RHIT Quality and PI

The type of indicator about the placement and number of fire extinguishers would be a(n) structure. outcome. process. regulation.

structure.

A plaintiff must establish which burden of proof to recover damages for medical negligence or malpractice? 1. A breach of the duty to care by the defendant. 2. Damages or injury from the defendant's negligence. 3. Duty of care relationship between defendant and patient. 4. Causation for harm to plaintiff from defendant's conduct. 1, 2, 3, and 4 1 and 3 Only 1

1, 2, 3, and 4

Clinical privileges are granted to the physician for an interval specified in the medical staff by laws, but not longer than 1 year. 3 years. 6 months. 2 years.

2 years.

Which department will most likely be responsible for taking corrective action regarding the following quality indicator? QUALITY INDICATOR: Number of insurance claims requiring resubmission due to errors (not related to coding) will not exceed 3%. Medical Staff Office Health Information Department Business Office

Business Office

According to current theory in the quality management field, should concurrent data collection or retrospective data collection be utilized? Concurrent and retrospective data collection methods are both necessary in order to effect meaningful interventions and contain costs. Retrospective data collection methods alone are appropriate in the reimbursement realities of this decade. Concurrent data collection methods alone are meaningful because they emulate health practitioner training.

Concurrent and retrospective data collection methods are both necessary in order to effect meaningful interventions and contain costs.

Which quality management theorist focused on zero defects as the goal of performance improvement efforts? Deming Crosby Peters Kaizen

Crosby

Which of the following is a disadvantage of retrospective data collection? Deficiencies in documentation can effect reimbursement. Reviewer bias is reduced. Data are all available. Fewer data collectors are required.

Deficiencies in documentation can effect reimbursement.

Which data bank is a result of HIPAA legislation? Health Care Integrity and Protection Data Bank National Practitioner Data Bank Fraud and Abuse Data Bank Privacy Information Breach Data Bank

Health Care Integrity and Protection Data Bank

Which department will most likely be responsible for taking corrective action regarding the following quality indicator? QUALITY INDICATOR: The number of DRG validation changes made by the QIO will not exceed 2%. Health Information Department Business Office Medical Staff Office Admissions

Health Information Department

What federal legislation passed in 1986 gave immunity from legal action to practitioners regarding some peer review process activities? Patient Protection and Affordable Care Act (PPACA) Utilization Review Act Health Insurance Portability and Accountability Act (HIPAA) Healthcare Quality Improvement Act

Healthcare Quality Improvement Act

The Anesthesia Department is adding a new indicator to its plan. The Chief Anesthesiologist has come to you, the Director of Quality Management, to help her design a data collection methodology. The two of you are now considering who will be doing the data collection. All of the following are factors in your deliberations EXCEPT the expertise of the staff. quality management organizational model of the institution. Joint Commission standards and required characteristics. the location of data.

Joint Commission standards and required characteristics.

Which department will most likely be responsible for taking corrective action regarding the following quality indicator? QUALITY INDICATOR: Ninety-five percent (95%) of physician appointments/reappointments will be completed within 90 days of receipt of all required materials. Admissions Medical Staff Office Health Information Department

Medical Staff Office

The Recovery Audit Contractor (RAC) program was developed to identify and reduce improper payments for collection of overpayments. Medicare claims. Medicaid claims. Medicare claims and collection of overpayments.

Medicare claims.

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

NCQA.

What feature distinguishes the Nominal Group Technique (NGT) from brainstorming? NGT can be accomplished by mail. NGT determines the importance of responses through a rating system. NGT draws responses from a large group of people. NGT uses a visual device like a flip chart to keep track of responses.

NGT determines the importance of responses through a rating system

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

National Patient Safety Goals (NPSG).

The desk is has a huge influx of calls on Mon, Tues, and Wed. This creates a problem in getting pt information out within a time frame. The staff has agreed to record the reason for phone calls. They want to solve the response-time problem by reducing the turnaround time for the largest category of phone calls. Which QI tool is best? scatter diagram run chart Pareto chart control chart

Pareto chart

A culture and sensitivity report was returned to the inpatient unit of Brian Hospital. The sensitivity showed bacterial resistance to the current antibiotic the patient was receiving. The patient continued on the same antibiotic without improvement. A generic quality screen identified this case for review. At a minimum, which committee should review this case? Information Governance Committee Safety Committee Pharmacy and Therapeutics Committee

Pharmacy and Therapeutics Committee

A surgeon left a clamp in a patient, resulting in a return to the operating room. In an integrated organizational quality management model, all of the following entities would receive data about the investigation EXCEPT the Credentials Committee. Pharmacy and Therapeutics Committee. Risk Management Program. Tissue Committee.

Pharmacy and Therapeutics Committee.

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

Plan, Do, Study, Act.

