Random

Question 1

Utilization Review Act of 1977

Answer 1

Utilization Review act requires hospitals to conduct a continued-stay review on all Medicare and Medicaid patients admitted in the hospital to determine if their continued stay is medically necessary.

Question 2

Deterministic Algorithms

Answer 2

Deterministic Algorithms is used in searching the Master Patient Index (MPI) for exact match of data elements like date of birth or social security number to find overlays or overlaps of patient’s information.

Question 3

Overlay

Answer 3

2 separate patients who have their medical information mixed together in one chart

Question 4

Overlap

Answer 4

One patient with multiple health records at different locations in the same health system.

Ex: maiden name registered at outpatient clinic, married name registered inpatient admission.

Question 5

Duplicate

Answer 5

One patient has multiple record numbers in one facility.

Example registered with a middle initial or registered with error inputting date of birth.

Question 6

HEDIS

Answer 6

Healthcare Effectiveness Data and Information Set. (HEDIS) from the NCQA it collects administrative data, claims data, and health record review data related to patient outcomes and effectiveness. Basically tracking quality of care.

Question 7

LIS

Answer 7

Laboratory Information System
Part of acute care setting this system will receive and order for lab work, generate a specimen work list, print specimen labels, create an accession number to track specimen and receive results.

Question 8

RIS

Answer 8

Radiology Information System (RIS) part of the hospital system it receives the order for a procedure, scheduled it, notifies personnel to perform procedure, tracks results

Question 9

OASIS

Answer 9

Outcomes and assessments Information set. It is the data set for skilled home health care of Medicare and Medicaid patients.

Think “my home is my oasis”

Question 10

UHDDS

Answer 10

Uniform Hospital Discharge Data Set (UHDDS)
A data set required by HHS for acute care setting (inpatient hospital) they used CMS 1450 claim form or UB04 & 837i electronic claim form to collect this data

Question 11

PAI

Answer 11

Patient Assessment Instrument it is Assessment tool completed at admission and discharge of a REHABILITATION facility.

Question 12

RAI

Answer 12

Resident Assessment Instrument (RAI) required by the federal govt a critical component to the LONG-Term care record. It is the care plan format based on MDS, triggger conditions, utilization guidelines, care area Assessments. Residents are assessed and reassessed every 60 days or earlier depending on condition. RAI is submitted to the state health dept then into CMS. Surveyors use this information

Question 13

CLIA

Answer 13

Clinical Laboratory Improvement Amendments (CLIA)
Regulates the QUALITY of lab testing and would prohibit access. A Covered Entity (CE) can deny a patient access to PHI without opportunity to review or appeal.

Question 14

> 50 years and PHI

Answer 14

over 50 years a deceased patients records are no longer protected by HIPAA.

Question 15

Omnibus Rule

Answer 15

2013 modification to ARRA and HITECH strengthen privacy and security makes CE and BA liable for compliance, limits PHI disclosure for marketing, research, fundraising.

Question 16

ARRA 2009-HITECH title xiii

Answer 16

HITECH- Allocated funds for implementing nationwide HIE.

ARRA- requires govt to develop standards by establishing ONC (office of national coordinator for HIT)

4 components of the bill:
Meaningful use EhRs will improve patient outcomes
Breach notification guidelines

EHR standards and certification
Regional support to get EHR up and running

Question 17

OIG

Answer 17

Office of the Inspector General issues annual guidelines for compliance to healthcare providers. OIG protects the integrity of HHS programs including CMS

Question 18

Stark Law

Answer 18

Physician self-referral law won’t allow physicians to refer patient to services where the doc would benefit.

Question 19

Anti kickback Act

Answer 19

Criminal offense if a referral is made knowing there is a reward or remuneration. The exception is the Safe Harbour Regulation that describe various payment or business practices that are not criminal

Question 20

EMTALA

Answer 20

Emergency Medical Treatment and Labor Act. The patient anti-dumping statute. Part of Consolidated Omnibus Budget Reconciliation Act (COBRA). Hospitals ER have to treat and stabilize patient before transferring regardless of ability to pay.

Question 21

Histogram

Answer 21

Chart frequency distribution and uses continuous data

Question 22

Scatter chart

Answer 22

Demonstrate relationship between two variables stronger the relationship the closer in line

Question 23

Line chart

Answer 23

Shows changes over time. Trends. Continuous data

Question 24

Bar chart

Answer 24

Describes qualitative , categorical or discrete variables