examines the past healthcare behaviors of their patients to determine their future costs for their healthcare. This is an example of ________. a. Descriptive analytics b. Predictive modeling c. Prescriptive analytics d. Real-time analysis

b Predictive modeling is a process used in predictive analysis to identify patterns that can be used to determine the odds of a particular outcome based on the observed data. That is, statistics from the past are reviewed to determine what is likely to happen in the future. Predictive modeling is used by many companies that want to predict future trends (Horton 2016a, 324).

Health departments use the health record to monitor outbreaks of diseases. In this situation what type of use of the health record does this represent? a. Educational b. Public health and research c. Medical review organization d. Patient care

b Public health and research uses data in the health record for many reasons including monitoring disease outbreaks (Sayles 2016b, 53).

A quality goal for the hospital is that 98 percent of the heart attack patients receive aspirin within 24 hours of arrival at the hospital. In conducting an audit of heart attack patients, the data showed that 94 percent of the patients received aspirin within 24 hours of arriving at the hospital. Given this data, which of the following actions would be best? a. Alert the Joint Commission that the hospital has not met its quality goal b. Determine whether there was a medical or other reason why patients were not given aspirin c. Institute an in-service training program for clinical staff on the importance of administering aspirin within 24 hours d. Determine which physicians did not order aspirin

b Quality measures are identified using ICD-10-CM diagnosis codes. Acute MI is also a Core Measure. These data are monitored, rated, and ultimately compared to nationwide benchmarks to point to areas of potential improvement in patient care outcomes. In this situation is it important to determine whether there was a medical or other reason why patients were not given aspirin within 24 hours of arrival at the hospital. This determination is critical to assess compliance with the quality goal (Shaw and Carter 2015, 182, 184).

The following data has been collected about the HIM department's coding productivity as part of the organization's total quality improvement program. Which of the following is the best assessment of this data? Coder Work Output (All Records Coded) Total Hours Worked Average Work Output per Hour Completed Work Percentage Completed Work Output (Records Coded Accurately) Completed Work per Hour Worked A 500 140 (full time) 3.57 91% 455 3.25 B 475 140 (full time) 3.39 96% 456 3.26 C 300 80 (part time) 3.75 85% 240 3.00 D 350 80 (part time) 4.69 70% 245 3.06 Department Average 3.69 3.17 Work Output: Number of work units as recorded by the employee or the process Total Hours Worked: Number of hours worked by the employee to produce work, which does not include time on meals, breaks, and meetings Average Work Output per Hour: Work output divided by total hours worked Completed Work Percentage: Percentage of records coded accurately Completed Work Output: Work output multiplied by completed work percentage Completed Work per Hour Worked: Completed work output divided by total hours worked a. Part-time coders are more productive than full-time coders. b. Full-time coders are more productive than part-time coders. c. All coders produce more than the departmental average. d. Part-time coders exceed the departmental average.

b Reading this graph, the full-time coder productivity is higher than part-time coder productivity. The cause for this difference must be identified before any solution can be developed to increase the productivity of the part-time coders (Prater 2016, 588).

The HIM manager at Community Hospital is responsible for reviewing audit trails detailing potential access issues within the EHR. Which one of the following would be a type of activity that the manager would want to review? a. Every access to every data element or document type that occurred within the facility b. Whether the person viewed, created, updated, or deleted information belonging to a patient with the same last name c. Physical location of the redundant servers used for backup d. Whether all patients setup accounts in the patient portal

b The HIPAA Security Rule requires that access to electronic PHI in information systems is monitored. Included in the same standard is the requirement that covered entities examine the activity using access audit logs. Often they record time stamps that record access and use of the data elements and documents; what was viewed, created, updated, or deleted; the user's identification; the owner of the record; and the physical location on the network where the access occurred. Reviewing the audit trail information would be the first step to identify all employees who have accessed this patient's information (Thomason 2013, 177).

Which of the following is made up of claims data from Medicare claims submitted by acute-care hospitals and skilled nursing facilities? a. NPDB b. MEDPAR c. HIPDB d. UHDDS

b The Medicare Provider Analysis and Review (MEDPAR) file is made up of acute care hospital and SNF claims data for all Medicare claims. The MEDPAR file is frequently used for research on topics such as charges for particular types of care and DRGs. The limitation of the MEDPAR data for research purposes is that the file contains only Medicare patients (Sharp 2016, 185).

