Question 1

The policy and procedure manual no longer reflects current practices. This situation is a risk management issue because

Accepted Answer

The answer of The policy and procedure manual no longer...

Question 2

The responsibility for performing quality monitoring and evaluation activities in a departmentalized hospital is delegated to the

Accepted Answer

In a departmentalized hospital, the responsibility for performing quality monitoring and evaluation activities is delegated to the clinical chairpersons of medical staff committees or ancillary department directors. These individuals have the operational and clinical knowledge necessary to oversee quality in their respective areas of responsibility. The director of utilization management, chairman of the board of trustees, and chief executive officer may have oversight responsibilities for quality, but the day-to-day monitoring and evaluation activities are best left to those with direct operational responsibility.

Question 3

Clinical privileges are granted to the physician for an interval specified in the medical staff bylaws, but not longer than

Accepted Answer

Clinical privileges are granted to the physician for an interval specified in the medical staff bylaws, but not longer than 2 years. After this time period, the physician must undergo the reappointment process to retain their privileges.

Question 4

The Utilization Review Coordinator reviews inpatient records at regular intervals to justify necessity and appropriateness of care'to warrant further hospitalization. Which of the following utilization review activities is being performed?

Accepted Answer

The activity being described is a continued stay review, which is performed during a patient's hospitalization to determine if further hospitalization is necessary and appropriate. Admission review occurs at the time of a patient's admission to the hospital, pre-admission occurs before a patient is admitted to the hospital, and retrospective review occurs after a patient has been discharged from the hospital.

Question 5

With the passage of Medicare (Title XVIII of the Social Security Act) in 1965, which of the following functions became mandatory?

Accepted Answer

With the passage of Medicare, utilization review became mandatory. Utilization review is the process of evaluating and monitoring the use of healthcare services to ensure that they are necessary and appropriate, and that they meet certain standards of quality. This was an important step towards controlling healthcare costs and improving the quality of care provided to Medicare beneficiaries.

Question 6

The Joint Commission recently surveyed an acute care hospital. The hospital just received the survey report and the accreditation decision. Which of the following categories should the hospital leaders address first?

Accepted Answer

The hospital leaders should address the Requirements for Improvement (RFIs) first because these are areas where the hospital is not meeting standards and requires improvement in order to maintain accreditation. The other categories, such as Grid Elements and Written Progress Reports, are important but may not be as urgent as addressing the RFIs. Triennial Exception Rules also may not be relevant if the hospital is not seeking an exception.

Question 7

What quality indicator would prove useful in tracking customer satisfaction in the correspondence/release of information function?

Accepted Answer

The most useful quality indicator for tracking customer satisfaction in the correspondence/release of information function would be the turnaround time from the date a request is received to the date the information is provided to the requester. This measures how quickly the function is able to fulfill customer requests, which is a critical factor in determining customer satisfaction. The other options (A, B, and C) do not directly measure customer satisfaction and are not as relevant to the function's performance in meeting customer needs.

Question 8

What criterion is critical in selecting performance indicators for a medical record department?

Accepted Answer

The most critical criterion in selecting performance indicators for a medical record department is that the indicators must include the most important aspects of performance. This ensures that the indicators are relevant and meaningful to the department's goals and objectives. It is not necessary to identify a specific number of indicators or to choose indicators that reflect only positively on the department. While it is helpful for indicators to align with Deming's 14 points, it is not a critical criterion.

Question 9

Most health care facilities use this type of screening criteria for utilization review purposes to determine the need for inpatient services and justification for continued stay.

Accepted Answer

Severity of illness/intensity of service criteria (SI/IS) is the most commonly used screening criteria for utilization review purposes to determine the need for inpatient services and justification for continued stay. SI/IS criteria assess the severity of the patient's illness and the intensity of services required to manage it. This helps to ensure that patients are receiving appropriate levels of care in the most appropriate setting. Critical pathways and Joint Commission defined and developed criteria are also used in utilization review but are more focused on ensuring that patients receive care in accordance with evidence-based guidelines and best practices. HEDIS measures are used to evaluate health plan performance and measure quality of care, but are not typically used in the same way for utilization review purposes.

