Chapters 7&8 Quiz Review

Question 1

accountability measures

Answer 1

specifically refers to Joint commission system that measures quality and accountability for treatment of certain diagnosis such as a myocardial infarction (heart attack)

there are specific measures that the organization will meet for accreditation

Question 2

allowed charges

Answer 2

the maximum amount Medicare (or any 3rd party payer) will reimburse for services

Question 3

ambulatory payment classifications (APCs)

Answer 3

• payment system for ambulatory stay

are assigned to certain outpatient encounters (for example, ambulatory surgery, emergency department visits, or blood transfusions) and are based on the CPT codes assigned to each service

Question 4

copy (cut) and paste

Answer 4

the copying of previous encounter that may or may not be accurate for the current encounter

-can lead to note bloat-documenting more than actually applies to the current encounter, such as past medical problems that no longer exist but are being carried forward to future encounters

Question 5

designated record set (DRS)

Answer 5

as defined by HIPAA

any records maintain by a covered entity that are used for patient care to make payment decisions, such as

health records
billing records
insurance enrollment records,
insurance claims
coverage decisions

Question 6

Hospital Acquired Conditions (HAC)

Answer 6

Diagnoses that appeared after a patient was admitted but which perhaps should not have occurred- for instance a urinary tract infection in a patient who was catharized while hospitalized or a fall that resulted in a fracture

Question 7

Hospital Readmission Reduction Program (HRP)

Answer 7

part of the affordable care act

a program that requires CMS to reduce payments to hospitals with excessive readmission rates

Question 8

Incident (occurrence) report

Answer 8

data collected about any abnormal occurrence involving a patient, a visitor, or an employee that detail the circumstances surrounding the incident and are used in the facility’s internal investigations

-it is never filed as part of the patient’s record, nor is the report itself referred to in the record since its purpose is that of an internal investigation tool.

Question 9

MS-DRG

Answer 9

payment system for the in patient stay–

-takes into account severity of illness and resource utilization and results in a more accurate computation of the costs incurred to care for each patient

Question 10

Pioneer ACO Program

Answer 10

an ACO Model for hospitals and care providers who have experience with coordinating care for patients across the continuum of care (across different care settings)

Question 11

Provider network

Answer 11

A network of hospitals, physicians, ambulatory clinics, and so forth with which a managed care insurance plan contracts to provide services to enrollees at an agreed upon reduced rate, saving the enrollee out of pocket expenses for medical care; often referred to as “in Network”

Question 12

Resource-based relative value scale (RBRVS)

Answer 12

reimbursement method used by Medicare and Medicaid to reimburse physicians according to a fee schedule that is based on weights assigned to resources used to provide the services. Including

cost of work performed
the expenses incurred to operate a medical practice
cost of malpractice insurance

and that is adjusted based on the geographic region where the practice is located

Question 13

The HIPAA-Designated Record Set

Answer 13

DRS- Any group of any records maintained by a covered entity including

• patients’ medical and billing records as maintained by (or for) the healthcare provider
• enrollment, payment, claims adjudication (determination of whether the plan will pay and the amount), and case management or medical management record systems maintained by or for a health plan
• medical records that are used in whole or in part by the covered entity to make decisions about individuals

Question 14

The Health Record in Assessing Quality

Answer 14

• Assessing the quality of healthcare and healthcare documentation is performed by audits done internally through quality assessment and externally through outside agencies
• HIM professions are responsible to understand the flow of information as well as data sources within the organization and to use this to supply information to governing board of the institution to make educated decisions

Question 15

Internal quality assessment

Answer 15

focuses on qualitative analysis of health records

Question 16

Quantitative analysis

Answer 16

ensures required reports and signatures are present

Question 17

Qualitative analysis

Answer 17

focuses on the content of each report and ensures that the information on the report is complete, accurate, and thorough

Question 18

Digital records can be

Answer 18

analyzed using software programs that identify completeness and accuracy as well as chart bloat

Question 19

External quality assessment

Answer 19

initiatives are required by the Joint Commission as well as the CoP

“hospitals must develop, implement, and maintain an effective, ongoing, hospital wide, data driven quality assessment and performance improvement program”

Question 20

Utilization management

Answer 20

is performed to review the appropriateness of admission and facility services

Question 21

Professional Standards Review Organization (PSROs)

Answer 21

perform periodic reviews on utilization and quality on behalf of the federal government

Question 22

Peer Reviews

Answer 22

organization that replaced PSROs to perform medical necessity and quality of care monitoring

which contain recommendations from peers inside the organization, are a benefit

Question 23

Hospital Quality initiative

Answer 23

helps to assure quality healthcare through accountability and public disclosure

Question 24

A core measurement system using accountability measures

Answer 24

by the Joint Commission to measure the quality and safety of healthcare

Question 25

Quality Improvement (QI)

Answer 25

is an ongoing program that is supported by the organization’s governing board with the goal to regularly improve quality of all levels

• Plan, Do, Study, Act (PDSA)
• Plan, Do, Check, Act (PDCA)
• Six Sigma

Question 26

Benchmarking

Answer 26

provides a way for organizations to identify areas for improvement using public information on the performance or outcomes

Question 27

What is the health record used for?