The Joint Commission recently surveyed an acute care hospital. The hospital just received the survey report and the accreditation decision. Which of the following categories should the hospital leaders address first? Grid Elements Triennial Exception Rules Requirements for Improvement Written Progress Reports

Requirements for Improvement

What criterion is critical in selecting performance indicators for a health information management department? Select only indicators that reflect positively on the department. Indicators must correlate with Deming's 14 points. The indicators must include the most important aspects of performance.

The indicators must include the most important aspects of performance.

Which of the following is incorrect about the use of control charts? The lower control limits are always ± 2 standard deviations. Control charts can be used to measure key processes over time. The upper control limits are always ± 1.8 standard deviations. The upper and lower control limits are always ± 2 standard deviations. The upper control limits are always ± 1.8 standard deviations.

The upper control limits are always ± 1.8 standard deviations.

Which quality management theorist believed that merit raises, formal evaluations, and quotas established through benchmarking hinder worker productivity and growth? Philip Crosby Joseph Juran W. Edwards Deming Brian Joiner

W. Edwards Deming

The QI plan for your hospital requires each coder maintain a minimum of 94.5% accuracy in coding. You manage the coding department, and the past year's average accuracy rating was 95.3%. The QI plan allows a standard deviation (SD) of ±2 against the minimum of 94.5% accuracy. Did your coding staff's overall average meet within standard deviation range? No, because it is > ±2 above SD Yes, within ±2 above SD No, because it is > ±2 below SD Yes, within ±2 below SD

Yes, within ±2 above SD

What feature is a trademark of an effective PI program? a continuous cycle of improvement projects over time a one-time cure-all for a facility's problems an unmanageable project that is too expensive a cost-containment effort

a continuous cycle of improvement projects over time

What quality improvement (QI) tool uses criteria to weigh different alternatives? This display would assist in viewing all relevant information at the same time. a flowchart a decision matrix the PDSA method a customer satisfaction survey

a decision matrix

Your hospital is required by the Joint Commission and CMS to participate in national benchmarking on specific disease entities for quality of care measurement. This required collection and reporting of disease-specific data is considered risk assessment. a series of core measures. a group of sentinel events. an environment of care.

a series of core measures.

As the new Coding Manager, you met with the coding staff to encourage feedback on ways to increase coding accuracy to meet established benchmarks. The coders provided feedback through brainstorming that you compiled on flipcharts and organized into categories. This is known as a(n) nominal group technique. affinity diagram. cause-and-effect diagram. flow process chart.

affinity diagram.

The Blood Usage Review Committee has a quality monitor established to review all blood transfusion reaction cases. The HIM Director will be working with the committee to identify and abstract patient outcome information for committee evaluation. What data should be collected? type and cross-match accuracy all relevant data. justification for the transfusion

all relevant data.

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

an increase in 5010 rejections

The Joint Commission requires health care facilities manage the environment of care by implementing seven (7) various safety plans, which must be evaluated at least quarterly. annually. biannually. monthly.

annually.

The current hospital policy time frame for authenticating verbal orders adheres to the CMS COP that requires the ordering physician, or another health care practitioner responsible for the care of the patient, to write orders according to hospital policy and authenticate both on physician's time schedule. based on the severity of the illness. within 12 hours. as per governmental and facility policies.

as per governmental and facility policies.

The hospital Quality Department adopted the Lean Management quality model using JIT, which ensures required process items and resources are always kept stocked in Central Processing. available at the right place and the right time. automatically restocked to maintain a surplus. for the correct patient, using the correct procedure, at the correct site.

available at the right place and the right time.

The Joint Commission has a standard stating that a hospital must plan and design information management processes to meet _____________ information needs. patient record external both internal and external internal

both internal and external

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

both system tracers and patient tracers.

You sit on the quality improvement team for the Nursing department that meets to generate ideas to address verbal order documentation problems about the "Read Back Verbal Order" policy. What QI tool would prove useful in sharing input and various recommendations for solving this problem? brainstorming flowchart check sheet scatter diagram

brainstorming

HEDIS gathers data in which of the following areas? prenatal care severity of illness indicators average length of stay breast cancer screenings

breast cancer screenings

Surgical case review includes all the following EXCEPT determination of surgical justification based on clinical indication(s) in cases where no tissue has been removed. cases with serious surgical complications or surgical mortalities. cases with elements missing in the preoperative anesthesia consultation. cases with elements missing in the preoperative anesthesia consultation.

cases with elements missing in the preoperative anesthesia consultation.

The primary advantage of concurrent quality data collection is that practitioners receive immediate feedback about patient processes and outcomes. multiple chart reviews eliminate collector bias. staffing is decreased. chart completion issues can be remedied promptly.

chart completion issues can be remedied promptly.

The responsibility for performing quality monitoring and evaluation activities in a departmentalized hospital is delegated to the chairman of the board of trustees. chief executive officer. director of utilization management. clinical chairpersons of medical staff committees or ancillary department directors.

clinical chairpersons of medical staff committees or ancillary department directors.

