Extra Focus

Question 1

Skilled nursing facilities (SNF), commonly called nursing homes, provide 24 hour nursing care and assistance with daily living. Residence include the elderly as well as younger patients with permanent or temporary disabilities. How long will Medicare cover an SNF stay?
A.  3 to 120 days
B.  4 to 90 days
C.  3 to 100 days
D.  2 to 45 days

Answer 1

C. 3 to 100 days

Rationale: skilled nursing facility, SNF, stays can be as brief as three days, and as long as 100 days per benefit period.

Question 2

Client empowerment primarily requires:
A.  Intellectual capacity
B.  Institutional support
C.  Options, authority, and action
D.  Time and effort

Answer 2

C. Options, authority, and action

Rationale: Ford certified patient advocates provide clients with information and resources to facilitate informed decision making regarding care and treatment, including palliative and end-of-life care. Clients need to have sufficient information about their health conditions and about healthcare systems and processes in order to become a knowledgeable partner and decision making.

Question 3

Mr. Andrews has been discharged after spending five days in the hospital. He requires daily dressing changes for an open wound. How many days will Medicare part A pay for home health?
A.  60 days
B.  90 days
C.  30 days
D.  100 days

Answer 3

D. 100 days

Rationale: Medicare part A also pays for home health. It covers the first 100 visits following a three day inpatient stay or SNF stay and there is no co-pay or deductible.

Question 4

What percentage of Americans have difficulty accessing care?
A.  More than 15%
B.  More than 30%
C.  More than 10%
D.  More than 25%

Answer 4

D. More than 25%

Rationale: 85% of Americans report having a regular source of ongoing care, but more than 25% encounter difficulty accessing the healthcare system.

Question 5

A legal document that specifically that specifically designates someone to make decisions regarding medical and end of life care if a client is mentally incompetent is an:
A.  Durable power of attorney
B.  Advance directive
C.  Do not resuscitate order, DNR
D.  General power of attorney

Answer 5

A. Durable power of attorney

Rationale: a durable power of attorney, POA, enables a person to appoint an agent, such as a trusted relative, friend, or attorney to handle specific health, legal, and financial responsibilities.

Question 6

A decision by a patient about a diagnostic or therapeutic procedure based on choice, which requires the decision to be voluntary by the person who asked to understand information and make decisions on a set of values and goals is the definition of:
A.  Informed consent
B.  Ethical standard
C.  Shared decision making
D.  Empowerment

Answer 6

C. Shared decision making

Rationale: informed decision making, also known as shared decision support, a decision by patient about a diagnostic or therapeutic procedure based on choice, which requires the decision to be voluntary by the person who has the capacity to understand information and make decisions on a set of values and goals.

Informed decision making = Shared decision making

Question 7

Which of the following represents a barrier to providing adequate cultural care in the US?
A. Lack of alternative medicine providers
B. Lack of adequate translation services
C. Lack of disease burden in racial and ethnic minority populations
D. Lack of caring by medical staff

Answer 7

B. Lack of adequate translation services

Rationale: consumers do not have adequate translation services, nor do healthcare staff have sufficient training to communicate across cultures.

Question 8

Susan’s client is on Medicare. She has congestive heart failure and diabetes. On average she will see how many different positions each year?
A.  21
B.  5
C.  3
D.  13

Answer 8

D. 13

Rationale: Medicare beneficiaries, on average, C5 different positions a year, and those with chronic diseases, such as chronic heart failure, coronary artery disease, and diabetes, see an average of 13 different physicians a year.

Question 9

What is the percentage of medication errors after leaving the hospital for patients over 65?
A.  30%
B.  40%
C.  55%
D.  70%

Answer 9

B. 40%

Rationale: studies have shown that as many as 40% of patients over 65 had medication errors after leaving the hospital, and 18% of Medicare patients discharge from the hospital are readmitted within 30 days.

Question 10

Which chronic condition is the most prevalent and expensive?
A.  Alzheimer’s disease
B.  Diabetes
C.  Heart failure
D.  Cancer

Answer 10

C. Heart failure

Rationale: heart failure is the most prevalent and expensive chronic disease in the US.

Question 11

With Medicare, the benefit period ends:
A. 30 days after discharge from an inpatient facility
B. 150 days after discharge from an inpatient facility
C. 60 days after discharge from an inpatient facility
D. At the time of discharge from an inpatient facility

Answer 11

C. 60 days after discharge from an inpatient facility

Rationale: the benefit. Begins when the person is first advantage of the hospital and ends when the person has been out of the hospital with skilled nursing facility for 60 consecutive days.