Community Hospital discharged 9 patients on April 1. The length of stay for each of the patients was as follows: for patient A, 1 day; for patient B, 5 days; for patient C, 3 days; for patient D, 3 days; for patient E, 8 days; for patient F, 8 days; for patient G, 8 days; for patient H, 9 days; for patient I, 9 days. What was the average length of stay for these nine patients? a. 5 days b. 6 days c. 8 days d. 9 days

b The average length of stay is the mean length of stay of hospital inpatients discharged during a given period of time. Add the total days for each patient (for a total of 54 days) and divide by 9 patients = 6 days (Horton 2016b, 390).

Given the following information, which of the following has the lowest work RVU? Sample RVUs for Selected HCPCS Codes HCPCS Code Description Work RVU Practice Expense RVU Malpractice Expense RVU 99204 Office visit 2.43 1.20 0.23 10080 I&D of pilonidal cyst, simple 1.22 1.58 0.20 45380 Colonoscopy with biopsy 4.43 2.72 0.67 52601 TURP, complete 15.26 8.04 1.50 a. Office visit b. I&D of pilonidal cyst, simple c. Colonoscopy with biopsy d. TURP, complete

b When analyzing this table one is able to determine that 1.22 is the lowest relative value unit (RVU) (Brinda 2016, 150; Watzlaf 2016, 347).

Sometimes data do not follow a normal distribution and are pulled toward the tails of the curve. When this occurs, it is referred to as having a skewed distribution. Because the mean is sensitive to extreme values or outliers, it gravitates in the direction of the extreme values thus making a long tail when a distribution is skewed. When the tail is pulled toward the right side, it is called a ________. a. Negatively skewed distribution b. Positively skewed distribution c. Bimodal distribution d. Normal distribution

b When the tail is pulled toward the right side, it is called a positively skewed distribution; when the tail is pulled toward the left side of the curve it is called a negatively skewed distribution (Watzlaf 2016, 361-362).

Suppose that you want to display the number of deaths due to breast cancer for the years 2005 through 2015. What is the best graphic technique to use? a. Table b. Histogram c. Line graph d. Bar chart

c A line graph may be used to display time trends. A line graph is especially useful for plotting a large number of observations. It also allows several sets of data to be presented on one graph (Watzlaf 2016, 351).

The following data fields comprise a database table: patient last name, patient first name, street address, city, state, zip code, patient date of birth. Given this information, which of the following is a true statement about maintaining the data integrity of the database table? a. Patient last name should be used as the primary key for the table. b. Patient date of birth should be used as the primary key for the table. c. None of the data fields are adequate to use as a primary key for the table. d. Patient last and first name should be used as the primary key for the table.

c A primary key must uniquely identify a record. None of the options provided will uniquely identify a record. Multiple individuals may have the same name and birth dates (Johns 2015, 127-128).

The Information Services Department has requested information about the electronic signature system being used in your facility. They would like to know the locations where physicians are accessing the system. Review the information in the table below and determine which site has the highest percentage of use. Community Hospital Electronic Signature System 500 Physicians on Staff; 489 Using the System Site No. of Physicians Using the System at This Site % of Physicians Using the System at This Site Medicine, 2 West 54 11.04% Medicine, 2 East 62 12.68% Pediatrics, 3 West 42 8.59% Obstetrics, 1 West 12 2.45% Physician's lounge 87 17.79% HIM department 65 13.29% Personal mobile device 92 18.81% Physician home 75 15.34% a. HIM department b. Obstetrics, 1 West c. Personal mobile device d. Physician home

c A table is an orderly arrangement of values that groups data into rows and columns. Almost any type of quantitative information can be grouped into tables. Columns allow you to read data up and down, and rows allow you to read data across. The columns and rows should be labeled. In this table, personal mobile device has the highest percent of physicians using the system (Horton 2016a, 249-250).

