Laboratory Management

Front 1

What organization adminsters the CLIA and HIPAA?

Back 1

CMS (Centers for Medicare and Medicaid Services

Front 2

What does CLIA stand for?

Back 2

Clinical Laboratory Improvement Amendments

Front 3

What does HIPAA stand for?

Back 3

Health Insurance Portability and Accountability Act

Front 4

What is the relationship of the Joint Commission to hospitals and laboratories?

Back 4

the Joint Commission is an independent, not-for-profit organization that evaluates and accredits hospitals and laboraties.

Front 5

How often does the Joint Commision survey hospital and laboratories?

Back 5

Hospitals: every 3 years

Laboratories: every 2 years

Front 6

What's the difference between acreditation and certification?

Back 6

Accreditation: what the Joint Commission or CAP does in their surveys.

Certification: what CLIA88 grants you if you have accreditation. Without cerficiation, you cannot get paid by Medicare and Medicaid

Front 7

What's the functional difference between the Joint Commission and CAP?

Back 7

Both organizations survey laboratories for accreditation. Joint Commission also accrediates hospitals in addition to laboratories.

Front 8

What is the Council for Accreditation of Allied Health Education Programs (CAAHEP)?

Back 8

CAAHEP is an independent certifying agency for health education programs including accrediation for cytotechnology training programs in the United States.

Front 9

What department oversees CMS?

Back 9

Department of Health and Human Services

Front 10

What does OSHA stand for?

Back 10

Occupational Safety and Health Administraiton

Front 11

What department oversees OSHA?

Back 11

Department of Labor

Front 12

How does a lab obtain a CLIA certificate?

Back 12

By obtaining acreditation from the Joint Commission or CAP

Front 13

Why is it important to get a CLIA certificate?

Back 13

To bill for and receive Medicare or Medicaid payments

Front 14

What are three of the main features of the HIPAA law?

Back 14

1. Protection of heathcare coverage for people who change jobs

2. Protection of patient privacy

3. Requires that every provider who does bunsiness electronically use the same health care transactions, code sets, and identifiers

Front 15

What are the responsibilities of the laboratory director?

Back 15

1. Ultimate responsibility for the work performed in the laboratory

2. Overall operation and administration, including employment of personnel

NOTE: may also perform duties of the technical supervisor and general supervisor

Front 16

What are the qualifications for Laboratory Director of a cytology lab?

Back 16

1. License to practice medicine or osteopathy

2. Anatomic pathologist or must employ an anatomic pathologist as the Technical Supervisor

3. Possess a license as Laboratory Director issued by the state in whcih the laboratory is located

Front 17

What are the responsibilities of the Technical Supervisor?

Back 17

1. Technical and scientific oversight of the laboratory

2. Establish QC procedures

3. Resolve technical problems

4. Evaluate competency of personnel

5. Monitor test results

6. Perform semiannual evaluations of cytotechs

7. Establsih a workload limit for each cytotch and reassessing it at least every 6 months

Front 18

What are the qualifications of the Tehcnical Supervisor?

Back 18

1. License to practice medicine or osteopathy

2. Certified in anatomic pathology OR certified by the American Society of Cytopatholoyg to practice cytopathology (last examination 1978)

Front 19

What are the responsibilities of the General Supervisor?

Back 19

Day to day oversight of the operations and personnel

Front 20

What are the qualifications of the General Supervisor?

Back 20

1. Same as Technical Supervisor OR

2. Cytotechnologist with at least 3 years of full-time experience within the past 10 years

Front 21

What are the qualifications of a cytotechnologist?

Back 21

Any 1 of the following:

1. Bachelor's degree and graduation from a school of cytotechnology accredited by CAAHEP

2. Certified in cytotehcnology by an approved agency (American Society of Clinical Pahtologists or HEW)

3. Grandfathered based on experience (ended 9/1/1994)

Front 22

How long are the following items kept?

1. Requisition forms

2. Worksheets (QC/QA paperwork, PT results)

3. Slides

4. Reports (paper or electronic)

Back 22

1. Requisition forms: 2 years

2. Worksheets (QC/QA paperwork, PT results): 2 years

3. Slides: 5 years

4. Reports (paper or electronic): 10 years

Front 23

What elements must be submitted in order to bill for a test?

Back 23

1. Date and location of service

2. CPT (procedure code)

3. ICD-9 (tells you what disease the patient has)

Front 24

What does CPT stand for?

Back 24

Current procedural terminology

Front 25

Who owns and maintains CPT?

Back 25

AMA

Front 26

T or F: A cytotechnologist screen of a pap smear is billed under the professional fee.

Back 26

False: Cytotech review is part of the technical fee. Only the Pathologist review is billed under professional fee.