Question 10

The primary source document used in quality assessment monitoring is the

Accepted Answer

The medical record is the primary source document used in quality assessment monitoring as it contains detailed information about the patient's medical history, treatment plan, and outcomes. The admission and discharge register, procedure index, and diagnosis index may contain useful information, but they are not as comprehensive as the medical record.

Question 11

The coding supervisor is responsible for reviewing a random sample of each coder's work and reporting on the error rate for each coder. A check sheet is used to collect the number of char reviewed, the number of errors for each coder, and the type of errors. What types of graphs orj charts could be used to report the information gathered?

Accepted Answer

All of the mentioned charts can be used to report different aspects of the data: bar charts for comparing error rates, Pareto charts for identifying the most common types of errors, and histograms for showing the distribution of errors.

Question 12

Major responsibilities of the Risk Manager generally include

Accepted Answer

The major responsibilities of a Risk Manager include loss prevention and reduction, liability claims management, and participation in safety and security programs. Thus, option D - all of the above is the correct answer.

Question 13

The Blood Usage Review Committee has a quality monitor established to review all blood transfusion reaction cases. The HIM Director will be working with the committee to identify and abstract patient outcome information for committee evaluation. What data should be collected?

Accepted Answer

All of the choices should be collected in order to fully evaluate and understand the transfusion reaction cases. The effects of the transfusion reaction are important to determine the severity and potential harm caused. Type and cross-match accuracy should be evaluated to prevent future errors. Justification for the transfusion is important to determine if it was appropriate and necessary.

Question 14

The HIM department is asked to pull records for review by the Quality Improvement Organization (QIO). The QIO reviewers analyze records to ensure that health care services are

Accepted Answer

The Quality Improvement Organization (QIO) reviewers analyze records to ensure that health care services are rendered according to appropriate professional standards, medically necessary, and performed in the most efficient, effective, and economical manner. Therefore, all the choices (A, B and C) are correct.

Question 15

The process of comparing the outcomes of HIM abstracting functions at your facility with those of comparable departments of superior performance in other health care facilities to help improve accuracy and quality is referred to as

Accepted Answer

The process described is benchmarking, which involves comparing one's own performance to that of high-performing organizations in order to identify areas for improvement. Focused review, peer review, and occurrence screening may be related to quality improvement but do not specifically involve comparing performance to other organizations.

Question 16

What feature distinguishes the Nominal Group Technique (NAT) from brainstorming?

Accepted Answer

The distinguishing feature of the Nominal Group Technique is that it determines the importance of responses through a rating system, whereas brainstorming does not have a formalized system for evaluating the importance of ideas. Option A is incorrect because brainstorming can also be done through virtual means. Option B is incorrect because both techniques use visual aids to track responses. Option C is incorrect because both techniques involve gathering ideas from a group of people.

Question 17

In compiling statistics to report the specific cause of death for all open-heart surgery cases, the quality coordinator assists in documenting

Accepted Answer

Documenting the specific cause of death for open-heart surgery cases is a way of reporting patient care outcomes.

Question 18

The effective coordination of utilization review, quality assessment functions, and risk management activities can help eliminate

Accepted Answer

Effective coordination can help eliminate duplicate record review by streamlining processes and ensuring that reviews are not unnecessarily repeated.

Question 19

Needlesticks, patient or employee falls, medication errors, or any event not consistent with routine patient care activities would require risk reporting documentation in the form of an

Accepted Answer

The best choice is incident report because it is the standard form used to document any event that deviates from routine patient care activities and has the potential to result in harm to patients or employees. Operative report and emergency room report are only used to document specific medical procedures or visits, respectively. Insurance claim is not the appropriate form for documenting an event, but rather a request for reimbursement or coverage for a specific expense.

Question 20

The medical malpractice crisis of the 197Os prompted development of what type of programs in health care facilities?

Accepted Answer

The medical malpractice crisis of the 1970s prompted the development of risk management programs in health care facilities to identify and reduce potential risks and errors that could result in malpractice claims. Utilization management, financial analysis, and quality improvement programs are all important aspects of health care operations, but they were not necessarily developed specifically in response to malpractice concerns.

Exam 1: Registered Health Information Administrator