The coding department at Community Physician's Clinic developed the following report for the denials committee at the clinic. The billing report shows the following information. Using the information below, identify which payment source has the highest denial rate. Community Physician's Clinic Coding Department Denials - October, 20XX Payment Source Number of Claims Sent Number of Denials Percentage of Denials Medicare 460 43 9.35% Medicaid 345 35 10.14% Tricare/Military 182 14 7.69% Commercial payers 1307 83 6.35% Worker's Compensation 6 1 16.17% Total 2300 176 7.65% a. Medicare b. Commercial payers c. Worker's Compensation d. Tricare/Military

c A table is an orderly arrangement of values that groups data into rows and columns. Almost any type of quantitative information can be grouped into tables. Columns allow you to read data up and down, and rows allow you to read data across. The columns and rows should be labeled. In this table, the payment source with the highest denial rate is Worker's Compensation (Horton 2016a, 249-250).

Information that has been taken from the health records of injured patients and entered into the trauma registry database has been: a. Aggregated b. Mapped c. Abstracted d. Queried

c After trauma cases have been identified, information is abstracted from the health records of the injured patients and entered into the trauma registry database (Sharp 2016, 178).

Which of the following reportable diseases usually requires telephone reporting as opposed to other methods of reporting? a. Chicken pox b. Influenza c. Measles d. Pertussis

c All states have a health department with a division that is required to track and record communicable diseases. When a patient is diagnosed with one of the diseases from the health department's communicable disease list, the healthcare organization must notify the public health department. Measles usually requires immediate notification to the public health department. The other three need to be reported, but not necessarily immediately (Shaw and Carter 2015, 189).

Data found on sites such as Hospital Compare use aggregated data to describe the experiences of unique types of patients with one or more aspects of their care. This data collection is called: a. Patient-specific b. Aggregated c. Comparative d. Detailed

c Comparative data collection uses aggregate data to describe the experiences of unique types of patients with one or more aspects of their care. Hospital Compare is located on the CMS website and provides aggregate data of hospitals across the country (Shaw and Carter 2015, 428).

Data found on sites such as Hospital Compare use aggregated data to describe the experiences of unique types of patients with one or more aspects of their care. This data collection is called? a. Patient-specific b. Aggregated c. Comparative d. Detailed

c Comparative data uses aggregate data to describe the experiences of unique types of patients with one or more aspects of their care (Shaw and Carter 2015, 428).

The following table compares Community Hospital's pneumonia length of stay (observed LOS) to the pneumonia LOS of similar hospitals (expected LOS). Given this data, where might Community Hospital want to focus attention on its pneumonia LOS? LOS Summary for Pneumonia by Clinical Specialty Clinical Specialty Cases Observed LOS Expected LOS Savings Opportunity Cardiology 1 6 6.36 0 Family Practice 17 8.47 6.26 38 Internal Medicine 34 3.82 4.89 -36 Endocrinology 1 3 3.93 -1 Pediatrics 7 3.43 3.55 -1 a. Cardiology b. Endocrinology c. Family practice d. Internal medicine

c Family practice has the largest variance with the potential for the most savings (Shaw and Carter 2015, 95-97).

The HIM department recently performed an audit of health records. The audit showed that for the 10,000 records filed there was a 7 percent error rate. Given that the national average labor cost of each misfile is $200, what is the labor cost for the department for handling these misfiled records? a. $1,400 b. $14,000 c. $140,000 d. $285,714

c Filing accuracy can be checked by conducting a random audit of the storage area. To conduct a study, a section of the permanent file room can be checked for misfiles. Any files found are noted, and a filing accuracy rate can be determined and compared against the established standard. In this scenario, there was a 7 percent error rate for the 10,000 records filed in the sample. If the cost of each misfile is $200, this would cost the facility $140,000: (10,000 × 0.07) × $200 = $140,000 (Sayles 2016b, 66-67).

Given the following information, in which city is the GPCI the highest for practice expense? Sample Geographical Practice Cost Indices (GPCI) for Selected Cities City Work GPCI Practice Expense GPCI Malpractice Expense GPCI St. Louis 1.000 0.968 1.064 Dallas 1.009 1.001 0.969 Seattle 1.020 1.098 0.785 Philadelphia 1.015 1.084 1.619 a. St. Louis b. Dallas c. Seattle d. Philadelphia

c Geographic practice cost index (GPCI) is the number used to multiply each RVU so that it better reflects a geographical area's relative costs. The practice expense GPCI is higher in Seattle at 1.098 (Casto and Forrestal 2015, 152).

