Rhit, Domain 3

Front 1

Outcomes and assessment information set- C

Back 1

Core items for the comprehensive assessment of adult Home Care form the basis for measuring the patient outcomes for the purpose of outcome-based quality improvement

Hint 1

Sayles 2013, 278

Front 2

Policy

Back 2

Describes General guidelines that direct Behavior or direct and constrain decision-making in the organization

Front 3

Vital risk areas for the accuracy of the claims submission process

Back 3

Coding and billing , documentation, and medical necessity for tests and procedures.

Front 4

Fraud

Back 4

Intentional deception or misrepresentation leading to some unauthorized benefit

Front 5

Abuse

Back 5

Unnecessary costs or false representation or failure to disclose fact

Front 6

Federal sentencing guidelines

Back 6

Corporate compliance programs became common after the adoption of this

Front 7

Ability to subpoena audit trails

Back 7

A legal concern regarding the EHR

Front 8

7 steps of ineffective program to prevent and detect violations of law

Back 8

These Federal sentencing guidelines have become the blueprint for an effective compliance program for healthcare organizations

Front 9

Accreditation

Back 9

The act of granting approval to a healthcare organization

Front 10

A compliance officer should Ensure

Back 10

A hotline to receive complaints and Adoption of procedures to protect whistleblowers from retaliation is in place

Front 11

A comprehensive compliance program has

Back 11

7 elements as the minimum necessary outlined by the oig

Front 12

Documentation education

Back 12

Part of a compliance education a focused effort should be made to provide documentation education to the medical staff

Front 13

Ahrq

Back 13

Agency for healthcare research and quality, the agency most involved in Health Care Services Research

Front 14

Ahrq

Back 14

Looks at issues related to the efficiency and effectiveness of healthcare delivery system common disease protocols and guidelines for improved disease outcomes.

Hint 14

Sayles 2013,457

Front 15

Oig

Back 15

Office of the Inspector General

Front 16

Office of the Inspector General

Back 16

Issues compliance program guidance for various types of healthcare organizations, posts documents that most Healthcare organizations need to develop Fraud and Abuse compliance plans.

Front 17

Data security

Back 17

Includes ensuring that workstations are protected from unauthorized access

Front 18

Log off automatically

Back 18

If a workstation is inactive for a period of time by the organisation it should do this

Front 19

Automatic log off

Back 19

Helps prevent unauthorized users from accessing ephi when an authorized user walks away from the computer without logging out of the system

Front 20

Retrospective utilization review

Back 20

Conducted after the patient has been discharged

Front 21

Retrospective review

Back 21

Examines the medical necessity of services provided to the patient while in the hospital

Front 22

Hie

Back 22

Health information Exchange

Front 23

Identity management

Back 23

Used to provide access controls, authentication, and audit logging in health information Exchange

Front 24

HITECH

Back 24

ARRA ESTABLISHED

Front 25

Joint Commission

Back 25

Accrediting organization that has instituted continuous Improvement and Sentinel event monitoring and uses Tracer methodology

Front 26

Middle managers

Back 26

Role of developing implementing and revising the organization's policies

Front 27

Business associate agreements

Back 27

The Creator of health information should obtain a business associate agreement with the receiver

Front 28

Staffing tools

Back 28

May be used to plan and manage staff resources.

Front 29

Position descriptions

Back 29

Outline the work and qualifications required by the job

Front 30

Middle managers

Back 30

Execute the organizational plans developed at the board and executive levels the operational information that Executives need to develop meaningful plans for organizations future

Front 31

Performance standards

Back 31

Established expectations for how well the job will be done and how much work will be accomplished

Front 32

Written policies and procedures

Back 32

Explaining Staffing requirements and scheduling assist the supervisor and being fair and objective and help the staff understand the rules

Front 33

The Joint Commission

Back 33

Most visible organization responsible for accrediting healthcare organizations since the 1950s primary focus at this time is to determine whether organizations continually monitoring the quality of care they provide

Front 34

Requirements of The Joint Commission

Back 34

Continual Improvement process being placed throughout the entire organization, from the governing body down all Department lines.

