ANSWERS | WITH COMPLETE SOLUTION.
At which level of the Medicare Part A or B appeals process is the appeal
reconsidered by a qualified independent contractor?
a. first level appeal
b. second level appeal
c. third level appeal
d. fourth level appeal Answer - b. second level appeal
There are five levels of appeal.
First level entails a redetermination of claim; second level involves
reconsideration by a qualified independent contractor; third level includes a
hearing overseen by admin law judge; fourth level is a review of Medicare
Review Council; and fifth level is a judicial review in federal court.
If an at-risk patient is left unattended and has an adverse response to
medication, this is known as:
a. sentinel event
b. initiator
c. latent outcome
d. slip Answer - a. sentinel event
Sentinel event is an adverse occurrence that is not in the normal progression of
a patient's illness. In this scenario, an adverse drug event is considered a
,sentinel event. AND whenever a sentinel events is confirmed, the facility
should perform a Root Cause Analysis (RCA).
A Latent Outcome - less apparent failures of organization or design that
contributed to the error/patient harm.
A Slip - can be a fall or an everyday risk at hospitals.
A behavioral health specialist notices a particularly high number of restraint
deaths at a facility. An analysis of the root causes of these events is most likely
to indicate problems with:
a. Equipment
b. Staff orientation and training
c. Staffing levels
d. Alarm systems Answer - b. Staff orientation and training
Equipment, staffing levels, and alarm system can also be culpable in restraint
deaths, but problems with orientation and training are much more likely.
Which piece of legislation established a new set of standards for corporate
responsibility?
a. sarbanes-oxley act
b. united states patriot act
c. foreign corrupt practices act
d. stark law Answer - a. sarbanes-oxley act
Sarbanes-oxley act was passed after a series of high-profile financial scandals in
early 2000s to protect shareholders, improving corporate governance and
accountability setting new set of standards for corporate responsibility.
, According to the Federal Sentencing Guidelines, which of the following factors
could increase the punishment of an organization?
a. obstruction of justice
b. violation of direct court order
c. prior history of violations
d. all of the above Answer - d. all of the above
These are aggravating factors that increase the culpability score under the FSG.
See FSG chapter 8-C2.5 https://guidelines.ussc.gov/gl/%C2%A78C2.5
When a hospital official notes that most errors are occurring at the "sharp end"
she means that:
a. they involve surgical tools or knives
b. they occur in clusters
c. they occur during the interactions between caregivers and patients
d. they are most likely to occur during busy periods Answer - c. they occur
during the interactions between caregivers and patients.
The "sharp end" and "blunt end" are used by quality management
professionals to describe areas of practice.
"Sharp end" is all of the operations that involve direct contact with
patient/client/customer.
"Blunt end" is all actions that take place outside awareness of
patient/client/customer.
The majority of fraud and abuse violations relate to irregularities in:
a. treatment
b. diagnosis