Question 12

A Medicare advantage plan, MAP, is an:
A. Supplemental (Medigap) insurance plan administered by private insurance companies
B. Plan approved by Medicare but administered by private insurance companies
C. Optional plan administered by Medicare
D. Form of Medicaid for Medicare recipients

Answer 12

B. Plan approved by Medicare but administered by private insurance companies

Rationale: Medicare part C is also called Medicare advantage, it allows beneficiaries to enroll in a private insurance plan (like an eight outside HMO), which will cover all regular Medicare benefits and may cover more or require reduced co-pays and deductibles.

Question 13

A legal document that directs the healthcare provider/agency in who to contact for approval/consent of treatment decisions or options whenever the patient is no longer deemed competent to decide for self is known as a:
A.  Advanced directive
B.  Living will 
C.  Legal surrogate
D.  Healthcare proxy

Answer 13

D. Healthcare proxy

Rationale: a healthcare proxy is a legal document that directs the healthcare provider/agency and who to contact for approval/consent of treatment decisions or options whenever the patient is no longer deemed competent to decide for self.

Proxy = who

Question 14

Mrs. Ross has diabetes, heart failure, and COPD. Which of the following represents a barrier to self management?
A. Her daughter and grandchildren live with her
B. Her PCP is part of a PCMH
C. She lives in a rural part of the community
D. She has not signed up for Medicare part D

Answer 14

C. She lives in a rural part of the community

Rationale: many rural areas do not have adequate Internet access hampering her ability to access applications they can track chronic conditions such as heart failure and diabetes, medical records and communicate with providers virtually.

Question 15

Mr. Green is 45 and has exhausted all treatment options for his glioblastoma. His cancer is slow-growing and he is expected to live for at least another eight months. He asks Robert if he is eligible for hospice care. What is Roberts best answer?

Yes, Hospice can provide support for months.

Answer 15

Rationale: Hospice can provide support for months. Even though many people believe that Hospice is only available in the last days or weeks of life, it can provide support for months. However, Medicare pays for hospice care if the clients physician believes the client has six months or less to live, the cancer does not respond to treatment, and the clients medical condition does not improve.

Question 16

Under the health insurance portability and accountability act (HIPAA) regulations, Hein to request copies of imaging results must receive them within:
A.  24 hours
B.  30 days
C.  48 hours
D.  14 days

Answer 16

B. 30 days

Rationale: under HIPAA regulations, clients to request copies of imaging results and other records must generally receive them within 30 days. The request may have to be submitted in writing, and the client may have to pay for any costs, such as CDs, copying, and mailing.

Question 17

Which patient Bill of Rights for bids the transfer of patients when they refuse certain kinds or levels of care?
A. National Institute of health patient Bill of Rights
B. Hospice Association of America patient Bill of Rights
C. Affordable care act patient protections
D. American hospital association patient bill of rights

Answer 17

D. American hospital association patient Bill of Rights

Rationale: the AHA Bill of Rights requires humane and dignified treatment, for bids transferring patients when they refuse certain kinds or levels of treatment, and requires medical professionals to treat people with HIV/AIDS.

Question 18

Our patient referrals and transitions should meet the six Institute of medicine (IOM) aims of high-quality healthcare.

STEEP:
Safe, Timely, Effective, Efficient, Equitable, Patient-centered

Answer 18

The 6 IOM aims of high quality health care:

1. Safe: referrals at transitions are planned and managed to prevent harm to patients from medical or administrative errors
2. Timely: patients receive needed transitions and consultative services without unnecessary delays
3. Effective: referrals and transitions are based on scientific knowledge, and executed well to maximize their benefit
4. Efficient: referrals and transitions are limited to those that are likely to benefit patients, and avoid unnecessary duplication of services
5. Equitable: the availability and quality of referrals and transitions does not vary by the personal characteristics of patients
6. Patient centered: referrals and transitions are responsive to patient and family needs and preferences

Question 19

The Jones family still has $105 to the hospital where their son was born. How many points can this drop their credit score?
A.  60 to 80 points
B.  20 to 40 points
C.  100 to 150 points
C.  40 to 60 points

Answer 19

C. 100 to 150 points

Rationale: medical debt Cano longer affective consumers credit score if it totals less than $100. Medical debt can have a profound effect on a credit score, with even one small missed bill, dropping a score 100 to 150 points

Question 20

The division of the federal government that enforces privacy standards is:
A.  OIG
B.  OCR
C.  HIPAA 
D.  OSHA

Answer 20

B. OCR

Rationale: office of civil rights, 0CR, is the federal government division that enforces the privacy standards.

Question 21

What is the percentage of people with medical debt who have to reduce spending on food, clothing and basic household items?
A.  About 70%
B.  About 55%
C.  About 80%
D.  About 65%

Answer 21

A. About 70%

Rationale: overall, about seven and 10 reports cutting back or delaying vacations or major household purchases (72%) as well as reducing spending on food, clothing, and bass hook household items 70%).