Front 35

Deficit reduction Act of 2005

Back 35

Made compliance programs mandatory

Front 36

Policy

Back 36

He clearly stated and comprehensive statement that establishes the parameters for decision-making and action

Front 37

Policies

Back 37

Developed at both the institutional and departmenttal levels. Should be consistent within the organization. They must be developed in accordance with applicable laws and reflect actual practice.

Front 38

DRA of 2005

Back 38

The mandatory Deficit reduction Act of 2005 was enacted in 2006.

Front 39

UR

Back 39

utilization review is the process of determining whether the health care provided to a specific patient is necessary

Front 40

Basis for utilization review

Back 40

Pre-established objective screening criteria according to time frames specified in the organization's plan

Front 41

Utilization management

Back 41

What process is used to determine the appropriate of Medical Services during specific episodes of care

Front 42

Types of utilization review

Back 42

Pre-admission

Continued stay

Discharge

Front 43

Basic functions of the utilization review process

Back 43

Case management

Discharge planning

Utilization review

Front 44

What are insufficient to determine whether the hospital is in compliance

Back 44

The medical record committee wants to determine if the hospital is in compliance with Joint Commission standards for medical record delinquency rates. The HIM director has compiled a report that shows that records are delinquent for an average of 29 days after discharge. Given this information what can the committee conclude?

Hint 44

#238

Front 45

Business associate agreement

Back 45

The Creator should seek a business associate agreement with the receiver of the information

Front 46

The Joint Commission

Back 46

The largest Healthcare standard-setting body in the world since 1952

Front 47

Physician offices

Back 47

Do not have to meet the standards in the conditions of participation for Medicare and Medicaid reimbursement

Front 48

Data security program

Back 48

Auditing information system activity is an important part of this

Front 49

Unauthorized access to a system

Back 49

An audit Trail may be used to detect this

Front 50

Auditing information of the system

Back 50

Performed by examining and evaluating audit trails

Front 51

Audit Trail

Back 51

Record of system and application activity by users

Front 52

Elements of performance

Back 52

Specific performance expectations and or structures and processes that provide detailed information for each of the Joint Commission standards

Front 53

EPs, or elements of performance

Back 53

Must be in place for an organization to provide safe high quality Care, treatment, and services.

Front 54

Critical for HIM professionals working in an accredited facility

Back 54

Knowledge of EPs pertaining directly to the Health Care record and documentation in the record

Front 55

Healthcare quality improvement Act

Back 55

The creation of the National Practitioner Data Bank was mandated by this

Front 56

NPDB

Back 56

National Practitioner Data Bank

Front 57

National Practitioner Data Bank

Back 57

Provide a Clearinghouse for information about medical practitioners who have a history of malpractice suits and other quality problems.

Front 58

Hospitals are required to consult

Back 58

The NPDB national Practitioner Data Bank before granting medical staff privileges to healthcare practitioners

Front 59

Bylaws

Back 59

Dictate how a medical staff operates

Front 60

Considered legally binding

Back 60

Hospital bylaws spell out specific qualifications that Physicians must demonstrate before they can practice medicine in the hospital. Any changes must be approved by a vote of the medical staff and the hospital governing body

Front 61

CEO

Back 61

Chief executive officer

Front 62

Chief executive officer

Back 62

Primary responsibility is Implementing the policies and strategic direction of the hospital or Healthcare organization and building effective executive management team

Front 63

License

Back 63

Medical school graduates must pass attached before they can practice medicine

Front 64

State Medical boards

Back 64

Administer licensure test, passing scores vary by state. Most Physicians also complete several years of residency training in addition to medical school

Front 65

Section 164 .524 of the Privacy Rule

Back 65

States that an individual has the right to access to inspect and obtain a copy of his or her own protected health information that is contained in a designated record set such as a health record.