For research purposes, an advantage of the Healthcare Cost and Utilization Project (HCUP) is that it: a. Contains only Medicare data b. Is used to determine pay for performance c. Contains data on all payer types d. Contains bibliographic listings from medical journals

c Healthcare Cost and Utilization Project (HCUP) consists of a set of databases that are unique because they include data on inpatients whose care is paid for by all types of payers, including Medicare, Medicaid, private insurance, self-paying, and uninsured patients. Data elements include demographic information, information on diagnoses and procedures, admission and discharge status, payment sources, total charges, length of stay, and information on the hospital or freestanding ambulatory surgery center (Sharp 2016, 188).

Mr. Jones was admitted to the hospital on March 21 and discharged on April 1. What was the length of stay for Mr. Jones? a. 5 days b. 10 days c. 11 days d. 15 days

c Length of stay (LOS) is calculated for each patient after he or she is discharged from the hospital. It is the number of calendar days from the day of patient admission to the day of discharge (31 - 21) + 1 = 11 days (Horton 2016b, 390).

Community Hospital has been collecting quarterly data on the average monthly health record delinquency rate for the hospital. This graph depicts the trend in the delinquency rate. The hospital has established a 35 percent benchmark. Given this data, what should the hospital's Performance Improvement Council recommend? a. Continue tracking the delinquency rate to see if the last two quarters' trend continues b. Establish a higher benchmark to accommodate an increase in delinquent records c. Further analyze the data to determine why the benchmark is not being met d. Take an average of all the data points to arrive at a new benchmark

c Once a benchmark for each performance measure is determined, analyzing data collection results becomes more meaningful. Often, further study or more focused data collection on a performance measure is triggered when data collection results fall outside the established benchmark. When variation is discovered or when unexpected events suggest performance problems, members of the organization may decide there is an opportunity for improvement (Shaw and Carter 2015, 29).

David works for an organization that utilizes health record data to prove or disprove the efficacy of a healthcare treatment. What type of organization does David work for? a. Educational b. Policy-making c. Research d. Third-party payer

c Research organizations conduct medical research and include state disease registries such as the cancer registry, research centers, and others who explore diseases and their treatments (Sayles 2016b, 54-55). 133 Correct0 Wrong0 Unanswered133

A secondary data source includes ________. a. Vital statistics b. The medical record c. The physician's index d. A videotape of a counseling session

c Secondary data sources are data derived from primary sources and may be collected by someone other than the primary user. Secondary data sources are facility specific. The physician index is an example of a secondary data source (Horton 2016a, 5).

Based on this output table, what is the average coding test score for the beginner coder? Coding Test Score Coder Status Mean N Standard Deviation Advanced 93.0000 3 5.00000 Intermediate 89.5000 2 .70711 Beginner 73.3333 3 6.42910 Total 84.7500 8 10.51190 a. 93 b. 6.4 c. 73 d. 90

c Since the mean is the average and the value next to the "beginner" under coder status is 73.3333, round the value to a whole number and the best answer is 73 (Watzlaf 2016, 359).

Community Hospital performed a cost-savings analysis between its current paper-based, on-site coding processes and an e-WebCoding telecommuting model. Given the graph here, what does the cost analysis show? a. The current system saves more than the e-WebCoding system would. b. The current system reduces DNFB significantly. c. Cost comparison reflects a net reduction in overall expenses on a monthly basis for the e-WebCoding system. d. There is not enough information to make a determination.

c The data on the graph show there is a net reduction in overall expenses on a monthly basis for the e-WebCoding system. Learning to use data analysis tools and data aggregation techniques is important for improvement decisions. Making decisions based on actual experience and aggregate data is much better than making decisions based on intuition or gut feelings (Shaw and Carter 2015, 95-97).

Which rate is used to compare the number of inpatient deaths to the total number of inpatient deaths and discharges? a. Net hospital death rate b. Fetal/newborn/maternal hospital death rate c. Gross hospital death rate d. Adjusted hospital death rate

c The gross hospital death rate is the proportion of all hospital discharges that ended in death. It is the basic indicator of mortality in a healthcare facility. The gross death rate is calculated by dividing the total number of deaths occurring in a given time period by the total number of discharges, including deaths, for the same time period (Horton 2016b, 392-393).

