Quality Assurance and Compliance

Question 1

Quality Assurance Definition

Answer 1

Correlation of appropriate tests and test results with patient care modalities to ensure the highest quality of treatment

Question 2

Quality Control Definition

Answer 2

A systematic group of activities that recognizes errors and assures that results are correct,

Question 3

Quality Assurance purpose and goals

Answer 3

QA is a proactive process involving all levels of the lab that identifies problems and the necessary corrective actions to resolve these problems, also must follow up to make sure these corrective actions are working.

Question 4

Quality Assessment/Assurance Monitors what 3 phases of testing?

Answer 4

Pre-analytical, analytical and post-analytical

Question 5

How do you document your QA activities?

Answer 5

1. Date and initials of person reviewing the problem.
2. Scope and analysis of the problem
3. Document corrective action and effectiveness of it.
4. Document that the issue has been discussed with relevant staff, directors and supervisors.
5. Retain documentation for 2 years

Question 6

What is a Compliance plan ?

Answer 6

A plan to assist laboratories in devising internal controls that foster adherence to federal and state laws and regulations, especially important to Medicare and Medicaid.

Question 7

7 Elements of a Compliance plan include:

Answer 7

1. Written Policies and Procedures
2. A compliance officer and committee
3. Compliance training for staff
4. Hotline to anonymously report suspected violations
5. A system to respond to and take disciplinary actions against violators
6. Internal monitoring and audits of the system
7. Investigation and correct compliance problems

Question 8

The laboratories role in medical necessity. *

Answer 8

They should only submit claims that they believe are medically necessary. They should have requisitions containing ICD-10 forms supporting medical necessity. They should monitor test utilization over time.

Question 9

Stark Law *

Answer 9

Prohibits a physician from making referrals to a laboratory with which the physician or a family member has a financial relationship.

Question 10

Fair Labor Standards Act (FLSA) *

Answer 10

Requires minimum wage and overtime of one and a half rate

Question 11

Learned Professionals such as Medical Technologists are *

Answer 11

Exempt from the Fair Labor Standards Act

Question 12

HIPPA definition

Answer 12

Health Insurance Portability and Accountability Act of 1996

Question 13

HIPPA Title I

Answer 13

Focus on Health Care Access, Portability, and Renewability. Regulates availability of health insurance policies, requires coverage for existing conditions,

Question 14

HIPPA Title II

Answer 14

Preventing Health Care Fraud and Abuse. PRIVACY RULE except under certain circumstances. Transaction and code sets rule, Security rule which pertains to electronic PHI, Unique Identifiers Rule, Enforcement Rule to make violators pay penalties.

Question 15

HIPPA Title III

Answer 15

Tax-related Health Provisions Governing Medical Savings Accounts, amounts and availability

Question 16

HIPPA Title IV

Answer 16

Application and Enforcements of Group Health Insurance Requirements. Specifies conditions for health plans to cover existing conditions and continuation of coverage, COBRA.

Question 17

HIPPA Title V

Answer 17

Revenue Offset Governing Tax Deductions for Employers, prohibits tax-deduction of interest life insurance loans, company endowments, or contacts.

Question 18

?????HIPPA Covered Entity and Business Associates

Answer 18

HIPPA only applies to covered entities such as Health Care Providers, and those laboratories that do not conduct transactions electronically????

Question 19

What is Protected Health Information (PHI)?

Answer 19

Individually identifiable health information transmitted by covered entity or its business associate in any form which is protected by the HIPPA Privacy rule.

Question 20

PHI includes?

Answer 20

Names, geographical, dates, Phone or fax #’s, email, social security, medical record, health ins., account #’s, license #’s, photos, or any other identifiers.

Question 21

When can PHI be released without prior authorization?

Answer 21

Child abuse, FDA, disease exposure, employer for OSHA, law enforcement, public health surveillance.

Question 22

Civil and Criminal Violations of HIPPA

Answer 22

Fines vary depending on willful neglect and whether it is an individual or an organization.