Front 66

Exceptions to Privacy Rule 164 .524

Back 66

To what may be accessed: such as Psychotherapy notes, information compiled in reasonable and anticipation of a civil, criminal or administrative action or proceeding, or PHI subject to the Clinical Laboratory improvements are all exceptions

Front 67

As long as state laws or regulations, Physicians do not state otherwise

Back 67

The HIPAA Privacy Rule provides patient with significant rights that allow them to have some measure of control over their health information

Front 68

Fees for medical records

Back 68

HIPAA allows a reasonable cost based fee when an individual requests a copy of PHI or agrees to accept a summary or explanatory information

Front 69

Reasonable cost based fee includes

Back 69

Cost of copying including supplies and labor, postage. Retrieval fees are not permitted to be charged to patients

Front 70

Automatic data controls to preserve confidentiality and integrity

Back 70

Edit check

Audit trails

Password management

Front 71

Security awareness program

Back 71

Is not an automatic control

Front 72

Access to information

Back 72

Within the context of an electric health records protecting data privacy means defending or safeguarding

Front 73

Protecting data privacy

Back 73

Means safeguarding access to information within the context of data security.

Front 74

Data privacy

Back 74

Only those who need to know information should be authorized to access it

Front 75

Data security

Back 75

Protection measures and tools for safeguarding information and information systems

Front 76

The HIPAA Privacy Rule intent

Back 76

Allow individual to obtain copies of records for a fee that is reasonable enough for an individual to pay for it

Front 77

The Privacy Rule requires

Back 77

The copy fee for the individual be reasonable and cost-based

Front 78

Risk management

Back 78

Conducts analysis, identify threats, determines likeliness threats may occur, and estimates the impact of events for an electronic health record

Front 79

A written contingency plan

Back 79

To handle an emergency response in the event of an Untoward event.

Front 80

Administrative safeguards

Back 80

Include policies and procedures that address the management of Computer Resources

Front 81

Employees

Back 81

Biggest threat to the security of healthcare data

Front 82

Once a year

Back 82

To ensure revelancy, security policies and procedures should be reviewed

Front 83

Good forms design

Back 83

Needed within an EHR to create ease-of-use. The use of a selection box allows the user to select a value a predefined list.

Front 84

Radio buttons

Back 84

Are used for singles elections within the EHR

Front 85

Minimize keystrokes

Back 85

By using pop-up menus, good electronic forms design

Front 86

Completeness check

Back 86

Performed for all required data, good electronic forms design

Front 87

Text box

Back 87

To enter text , good electronic forms design

Front 88

Clinical forms committee

Back 88

oversees the development and approval of new forms for the health record

Front 89

Clinical forms committee

Back 89

Provides oversight for the development review and control of all enterprise-wide information capture tools including paper forms and design of computer screens

Front 90

Physical control

Back 90

Placing blocks on computer room doors

Front 91

EDMS

Back 91

Electronic data management system

Front 92

24 pound paper for double sided forms

Back 92

Recommended for design of forms for an electronic data management system

Hint 92

Sayles 2013, 364

Front 93

Physical access controls

Back 93

Safeguards that protect physical equipment Media or facilities

Front 94

20 - 24 pound paper is recommended for use in copiers, scanners and fax machines

Back 94

In an electronic data management system paper forms are added to the electronic health record using a scanner so the weight of the paper is important

Hint 94

Sayles 2013, 356

Front 95

Before action is taken

Back 95

The HIM supervisor should determine if a breach has occurred via the audit Trail

Front 96

Coding policies

Back 96

Ahima code of ethics

Ahima standards of ethical coding

Official coding guidelines

Applicable federal and state regulations

Internal Documentation policies requiring the presence of a physician documentation to support all coded diagnosis and procedure code assignments

Front 97

Public Law 113 - 36

Back 97

Mandated the establishment of Fraud and Abuse control programs to battle Health Care Fraud and Abuse

Front 98

Access to ePHI controls

Back 98

User-based access

Role-based access

Context based access

Front 99

Reign based Access Control

Back 99

Does decisions are based on the rules individual users have as a part of an organization. Each user is given various privileges to perform their role or function.