Community Hospital discharged nine patients on April 1. The length of stay for each of the patients was as follows: for patient A, 1 day; for patient B, 5 days; for patient C, 3 days; for patient D, 3 days; for patient E, 8 days; for patient F, 8 days; for patient G, 8 days; for patient H, 9 days; patient I, 9 days. What was the median length of stay? a. 5 days b. 6 days c. 8 days d. 9 days

c The median is the midpoint of a frequency distribution. It is the point at which 50 percent of observations fall above and 50 percent fall below. Eight is the mid-point of the distribution where 50 percent of the observations fall above and below eight (Watzlaf 2016, 359).

A report that lists the ICD-10-CM codes associated with each physician in a healthcare facility can be used to assess the quality of the physician's services before he or she is: a. Scheduled for a coding audit b. Subjected to corrective action c. Recommended for staff reappointment d. Involved in an in-house training program

c The medical staff department is particularly interested in the ICD-10-CM codes associated with each physician. Because diagnostic codes can identify untoward events that occur during hospitalization, the quality of a physician's services can be identified through reports called physician reappointment summaries. These summaries outline the number of cases by diagnosis and procedure type, LOS, and infection and mortality statistics. At reappointment to a facility's medical staff, code-based reports are required. The medical staff department accumulates these reports and works with the elected or appointed medical staff leadership to ensure that a thorough analysis of each physician's activities takes place before he or she is reappointed to the staff (Schraffenberger and Kuehn 2011, 443).

In the scatter chart below what can be concluded about the relationship between age and income. a. There is a strong negative relationship between age and income b. There is no relationship between age and income c. There is a strong positive relationship between age and income d. There is not enough information to determine the relationship

c The scatter chart is showing a strong positive relationship between age and income because as age increases so does income. A negative relationship would show that as age increases income decreases, and that is not the case in this scatter chart example (Watzlaf 2016, 353).

Hospital A discharges 10,000 patients per year. Hospital B is located in the same town and discharges 5,000 patients per year. At Hospital B's medical staff committee meeting, a physician reports that he is concerned about the quality of care at Hospital B because the hospital has double the number of deaths per year than Hospital A. The HIM director is attending the meeting in a staff position. Which of the following actions should the director take? a. Make no comment since this is a medical staff meeting. b. Agree with the physician that the data suggest a quality issue. c. Suggest that the data be adjusted for possible differences in type and volume of patients treated. d. Suggest that an audit be done immediately to determine the cause of deaths within the hospital.

c When doing external benchmarking, the other organizations need not be in the same region of the country, but they should be comparable in terms of patient mix and size. The data from the two hospitals are not comparable because Hospital A discharges more patients than Hospital B. In addition, data on the comparability of severity of illness between the two hospitals is lacking and an informed decision cannot be made (Shaw and Carter 2015, 46).

Community Hospital's HIM department conducted a random sample of 200 inpatient health records to determine the timeliness of the history and physicals completion. Nine records were found to be out of compliance with the 24-hour requirement. Which of the following percentages represents the H&P timeliness rate at Community Hospital? a. 4.5% b. 21.2% c. 66.7% d. 95.5%

d A complete history and physical report represents the attending physician's assessment of the patient's current health status, and accreditation standards require it to be completed within 24 hours of admission. In this case, 191 instances of timely H&Ps out of 200 sampled is 95.5% accuracy. The calculation is (191/200) × 100 = 95.5% (Brickner 2016, 84; Horton 2016b, 383).

This type of chart plots all data points as a cell for two given variables of interest and, depending on frequency of observations in each cell, provides color to visualize high or low frequency. a. Barplot b. Scatter plot c. Boxplot d. Heatmap

d A heat map plots all data points as a cell for two given variables or interest, and depending on frequency of observations in each cell, provides color to visualize high or low frequency (Kellogg 2016a, 41).

