svandyke – 10.27.2017

The Healthcare Quality Handbook – CPHQ Prep

Chapter 7 – TEST REVIEW QUESTIONS

Accountability and Liability Pressures

  1. Per our handbook, the definition of liability is:
  2. a debt of gratitude for a service or favor
  3. the state or fact of being accountable or to blame for something
  4. legally responsible for something
  1. There are four main types of liability in healthcare: Contractual liability, Tort liability, Corporate liability, and Criminal liability.
  2. True
  3. False
  1. What are the three types of torts:
  2. Premediated Tort, Abandonment, Lenient Liability
  3. Intentional Torts, Negligence, and Strict Liability
  4. Disregard, Accidental, and Deliberate
  1. The definition of malpractice is:
  2. A failure by a physician or other professional to use the care and skill that other members of their profession would use under similar circumstances.
  3. Failure to use reasonable care, resulting in damage or injury to another.
  4. An immoral or illegal act, a task or action that performed harm.

Legal Foundations for Quality Practice

  1. A Prospective Payment System is:
  2. Payment plans pay healthcare providers based on their actual charges. A provider will treat a patient and submit an itemized bill to an insurance company detailing the services rendered.
  3. A method of reimbursement that provides healthcare providers – facilities and licensed independent practitioners – with a pre-negotiated fixed set of payment rates for each type of patient or group of services. The payment rate remains unchanged regardless of operating costs.
  4. Pays for most Inpatient and Outpatient services at 101 percent of reasonable costs (or cost+1) and are subject to Medicare Part A and Part B deductible and coinsurance amounts.
  1. What is a Quality Improvement Organization (QIO):
  2. An independent not-for-profit organization based in Cambridge, Massachusetts, is a leading innovator, convener, partner, and driver of resultsin health and health care improvement worldwide.
  3. As part of the DHHS national Quality Strategy, replaced the PROs, and is dedicated to improving health quality for Medicare beneficiaries.
  4. An organization with the mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.
  1. What is a Quality Innovation Network (QIN):
  2. Division of the QIO that provides healthcare organizations with education and outreach, and shares practices that worked in other areas. The QIN utilizes data to measure improvement, and works with patients, families, and community partners.
  3. A federal agency that conducts and supports health promotion, prevention and preparedness activities in the United States, with the goal of improving overall public health.
  4. An organization that offers Family and Community Health programs that target the entire population, including women and men, children, and adolescents.
  1. The activities of the QIO are known as the SoW, which stands for:
  2. Solicitation of Work
  3. Scope of Work
  4. Subcontract of Work
  1. What is an Accountable Care Organization (ACO)?
  2. A national web-based resource featuring the latest news and essential resources onpatient safety.
  3. An economical, Web-based quality benchmarking program specifically designed, developed and driven by small rural hospitals and rural health clinics to compare selected quality measures with other similar hospitals and clinics.
  4. Groups of doctors, hospitals, and other healthcare providers, who work together to give coordinated high quality care to their patients, at lower costs.
  1. Medicare currently offers three ACO programs, which are: Medicare Shared Savings Program, Advance Payment ACO Model, and Pioneer ACO Model.
  2. True
  3. False

Legal Foundations for Patient Protection

  1. The Patient Self-Determination Act (PSDA) is a law that requires that providers develop policies and procedures addressing a patient’s right to refuse treatment and to execute an “advance directive” in accordance with individual state laws.
  2. True
  3. False
  1. The Health Insurance Portability and Accountability Act (HIPPA) was enacted by the U.S. Congress in 1996 and was a major health insurance reform bill. It requires health plans to certify compliance with standards and healthcare rules, and other items.
  2. True
  3. False

Legislation Impacting Organizational Activities

  1. Aside from the Chief Compliance Officer, who else are likely candidates for being responsible to establish and oversee processes necessary to prevent or quickly identify any inaccurate billing practices or actual misbehavior that might result in errors being investigated as fraudulent practice by the Office of Inspector General (OIG)?
  2. Chief Financial Officer and Chief Operations Officer
  3. Quality Professional and Risk Management Professional
  4. Chief Executive Office and Chief Medical Officer
  1. Per the OIG Comprehensive Compliance Program, how many essential elements are there:
  2. Ten
  3. Five
  4. Seven
  1. What three initial documents is it recommended that a Healthcare Quality Professional review:
  2. Corporate Responsibility & Corporate Compliance, Corporate Responsibility & Health Care Quality, and Practical Guidance for Health Care Governing Boards on Compliance Oversight.
  3. The Quality Toolbox, Making Change Work, and Organization Culture & Leadership
  4. How Doctor’s Think, Who Moved My Cheese, and A Complaint Free World
  1. CMS works along with the CDC and FDA to assure clinical lab quality. What does CDC and FDA stand for:
  2. Clinical District Complex; Fiscal Data Alliance
  3. Centers for Disease Control; Federal Drug Administration
  4. Comprehensive Data Center; Financial Distress Association
  1. A device user facility is defined as:
  2. A facility that performs some specific useful task, to meet a particular need.
  3. A healthcare setting where appropriate care is accessible and obtainable to meet a patient’s needs.
  4. A hospital, ambulatory surgical facility, nursing home, outpatient treatment facility, or outpatient diagnostic facility, which is NOT a physician’s office.
  1. Serious illness or injury means either life-threatening, or resultant permanent impairment, and/or required medical or surgical intervention to prevent permanent impairment.
  2. True
  3. False
  1. A medical device is:
  2. A tool that provides clinical observations, facts, or materials, usually collected as a result of assessment activities.
  3. Is any item (other than a drug or biologic) used to diagnose, treat, or prevent a disease, injury or other condition.
  4. A clinical computer program that performs some specific useful task