Front 100

Review of record by the patient is permitted

Back 100

After the authorization for use and disclosure is verified. Usually Hospital Personnel should be present during on site reviews to assist with the requester

Front 101

As long as state laws or regulations or the position does not State otherwise

Back 101

Competent adult patients have the right to access their record.

Front 102

State laws on the issue of minors

Back 102

HIPAA the first two state laws, applicable state laws should be consulted regarding appropriate authorization.

Front 103

Medicare definition of fraud

Back 103

Intentional representation than an individual knows to be false or does not believe to be true but makes knowing that the representation could result in some unauthorized benefit

Front 104

Medicare conditions of participation

Back 104

Rules set forth by CMS

Front 105

Nationwide expansion OF RAC

Back 105

Was fully implemented and operational by January 2010

Front 106

Single sign-on

Back 106

Allow sign on to multiple related but independent software Systems

Front 107

Physical access controls

Back 107

Safeguards that protect physical equipment Media or facilities

Front 108

Access control

Back 108

Means being able to identify which employees should have access to what data

Front 109

Steps in medical necessity and utilization review

Back 109

Initial clinical review

peer clinical review

appeals consideration

Front 110

OIG WORK PLAN

Back 110

Can be used to discover current hot areas of compliance

Front 111

Common forms of fraud

Back 111

Services not rendered but billed

Misrepresenting the diagnosis to justify the payment

Unbundling or exploding charges

Front 112

Control to access services

Back 112

One aspect of managed care that has the greatest impact on Healthcare organizations

Front 113

Managed Care Systems control cost

Back 113

Primarily by presetting payment amounts and restricting patient access to Healthcare Services through pre-certification and utilization review processes

Front 114

Coding compliance plan

Back 114

Should include a physician query process, coding diagnosis not supported by health documentation, upcoding, correct use of encoder software, unbundling ,coding health records with incomplete documentation, assignment of discharge destination codes, and complete process for using scrubber software

Front 115

Evidence based practice guideline

Back 115

Explicit statement that directs clinical decision-making. Evidence-based clinical practice guidelines are Foundation of members care for specific clinical conditions

Hint 115

Casto and Forrestal 2013, 107

Front 116

Cost control

Back 116

The gatekeeper role of the primary care provider. They determined the appropriateness of Health Care Service, the level of Health Care personnel, and the setting in the Continuum of Care

Front 117

Safe harbors

Back 117

Exceptions to the federal anti-kickback statute that allows legitimate business Arrangements and are not subject to prosecution

Front 118

Fair market value compensation

Back 118

Common theme runs through safe harbors and that is the intent to protect certain Arrangements which is commercially reasonable items or services are exchanged for

Front 119

Twice

Back 119

Times each year Health Care Facilities required to practice emergency preparedness plans

Front 120

Commission on accreditation of rehab facilities

Back 120

Private not for profit organization committed to developing and maintaining practical customer-focused standards to help organizations measure and improve the quality value and outcomes of Behavioral Health and Medical Rehab programs

Front 121

CARF

Back 121

Commission on accreditation of Rehabilitation Facilities

Front 122

Deemed status

Back 122

Accrediting bodies such as Joint Commission can survey facilities for compliance with Medicare conditions of participation instead of the government

Front 123

Tracer methodology

Back 123

Evaluation that follows Hospital experiences of past or current patients

Front 124

PFP

Back 124

Priority Focus review follows the experience of care through the organization's entire Healthcare process and allows the surveyor to identify performance issues

Front 125

Standard of care for health condition

Back 125

Likely to be considered medically necessary

Front 126

Goals of case management

Back 126

Continuity of Care, cost-effectiveness, Quality and appropriate utilization

Front 127

ABN

Back 127

When a service is not considered medically necessary based on the reason for the encounter the patient should be provided with this indicating Medicare might not pay and the patient might be responsible for the entire charge

Front 128

Demand letter

Back 128

Document sent to the provider notifying them of an incorrect payment determination the Medicare recovery audit contractor

Front 129

Medical

Back 129

Type of identity theft occurring after a patient uses another person's name and insurance information to receive Healthcare benefits