If you want to display the parts of a whole in graphic form, what graphic technique would you use? a. Table b. Histogram c. Line graph d. Pie chart

d 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 (Watzlaf 2016, 351). 133 Correct0 Wrong0 Unanswered133

At Community Hospital, each full-time employee is required to work 2,080 hours annually. The table below shows the amount of time that four employees were absent from work over the past year. Community Hospital Health Information Management Department Coding Section Absentee Report Annual Statistics, 20XX Employee Name Vacation Hours Used Sick Leave Hours Used A 40 6 B 22 16 C 36 8 D 80 32 Which employee had the highest absentee rate? a. Employee A b. Employee B c. Employee C d. Employee D

d A rate is a ratio in which there is a distinct relationship between the numerator and denominator and the denominator often implies a large base population. Coder D had the highest absentee rate. In this situation the vacation hours used is added to the sick leave hours used and multiplied by 100 divided by 2,080 hours (for a full time employee). The absentee rate for each employee is calculated as follows: Coder A: [(40 + 6) × 100] / 2,080 = 4,600 / 2,080 = 2.21%; Coder B: [(22 + 16) × 100] / 2,080 = 3,800 / 2,080 = 1.826 = 1.83%; Coder C: [(36 + 8) × 100] / 2,080 = 4,400 / 2,080 = 2.115 = 2.12%; Coder D: [(80 + 32) × 100] / 2,080 = 11,200 / 2,080 = 5.38% (Horton 2016a, 23).

Which of the following is true about a primary key in a database table? a. Usually is not a unique number b. Changes in value c. Is dependent on the data in the table d. Uniquely identifies each row in a table

d Primary keys ensure that each row in a table is unique. A primary key must not change in value. Typically, a primary key is a number that is a one-up counter or a randomly generated number in large databases. A number is used because a number processes faster than an alphanumeric character. In large tables, this makes a difference. In the PATIENTS table, the PATIENT_ID is the primary key. It is good programming practice to create a primary key that is independent of the data in a table (Johns 2015, 127-128).

Analyze the following report of physician deficiency rates and determine which physician has the lowest deficiency rate for H&Ps completed within 24 hours of admission. Community Hospital Health Information Services Physician Documentation Deficiencies January 20XX Physician No. No. Admissions No. of H&Ps Not Completed within 24 Hours of Admission Rate of Deficiency 102 189 5 2.64 237 234 4 1.71 391 98 8 8.16 518 122 5 4.10 637 178 3 1.69 a. 102 b. 237 c. 391 d. 637

d A table is an orderly arrangement of values that groups data into rows and columns. Almost any type of quantitative information can be grouped into tables. Columns allow you to read data up and down, and rows allow you to read data across. The columns and rows should be labeled. In this table, the physician with the lowest rate of deficiency is number 637 (Horton 2016a, 249-250).

After the types of cases to be included in a registry have been determined, what is the next step in data acquisition? a. Case registration b. Case definition c. Case abstracting d. Case finding

d After the cases to be included have been determined, the next step is usually case finding. Case finding is a method used to identify the patients who have been seen or treated in the facility for the particular disease or condition of interest to the registry (Sharp 2016, 175).

The HIM data analytics professional is reviewing a chart (shown here) on nosocomial infections presented by the hospital's infection control committee. The committee is reporting that the decrease in infection rate has accelerated during the past 10 years. What comments should the data analytics professional make? a. Concur with the conclusion of the committee b. State that the greatest decrease in infection rate in a year took place in 2005 c. State that the greatest decrease in infection rate occurred in 1960 and 1970 d. Request a new data chart be presented that accurately reflects the trend of infection rate

d Both x and y axes are in unequal measures, so data are not accurately represented. Line graphs are used to display time trends as opposed to a histogram or bar chart (Watzlaf 2016, 351).

One of the questions on the patient satisfaction survey that is sent to the patient after discharge asks for the number of times the nurses checked the patient's vital signs in a day. This is an example of which type of data? a. Nominal b. Interval c. Qualitative d. Quantitative

d Healthcare data are divided into two broad categories of quantitative and qualitative data. Quantitative data are numeric while qualitative data describe observations. Quantitative data can be numerically counted. They deal with measurements (Horton 2016a, 322).

