Domain 5 Flashcards
During the Utilization Review Committee meeting, a case presented for discussion involved a surgical case resulting in unexpected loss of lower extremity below the knee due to complications requiring extended length of stay. Being a Sentinel event, the committee requested that an investigation and reporting was required to identify the cause and prevention of future occurrences. This investigation and required reporting to the Joint Commission is known as: A. Root cause analysis B. Potential compensate event C. Medication review D. Clinical report card
A. Root cause analysis (RCA) is a method of problem solving used for identifying the root causes of faults or problems
After a review of the patients record it was discovered there was no history and physical on the record at seven hours passed this patient’s admission time. This would be a sample of: A. Quantitative analysis B. Qualitative analysis C. Data mining D. Data warehousing
A. Quantitative analysis
Quantitative analysis refers to economic, business or financial analysis that aims to understand or predict behavior or events through the use of mathematical measurements and calculations, statistical modeling and research
The director wants to implement benchmarking for transcription at a clinic. There are 21 transcriptionists who average about 140 lines per hour. They support 80 physicians at a cost of 15 ents per line. What is the first step the director takes to establish benchmarks for this group?
A. Define what is to be studied and accomplished by instituting benchmarks
B. Hold a meeting to announce benchmark program
C. Obtain benchmarks from other institutions
D. Hire a consultant
A. Define what is to be studied and accomplished by instituting benchmarks. Benchmarking is comparing one’s business processes and performance metrics to industry bests and best practices from other companies
In qualitative analysis we ensure documentation supports the diagnosis. What documentation would a coder look for to substantiate the diagnosis of aspiration pneumonia?
A. Diffuse parenchyma lung disease on x-ray
B. Patient history of inhaled food, liquid or oil
C. Positive culture of Pneumoncystis Carinii
D. Positive culture for Streptococcus pneumonia
B. Patient history of inhaled food, liquid or oil
The United States federal government’s Medicare substitutes compliance with the Conditions of Participation requirements to hospitals that already have accreditations awarded by various other agencies that include Joint Commission, CARF, AOA, AAAHC. This is known as : A. Deemed status B. Due process C. Contingency statutory D. Waived status
A. Deemed status
Health care organizations that achieve accreditation through Joint Commission deemed status survey are determined to meet or exceed Medicare and Medicaid requirements
The primary objective of quality in healthcare both patient and provider is to:
A. Keep costs under control
B. Reduce death rates
C. Reduce the incidence of infectious diseases
D. Arrive at the desired outcomes
D. Arrive at the desired outcomes
Which of the following is not a responsibility of an organization’s quality management department?
A. Help departments to identify potential clinical quality problems
B. Participating in regular department meetings across the organization
C. Conduct medical peer review to identify patterns of care
D. Determining the method of studying potential problems
C. Conduct medical peer review to identify patterns of care
A coding supervisor who makes up the weekly work schedule would engage in what type of planning? A. Long range B. Operational C. Tactical D. Strategic
B. Operational
Operational planning is the process of planning strategic goals and objectives to tactical goals and objectives
This data set was developed by the National Committee for Quality Assurance to aid consumers with health related issues with information to compare performance of clinical measures for health plans: A. HEDIS B. UHDDS C. UACDS D. ORXYX
A. HEDIS
The healthcare Effectiveness Data and Information set (HEDIS) is a tool used by more that 90 percent of America’s health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 81 measures across 5 domains of care.
A key feature of performance improvement is:
A. Replacing unstructured decision making
B. Developing managers to control processes
C. An endless loop of feedback
D. Continuous cycle of improvement
D. Continuous cycle of improvement
The Joint Commission on site survey process incorporates tracer methodology, which emphasizes surveyor review by means of: A. Patient tracer B. System tracers C. Both system and patient tracers D. Policy and procedure manual reviews
C. Both system and patient tracers
In this case management step, the case manager confirms that the patient meets criteria for the care setting and depth of services can be provided at the facility.
A. Pre-admission care planning
B. Care planning at the time of admission
C, review the progress of care
D. Discharge planning
B. Care planning at the time of admission
Every organization’s risk management plan should include the following components except: A. Loss prevention and reduction B. Safety and secrurity management C. Peer review D. Claims management
C. Peer review
A standard of performance or best practice for a particular process or outcome is called a(an): A. Performance Measure B. Benchmark C. Improvement opportunity D. Data measure
B. Benchmark
Benchmarking is comparing one’s business processes and performance metrics to industry bests and best practices from other companies
A patient satisfaction survey conducted post discharge is a method of quality measure through: A. Prospective indicator B. Structured indicator C. Process indicator D. Outcome indicator
D. Outcome indicator
Out come indicators are measures that describe how well we are achieving our outcomes. They help us know whether things are changing in the way we intended