The hospital implemented an electronic query system to allow more effective communication with physicians and other health practitioners to improve clinical documentation in the patient record. This program is known as core measure reporting. evidence-based medicine. clinical documentation improvement (CDI). tumor registry (TR).

clinical documentation improvement (CDI).

The Utilization Review Coordinator reviews inpatient records at regular intervals to justify necessity and appropriateness of care to warrant further hospitalization. Which of the following utilization review activities is being performed? continued stay review retrospective review admission review preadmission

continued stay review

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

control chart

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

control chart

Continuous quality improvement is best described by the following statements EXCEPT standards are defined, measured, and systematically applied. corrective action targets clinicians more so than processes. monitoring is ongoing with periodic feedback. all personnel support quality improvement efforts, including top management and the governing body.

corrective action targets clinicians more so than processes.

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

credentialing

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

critical quality tree.

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

implementation of OTRA.

An ophthalmologist has requested permission to perform specialized laser procedures within the hospital. His request is evaluated by the Credentials Committee through a process to determine the specific procedures and services this physician can perform. This is known as delineation of privileges. discharge planning. reappointment. medical staff evaluation.

delineation of privileges.

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

diabetes.

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

discharged

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

due process

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

evidence-based medicine

As an HIM coding supervisor, you are asked to compare the current coding process with a proposed concurrent coding process. What visual tool would be the best to identify all the logical steps and sequence of each procedure? decision matrix cause and effect diagram flowchart checksheet

flowchart

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

graphically display a performance improvement project conducted.

In quality review activities, departments are directed to focus on clinical processes that are expensive. most commonplace. low volume. high risk.

high risk.

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

institutional review board (IRB).

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

intracycle monitoring.

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

key performance indicator

Which of the following processes is mandatory for health care facilities? accreditation certification AHA registration licensure

licensure

Major responsibilities of the Risk Manager generally include defining PHI. evaluating HIE data. vetting physician appointment applicants. loss prevention and reduction.

loss prevention and reduction.

As Director of the HIM department, you are asked to chair a committee that will review, select, and implement a CPOE system. The information has been collected, and you bring your committee together to prioritize their suggestions. This method of working with information is known as correlation analysis. Delphi process. force field analysis. nominal group process.

nominal group process

As supervisor of the record completion function of the HIM department, you are asked for record completion statistics for specific physicians who are being evaluated for reappointment to the medical staff. Which of the following information elements would you report for each physician? number of delinquent records prior physician malpractice claims history physician education and training

number of delinquent records

Patient mortality, infection and complication rates, adherence to living will requirements, adequate pain control, and other documentation that describe end results of care or a measurable change in the patient's health are examples of outcome measures. incident reports. threshold level. sentinel events.

outcome measures.

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

outcomes indicator.

What process assists a health care facility in continuously looking at the ways that problems develop and seeking ways to prevent problems from happening in the future? quality control utilization management performance improvement risk management

performance improvement

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

petechiae due to adverse drug reaction.

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

planning

When the policy and procedures manual no longer reflect current practices, it creates a situation that becomes a risk management issue because policy and procedures should represent the normal course of business. training of new personnel will not be standardized. supervisory time and effort will be wasted to correct the manual.

policy and procedures should represent the normal course of business.

The manager of the utilization review department wants to monitor and evaluate the prevention of inappropriate admissions. When would the manager need to collect data? long-term care review retrospective review prospective review concurrent review

prospective review

The manager of the Quality Department is listing various sources of data. Which of the following data sources would be an example of an external source? emergency room logs incident reports quality improvement organization (QIO) information patient registration and admission, discharge, transfer (ADT) information

quality improvement organization (QIO) information

The PQRS is a reporting system established by the federal government for physician practices who participate in Medicare for monetary incentives. credentialing. meaningful use incentives. quality measure reporting.

quality measure reporting.

The medical malpractice crisis of the 1970s prompted the development of _____________________ in health care facilities. risk management quality improvement programs utilization management financial analysis programs

risk management

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

scatter diagram

Most acute care facilities use this type of screening criteria for utilization review purposes to determine the need for inpatient services and justification for continued stay. Joint Commission defined and developed criteria Health Plan Employer Data & Information (HEDIS) measures severity of illness/intensity of service criteria (SI/IS) critical pathways

severity of illness/intensity of service criteria (SI/IS)

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

surgical review.

What quality indicator would prove useful in tracking customer satisfaction in the correspondence/release of information function? the number of medical record personnel required to perform the function the amount of overtime necessary to stay current the turnaround time from the date a request is received to the date the information is provided to the requester

the turnaround time from the date a request is received to the date the information is provided to the requester

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

using imaging guidance on all procedures

With the passage of Medicare (Title XVIII of the Social Security Act) in 1965, which of the following functions became mandatory? utilization review risk management quality assessment quality improvement

utilization review

The credentialing process requires healthcare facilities to review and file the provider's resume. interview previous patients. query the NPDB to collect and report malpractice judgement and settlements. watch the provider perform surgery.

watch the provider perform surgery.