Recently, a state senator was admitted to your facility for a serious medical condition. The facility privacy officer has been tasked with reviewing access logs daily to determine which of the following? a. Whether or not the patient is fit to continue public service b. What information should be shared with the media c. That the patient has received adequate care d. Whether all access by hospital employees was appropriate

d In order to maintain patient privacy certain audits may need to be completed daily. If a high profile patient is currently in a facility, for example, access logs may need to be checked daily to determine whether all access to this patient's information by workforce is appropriate (Thomason 2013, 173). 133 Correct0 Wrong0 Unanswered133

Which of the following is an example of how an internal user utilizes secondary data? a. State infectious disease reporting b. Birth certificates c. Death certificates d. Benchmarking with other facilities (duplicate term?)

d Internal users of secondary data are individuals located within the healthcare facility. For example, internal users include medical staff and administrative and management staff. Secondary data enable these users to identify patterns and trends that are helpful in patient care, long-range planning, budgeting, and benchmarking with other facilities (Sharp 2016, 173).

Which of the following is an example of how an internal user utilizes secondary data? a. State infectious disease reporting b. Birth certificates c. Death certificates d. Benchmarking with other facilities

d Internal users of secondary data are individuals located within the healthcare facility. Internal users include medical staff and administrative and management staff. Secondary data enable these users to identify patterns and trends that are helpful in patient care, long-term planning, budgeting, and benchmarking with other facilities (Sharp 2016, 173).

The facility privacy officer is visited at the hospital by a recent patient that is concerned that her nosy neighbor, who happens to be a hospital employee, accessed her electronic health record inappropriately in order to tell other neighbors about the patient's health conditions. In order to determine this occurred, the privacy officer requests an audit log of activity within the patient's health record. What part of the audit log would the privacy officer need to first analyze to determine if this patient complaint is valid? a. The physician documentation from her recent stay regarding the patient's health conditions b. Whether the patient had requested any amendments to her record c. If the record has any deficiencies that would cause the record to be delinquent d. Which employees viewed, created, updated, or deleted information

d It is a requirement of the HIPAA Security Rule to implement ways that document access to information systems that contain electronic PHI. One of the ways to do this is to review the individuals that have viewed, created, updated, or deleted information within a health record. In this instance the Privacy Officer should review this information to determine if the patient complaint is valid (Thomason 2013, 177).

Given the following information, from which payer does the hospital proportionately receive the least amount of payment? Payer Charges Payments Adjustments Charges Payments Adjustments BC/BS $450,000 $360,000 $90,000 23% 31% 12% Commercial $250,000 $200,000 $50,000 13% 17% 6% Medicaid $350,000 $75,000 $275,000 18% 6% 36% Medicare $750,000 $495,000 $255,000 39% 42% 33% TRICARE $150,000 $50,000 $100,000 7% 4% 13% Total $1,950,000 $1,180,000 $770,000 100% 100% 100% a. BC/BS b. TRICARE c. Medicare d. Medicaid

d Medicaid charges are larger than the charges to commercial insurance and TRICARE; however, the facility receives a smaller payment from Medicaid. There is an adjustment of 36 percent, meaning that the facility had to adjust their charges 36 percent from the actual amount billed and the amount they receive in payment (Watzlaf 2016, 347; Gordon and Gordon 2016a, 423).

Which of the following uniquely identifies each record in a database table? a. Data definition b. Data element c. Foreign key d. Primary key

d Primary keys ensure that each row in a table is unique. A primary key must not change in value. Typically, a primary key is a number that is a one-up counter or a randomly generated number in large databases (Johns 2015, 127-128).

Which of the following is used to plot the points for two variables that may be related to each other in some way? a. Force-field analysis b. Pareto chart c. Root cause analysis d. Scatter diagram

d Scatter diagrams are used to plot the points for two continuous variables that may be related to each other in some way. For example, one might want to look at whether age and blood pressure are related. One variable, age, would be plotted on the vertical axis of the graph, and the other variable, blood pressure, would be plotted on the horizontal axis (Watzlaf 2016, 353).

A consumer nonprofit organization wants to conduct studies on the quality of care provided to Medicare patients in a specific region. An HIT professional has been hired to manage this project. The nonprofit organization asks the HIT professional about the viability of using billing data as the basis for its analysis. Which of the following would not be a quality consideration in using billing data? a. Accuracy of the data b. Consistency of the data c. Appropriateness of the data elements d. Cost to process the data

d Several factors must be addressed when assessing data quality. These include: data accuracy, consistency, completeness, and timeliness. Cost to process the data does not influence the quality (Brinda 2016, 157-158).