Question 22

A client who needs help with gaining independence and performing baseline activities of daily living should receive which of the following:
A.  Audiologist
B.  Occupational therapy
C.  Psychologist
D.  Rehabilitation

Answer 22

B. Occupational therapy

Rationale: occupational therapist help people with medical conditions and disabilities achieve greater function and independence in their lives by promoting meaningful activities or occupations. The goal of occupational therapy is to improve patient’s performance and participation in every day life activities, thereby improving well-being.

Question 23

The most common type of prescribing or ordering air with medications is:
A.  Wrong route
B.  Wrong medication
C.  Wrong patient
D.  Wrong dose

Answer 23

D. Wrong dose

Rationale: the most common types of prescribing or ordering error involved the wrong dose. A clinicians reliance on prior information can lead to this kind of prescribing error.

Question 24

What is the percentage of medical bills reported to collection that are the result of billing or administrator of errors?
A.  10%
B.  5%
C.  20%
D.  30%

Answer 24

C. 20%

Rationale: an estimated 20% of all medical bills that are reported to collection are the result of a billing or other administrative error, affecting the credit of about 7 million Americans.

Question 25

Which reimbursement method gives providers a blank check?
A.  Fee-for-service
B.  Cost based reimbursement
C.  Prospective payment
D.  Charge based

Answer 25

B. Cost based reimbursement

Rationale: under cost based reimbursement, providers are given a blank check in regards to acquiring facilities and equipment and incurring operating costs. If payers reimburse providers for all costs, the incentive is to acquire more costs. Furthermore, services that may not truly be required will be provided because more services lead to higher costs and Hance lead to higher revenues.

Question 26

The most cost-effective solution for an elderly client with mild moderate Alzheimer’s disease you can no longer stay alone while her primary get her giver works part time outside the home is:
A.  Adult day care program
B.  Home health agency
C.  Residential care facility
D.  Adult day health care program

Answer 26

A. Adult day care program

Rationale: an adult daycare program designed for Alzheimer’s clients is the most cost-effective solution. These programs vary but average about $65 a day, and summer supported by grants to offset the cost for these with low incomes. I Adult day healthcare programs or health focus programs with RNs and therapists available with costs depending on services utilize. Residential care facilities may cost from $2000-$8000 or more monthly. Home health agencies charge on an hourly basis, usually about $25 per hour for an eight.

Question 27

Which type of error is common, but receives less attention?
A.  Transcription errors
B.  Medication errors
C.  Diagnostic errors 
D.  Surgical errors

Answer 27

C. Diagnostic errors

Rationale: diagnostic errors have received comparatively less attention, despite the fact that landmark patient safety studies have consistently found the diagnostic error is common.

Question 28

Which of the following is not one of the main types of compensation for healthcare services?
A.  Episode of care
B.  Pay for performance
C.  Fee for service
D.  Capitation

Answer 28

B. Pay for performance

Rationale: there are three main types of compensation for healthcare services. They are fee for service, capitation an episode of care.

Question 29

Roberts client has determined that she wants to pursue a clinical research study to help her manage her chronic illness. What is the next step?
A. Establish a goal and timeframe
B. Create a list of assets and liabilities
C. Assess the motivations of the decision makers
D. Determine outcomes of success

Answer 29

A. Establish a goal and time frame

Rationale: first, the patient advocate establishes a goal and timeframe for completion with the client. His client will need to pick the study (and a back up), determine if she needs eligibility requirements, and it rolls in the study.

Question 30

Which of the following is a major contributor to diagnostic errors?
A.  Lack of experience
B.  Clinician bias 
C.  Delayed results
D.  Primary care doctor shortage

Answer 30

B. Clinician bias

Rationale: an extensive body of research has examined the causes of diagnostic error at the individual clinician level. This work has been informed by the field of cognitive psychology, which studies how individuals process information and subsequently develop plans. As applied to healthcare, we have learned that clinicians frequently use heuristics which are short cuts or rules of thumb to come up with a provisional diagnosis, especially when faced with a patient with common symptoms.

Question 31

Betty is covered by Medicare A.  If she is admitted to rehabilitation hospitalIzation, the admission of functional independence measure, FIM, assessment must be obtained during the first:
A.  24 hours
B.  72 hours
C.  5 days
D.  48 hours

Answer 31

B. 72 hours

Rationale: the FIM score must be a pain within 3 days or 72 hours for a client covered by Medicare A for rehabilitation hospitalization.

Question 32

Which patient Bill of Rights for bids annual dollar limits on coverage?
A. National Institute of health patient Bill of Rights
B. American hospital association patient bill of rights
C. Hospice Association of America patient Bill of Rights
D. Affordable care act patient protections

Answer 32

D. Affordable care act patient protections

Rationale: the patient protection and affordable care act of 2010 places limits on what insurance companies can and cannot do, including annual dollar limits on Coverage.