Answer 27

Risk management activities to identify, evaluate and control areas of risk within an organization

Question 28

Data Compiled on incidence reports

Answer 28

documenting abnormal occurrences are used in assessing the controlling risk

Question 29

Health Information professionals

Answer 29

are responsible for reporting inappropriate documentation

Question 30

Private health insurance, Blue Cross

Payment Model

Answer 30

began in the 1920s and soon group health insurance through employers became the norm

Question 31

The Hill-Burton Act (1946)

Payment Models

Answer 31

provided a way for more hospitals to be built and for improved facilities to be added

Question 32

Title XVII of the Social Security Act AKA Medicare

Payment Model

Answer 32

became effective in 1966

Medicare covers US citizens and legal residents who are 65 years of age and older or who receive Social Security Disability Insurance (SSDI). Also covered are patients with end-stage renal disease or other conditions, such as ASL. Other Qualifications include having paid into the fund through a payroll tax or having paid into the Railroad Retirement fund.

Question 33

Medicaid

Answer 33

a federal program run through each state, was developed to assist low-income individuals with healthcare costs

Coverage required by Federal government includes inpatient hospital services, out patient hospital services, diagnostic laboratory and radiology, skilled nursing long term care, some home health services, physicians office visits, special programs for family planning, the services of a nurse midwife, vaccines for children, rural healthcare, and some periodic screening services (mammograms or colonoscopy)

Question 34

TRICARE

Answer 34

was designed to provide health coverage for active armed service personnel and their dependents and retirees

Question 35

Premium

Answer 35

amount paid for health coverage

Question 36

Meaningful Use Stage 1

Answer 36

the capture and sharing of data by EHRs and health information exchange

Question 37

Meaningful Use Stage 2

Answer 37

advancing clinical outcomes through improved measurement and patient-directed exchange

Quality and coordination of care

Question 38

Meaningful Use Stage 3

Answer 38

improved outcomes through coordination of element built under the earlier stages

Question 39

logical Observation Identifiers Names and Codes (LOINC)

Answer 39

Standard for coding laboratory
Standard required under all stages of meaningful use
used to identify and code laboratory observations (eg test results) to be exchanged between labs, providers, and other steak holders

Question 40

Affordable Care Act

Answer 40

designed to change both healthcare delivery and payment models

Question 41

HITECH

Answer 41

is centered on the digital capture, exchange, and analysis of clinical and financial patient records and the efficient use of these records

Goals are to-

achieve improved patient outcomes
lower healthcare costs

The programs funded by HITECH ensure that tax dollars are being well spent and that resulting system support interoperability

Question 42

American Recovery and Reinvestment Act

Answer 42

designed to change both healthcare delivery and payment models

Question 43

HIM Professional

Answer 43

progression of meaningful use means that patient data are going to be used in more places and for new uses. as such the responsibilities of health information management will increase and more healthcare workers with a wide variety of job responsibilities will need to understand HIM principles and guidelines

Question 44

The ONC Health IT standards Committee focuses on what three broad areas?

Answer 44

• Clinical Operations
• Clinical Quality
• Privacy and Security

Question 45

Vaccine Administered

Answer 45

standard for immunization messages. The CDC develops and maintains CVX codes under HL-7. The use of CVX standards is required for the immunization objectives encompassed under Meaningful Use

Question 46

RxNorm

Answer 46

standard for pharmacies

provides for the normalization of names for clinical drugs used in pharmacy management and drug interaction software

Question 47

Health Information Exchange (HIE)

Answer 47

is the efficient and effective exchange of electronic health data with other healthcare-related entities

• States are responsible to develop their own strategic plan for HIE and commonly choose a Health Information Organization to run the exchange of information while ensuring privacy and security

Question 48

List the Role of HIE

Answer 48

efficient and effective exchange of electronic health data with other healthcare-related entities

States are responsible to develop their own strategic plan for HIE and commonly choose a Health Information Organization to run the exchange of Information while ensuring privacy and security

Question 49

What is the ONC policy?

Answer 49

(add more from 218) to encourage Health Information Exchange and Promote it as a Verb

Question 50

What are Benefits of Health Information exchange?

Answer 50

Patient generated data

Electronic disease surveillance

Reduction in redundant tests

Question 51

What does Direct Messaging Service do?

Answer 51

sends patient data as attachments

Question 52

Compliance coordinator (or could be manager) is often resonsible

Answer 52

for managing questions about the legal health record

Question 53

Covered HIPAA entities do include

Answer 53

health insurance companies

Question 54

The JC maintains

Answer 54

a database of its intuitions quality reports

Question 55

The MPI is a crucial aspect of

Answer 55

quality assurance checks

• ensure the right patient
• ensure there isn’t duplicates

Question 56

Risk management has only been recognized since?

Previous to this what where hospitals viewed as?

Answer 56

Risk management-areas of risk are identified for instance a high infection rate for a particular nursing unit

1970s

Previous to this hospitals were viewed as charitable organizations

Question 57

Prior to 1966 elderly people may not have had access to

Answer 57

health care

Question 58

Present on Admission documentation ties to

Answer 58

reimbursement to quality of care

POA- chronic or comorbid conditions, such as the presence of diabetes mellitus or hypertension, which the patient contracted prior to admission

Question 59

covered entity

Answer 59

is any health plan (insurance or third party payer), clearinghouse (an entity that verifies that coded diagnoses and procedures are valid and in the proper format). or healthcare provider who stores, processes, and transmits any identifiable health information electronically

Question 60

The HIPAA Legal Health Records

Answer 60

LHR-information available to physicians, nursing staff, and ancillary staff on which diagnostic and treatment decisions are made, as opposed to what is protected by the HIPAA privacy rule in the case of the DRS

**each organization will follow federal Guidelines for HIPAA and they will follow their state law for what can be released to whom