Front 27

What does RVU stand for?

Back 27

Relative value unit

Front 28

What does ICD stand for?

Back 28

International Classificaiton of Diseases

Front 29

What are the three categories of Pap tests and their implications for Medicare beneficiary coverage?

Back 29

1. Screening, routing: no more than one test every 24 months is covered

2. Screening, high risk: no more than one test every 11 months is covered

3. Diagnostic: unlimited coverage

Front 30

What is the definition of a screening (routine) Pap test?

Back 30

1. No current sign, symptom, or compliant referable to the cervix

2. No previous abnormal Pap

3. No high-risk factors for cervical cancer

Front 31

What is the definition of a screening (high-risk) Pap test?

Back 31

1. Early onset of sexual activity (under 16 years)

2. Multiple sexual parters (greater than or equal to 5 in a lifetime)

3. History of sexually transmitted disease (including HIV)

4. Fewer than 3 negative Paps in the previous 7 years

5. Daughter of a woman given diethylstilbestrol during pregnancy

6. Abnormal Pap in the past 3 years (childbearing age women only)

Front 32

What is the defintion of a diagnostic Pap test?

Back 32

1. Previously diagnosed cacner of the vagina, cervix, or uterus

2. Previous abnormal Pap

3. Current abnormal findings of vagina, cervix, uterus, ovaries, or adnexa

4. Significant complaint referable to the female reproductive system

5. Any sign or symptom that might be related to a gynecological disorder

Front 33

What are the cytology slide re-examination requirements according to CLIA88?

Back 33

1. Prospective rescreening of 10% of negative Pap cases

2. Retrospective review of all negative Paps within past 5 years from women with a newly diagnosed high-grade squamous intraeptihelial lesion

3. Review of discrepancies between Pap and biopsy results

Front 34

Who is eligible to perform the 10% rescreen for Pap smears?

Back 34

Technical Supervisor, General Supervisor, or a Cytotech with 3 years of full-time experience in the past 10 years

Front 35

When does a prior report from an HSIL 5-year lookback need amendment?

Back 35

Only if the discrepancy will affect current patient care. This almost never happens because you're only looking back because there is a current abnormality.

Front 36

According to CLIA88 what is the maximum number of slides a cytotech or cytopathologist can primary ascreen in a 24 hour period?

Back 36

100 slides

Front 37

What is the minimum amount of time (in hours) in which cytotechs or cytopathologists have to primary screen the maximum amount of slides per 24 hour period?

Back 37

8 hours

Front 38

What is the formula for calculating prorated slides if the cytotech or cytopathologist spends less than the minimum amount of time (in hours) performing primary screening?

Back 38

Maximum slides = # hours examining slides x 100/8

Front 39

How many slides do the following count as?

1. 1 smear slide

2. 1 nongynecologic slides in which the cellular material covers 1/2 or less the slide surface

3. 1 cell block

4. 1 ThinPrep Pap slide

5. 1 ThinPrep nongynecologic slide

6. 1 nongyneoclogic cytospin slide

7. 1 SurePath Pap slide

8. 1 SurePath nongynecologic slide

Back 39

How many slides do the following count as?

1. 1 smear slide: 1 slide

2. 1 nongynecologic slides in which the cellular material covers 1/2 or less the slide surface: 1/2 slide

3. 1 cell block: 1/2 slide

4. 1 ThinPrep Pap slide: 1 slide

5. 1 ThinPrep nongynecologic slide: 1/2 slide

6. 1 nongyneoclogic cytospin slide: 1/2 slide

7. 1 SurePath Pap slide: 1 slide

8. 1 SurePath nongynecologic slide: 1/2 slide

Front 40

What is the definition of "false negative rate" (FNR)?

Back 40

The proportion of abnormal paps that are falsely negative.

FNR = FN/(TP + FN)

Front 41

What is the proposed upper limit for ASCUS:SIL ratio?

Back 41

3:1

Front 42

What is the ideal HR-HPV positive rate in ASCUS cases?

Back 42

~50%

Front 43

What is the definition of sensitivity?

Back 43

Sensitivity is the percentage of people with the disease who test positive.

Sensitivity = TP/(TP + FN)

Front 44

What is the definition of specificity?

Back 44

Specificity is the percentage of people without the disease who test negative.

Specificity = TN/(TN + FP)

Front 45

What is the definition of positive predictive value?

Back 45

The positive predictitve value is the chance that a person who tests positive really has disease.

PPV = TP/(TP + FP)

Front 46

What is the definition of negative predictive value?

Back 46

The negative predictive value is the chance a person who tests negative for the disease really does not have the disease.

NPV = TN/(TN + FN)