question

Which of the following documents the results of care for individual patients as well as for specific types of patients grouped by diagnostic category?

answer

Outcome measures

question

Which of the following organizations provides the most complete view of managed care plan quality?

answer

NCQA

question

___are Joint Commission's standards for improving patient safety.

answer

b. NPSGs

question

Which of the following is a technique used to generate a large number of creative ideas from a group?

answer

Brainstorming

question

The leader of the coding performance improvement team wants all of her team members to clearly understand the coding process. Which of the following would be the best tool for accomplishing this objective?

answer

Flowchart

question

The medical transcription improvement team wants to identify the cause of poor transcription quality. Which of the following tools would best aid the team in identifying the root cause of the problem?

answer

Fishbone diagram

question

Which of the following are detailed step-by-step guides used by healthcare practitioners to make clinical decisions related directly to patient care?

answer

Clinical practice guidelines

question

The final results of care, treatment, and services in terms of the patient's expectations, needs, and quality of life, which may be positive and appropriate or negative and diminishing, are included in what area of performance measurement?

answer

Outcomes

question

An unexpected occurrence involving death or serious physical or psychological injury, or risk thereof is called

answer

Sentinel event

question

A graphic tool used to organize and prioritize ideas after a brainstorming session is called a/an:

answer

Affinity diagram

question

Name the four core processes involved in the are, treatment, and services to patients.

answer

1. Assessing Patients needs. 2. Planning Care, treatment and services 3. Providing the care, treatment and services 4. Coordinating care, treatment and services (the answer is all of the above)

question

The outcome of this flow of care is an improvement in the patient's condition that allows discharge to the patient's home or to a different care setting:

answer

coordinating care, treatment and services

question

The established criteria against which the decisions and actions of healthcare practitioners and other representatives of healthcare organizations are assessed in accordance with state and federal laws, regulations, and guidelines are called

answer

clinical practices standards

question

Which of the following statements best defines utilization management?

answer

It is a set of processes used to determine the appropriateness of medical services provided during specific episodes of care.

question

Which of the following is not a type of utilization review?

answer

Documentation utilization review

question

What is the role of the case manager?

answer

To coordinate medical care and ensure the necessity of the services provided to beneficiaries.

question

Which of the following is not one of the basic functions of the utilization review process?

answer

Claims management

question

what term is used for the process of determining whether the medical care provided to a specific patient is medically necessary?

answer

Utilization review

question

The risk manager's principal tool for capturing the facts about potentially compensable events is the

answer

occurrence report

question

Events that occur in a healthcare organization that do not necessarily affect an outcome, but if were to recur, carry significant change of being a serious adverse event are called

answer

near misses

question

The four components in a fishbone diagram include:

answer

Men, Methods, Machines and Material ( answer is all of the above)

question

Analysis of a sentinel event from all aspects to identify how each contributed to the occurrence of the event and to develop new systems that will prevent recurrence is called

answer

root-cause analysis

question

Assessment of a patient's readiness to leave the hospital

answer

Discharge utilization review

question

Periodic review during a current admission to determine whether the patient still needs acute care services

answer

Continued-stay utilization review

question

Review of a planned admission to determine whether the services are medically necessary and whether the patient qualifies for impatient benefits

answer

Prospective utilization review

question

Process of determining whether the medical care provided to a specific patient is necessary

answer

Utilization management

question

Review of records some time following the patient's discharge to determine any of several issues, including the quality or appropriateness of the care provided

answer

Retrospective utilization review

question

Review conducted at the time of a hospital admission to determine the medical necessity and appropriateness of care in an acute care setting

answer

Admission utilization review

question

Review conducted prior to a hospital admission to determine whether the planned services are medically necessary and require treatment in an acute care setting

answer

Preadmission utilization review

question

Review of the patent's needs for care and the quality of the care provided at the time services are rendered

answer

Concurrent utilization review

question

Follow-up on a patient after discharge to ensure that the transition has gone smoothly and that the patient is receiving all of the services required is considered this case management step:

answer

post-discharge planning

question

Every healthcare organization's risk management plan should include the following components:

answer

Objectives, key elements, responsibilities, methods, and areas of focus for the current year

Healthcare QI, Analysis, Utilization and Risk Management – Flashcards

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