CHC Practice Test Complete Solutions

CHC Practice Test Complete Solutions 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 Ans- 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 Ans- 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 Ans- 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 Ans- 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 Ans- d. all of the above These are aggravating factors that increase the culpability score under the FSG. See FSG chapter 8-C2.5 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 Ans- 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 c. billing d. scheduling Ans- c. billing Which of the following words best describe the approach to punishment of the Federal Sentencing Guidelines: a. case-specific b. draconian c. consistent d. remedial Ans- a. case-specific FSG takes numerous factors into account when determining punishment. The range of penalties that may be applied to a given violation is broad, and organizations may affect the severity of their punishment with their actions subsequent to the violation Which of the following groups may request information from the Healthcare Integrity and Protection Data Bank? a. professional societies with formal peer review b. quality improvements organizations c. plaintiff's attorneys d. state agencies Ans- d. state agencies Other groups may include federal government, health plans, healthcare practitioners. Researchers are only allowed to obtain statistical data form the data bank. Research suggests that the largest proportions of adverse events attributable to negligence occur in the: a. post-trauma unit b. surgery unit c. maternity unit d. emergency unit Ans- d. emergency unit According to title II of HIPAA, disclosure of Protected Health Information related to which of the following actions requires the patient's express written authorization? a. state in which the treatment occur b. health care operations c. treatment d. payment Ans- a. state in which the treatment occur A covered entity may disclose PHI for TPO (treatment, payment, and healthcare operations) Which of the following groups is least likely to report errors: a. primary care physicians b. support staff c. independent contractors d. nurses Ans- c. independent contractors Why does Healthcare Quality Improvement Act provide confidentiality and legal immunity for health care peer review processes? a. to prevent malpractice suits b. to discourage complaints by patients c. to encourage participation by physicians d. to maintain a sterile work environment Ans- c. to encourage participation by physicians The Healthcare Quality Improvement Act provides confidentiality and legal immunity for healthcare Peer Review process to encourage participation by physicians. Which type of subpoena calls for the delivery of certain documents to the court? a. subpoena habeas corpus b. subpoena ad testificandum c. subpoena add infinitum d. subpoena duces tectum Ans- d. subpoena duces tectum "subpoena ad testificandum" - means the court demands specific person appear and give testimony. The other options are not legal terms. Which of the following is generally NOT included in an Explanation of Benefits (EOB): a. date of service b. insurance code for service c. doctor's fee d. patient's medical history Ans- d. patient's medical history EOB only explains the elements of the medical treatment that are covered by health insurance policy A healthcare facility's income statement is an example of: a. baseline audit b. retrospective audit c. concurrent audit d. snapshot audit Ans- b. retrospective audit Concurrent audit is real-time evaluations of records/policies. Snapshot audit is a comprehensive picture of the organization at a particular time. Baseline audit is also a comprehensive evaluation but undertaken for establishing benchmarks against which future performance may be compared. Hospitals that implement Computerized Provider Order Entry (CPOE) almost always see a decline in: a. medication errors b. diagnostic errors c. adverse events d. latent errors Ans- a. medication errors CPOE programs diminish error related to faulty transcript or unclear handwriting, and simplify inventory and decrease delays in order completion. In the Current Procedural Terminology (CPT) code set, Category II codes are for: a. emerging technology b. evaluation & management c. performance measurement d. medicine Ans- c. performance measurement CPT category I: evaluation & management. CPT category II: performance measurement. CPT category III: emerging technology. Because of a doctor's poor handwriting, a prescription must be reworked before it leaves the pharmacy. Which of the following is true? a. the doctor should be reprimanded b. the pharmacy should incorporate bar coding c. the prescription should not count towar