A celebrity injured while on vacation was admitted to the local community hospital for treatment of a fracture. On day two of the admission, the hospital was contacted by several media agencies stating that they were aware the patient was at the facility and requesting information about the current medical condition of this high profile celebrity patient. The CEO is concerned that an employee has shared information to the media regarding this patient. The facility privacy officer was tasked with determining if a facility employee leaked this information to the press. How would the privacy officer begin this analysis? a. Create a new policy about high-profile patient privacy b. Start by discussing the situation with the media to resolve their inquiries c. Make contact with employees in the facility d. Review audit trail information to determine which employees have accessed this patient's information

d The HIPAA Security Rule requires that access to electronic PHI in information systems is monitored. Included in the same standard is the requirement that covered entities examine the activity using access audit logs. Often they record time stamps that record access and use of the data elements and documents; what was viewed, created, updated, or deleted; the user's identification; the owner of the record; and the physical location on the network where the access occurred. Reviewing the audit trail information would be the first step to identify all employees who have accessed this patient's information (Thomason 2013, 177).

As part of your job duties, you are responsible for reviewing audit trails of access to patient information. All of the following are types of activity that you would monitor except: a. Every access to every data element or document type b. Whether the person viewed, created, updated, or deleted the information c. Physical location on the network where the access occurred d. Whether the patient setup an account in the patient portal

d The HIPAA Security Rule requires that access to electronic PHI in information systems is monitored. Included in the same standard is the requirement that covered entities examine the activity using access audit logs. Often they record: time stamps that record access and use of the data elements and documents; what was viewed, created, updated, or deleted; the user's identification; the owner of the record; and the physical location on the network where the access occurred. Creation of an account through the patient portal by the patient is appropriate use (Thomason 2013, 177).

Community Hospital had a total of 3,000 inpatient service days for the month of September. What was the average daily census for the hospital during September? a. 10 patients b. 96.77 patients c. 97 patients d. 100 patients

d The average daily census is the average number of inpatients treated during a given period of time. There are 30 days in September, so 3,000 / 30 = 100 (Horton 2016b, 387).

In which type of distribution are the mean, median, and mode equal? a. Bimodal distribution b. Simple distribution c. Nonnormal distribution d. Normal distribution

d The normal distribution is where data follows a symmetrical curve. The normal distribution is actually a theoretical family of distributions that may have any mean or any standard deviation. In a normal distribution, the mean, median, and mode are equal (Watzlaf 2016, 361).

Which term is used to describe the number of inpatients present at the census-taking time each day plus the number of inpatients who were both admitted and discharged after the census-taking time the previous day? a. Inpatient bed occupancy rate b. Bed count c. Average daily census d. Daily inpatient census

d The result of the official count taken at midnight is the daily inpatient census. This is the number of inpatients present at the official census-taking time each day. Also included in the daily inpatient census are any patients who were admitted and discharged the same day (Horton 2016b, 386).

Which of the following is the unique identifier in the relational database patient table? Patient Table Patient # Patient Last Name Patient First Name Date of Birth 021234 Smith Donna 03/21/1944 022366 Jones Donna 04/09/1960 034457 Smith Mary 08/21/1977 a. Patient last name b. Patient last and first name c. Patient date of birth d. Patient number

d The unique identifier in the patient table is the patient number. It is unique to each patient. Patient last name, first name, and date of birth can be shared with other patients, but the identifier will not be shared (Sayles and Trawick 2014, 56).

Community Hospital is using a system that will help them detect when intracranial pressure becomes high in patients with a recent CVA that will quickly send an alert to the physician. This is an example of ________. a. Descriptive analytics b. Predictive analytics c. Prescriptive analytics d. Real-time analysis

d Unlike retrospective analytical tools, such as predictive modeling, real-time analytics refers to data that can be accessed as they come into a computer system. Real-time analytics, also referred to as streaming analytics, implies instantaneous results; however, the data may not be immediately available, but rather available within a few minutes. The most valuable data in this category are those that are collected and analyzed during the customer interaction, not the review afterward (Horton 2016a, 325).