MOA 180 - Health Information Management & HIPAA » Fall 2022 » Week 7 Practice Quiz Chapters 6 & 7

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Question #1
A patient's vital signs are taken as ordered by the physician during the stay. What is one advantage of tracking vitals in EHRs?
A.   Vitals can be graphed and an infection is easily noted.
B.   Increasing body temperature is seen.
C.   Infection is easily seen by rising temperature.
D.   Vitals can be graphed.
Question #2
The person who is ultimately responsible for the care of the patient while hospitalized is known as the:
A.   attending physician.
B.   chief resident.
C.   hospitalist.
D.   surgeon.
Question #3
A hospitalist is employed by the hospital and is typically which?
A.   Board-certified cardiologist
B.   Board-certified internist
C.   Board-certified nurse practitioner
D.   Board-certified physician assistant
Question #4
Mary Smith is admitted to the hospital by her primary care physician; he documents the following in the history and physical: patient complaining of abdominal pain for the last 48 hours with nausea and vomiting. What part of the history and physical is this called?
A.   History of Present Illness (HPI)
B.   Admission order
C.   Past medical history
D.   Physical examination
Question #5
How is the inpatient census tracked?
A.   ADT system
B.   Manually counting the patients
C.   Subtracting the discharges from the inpatients
D.   Adding total number of patients admitted that day
Question #6
What is the definition of patient census?
A.   The number of patients in observation and inpatients at any given time
B.   The number of inpatients occupying beds at any given time
C.   The number of patients in observation and inpatients at midnight
D.   The number of inpatients occupying beds at midnight
Question #7
ADT plays an important role in Meaningful Use in all of the following ways EXCEPT:
A.   files are large and can be transmitted easily.
B.   automated reports are standardized.
C.   commonly exchanged information supports transition in care.
D.   clinical information is timely.
Question #8
One of the ways to document in the EHR is by using:
A.   a template.
B.   dictation.
C.   an outline.
D.   a prototype.
Question #9
Who generally documents the information in the MAR?
A.   Intern
B.   Nurse
C.   Hospitalist
D.   Physician
Question #10
The chief resident has seen Mrs. Smith and written progress notes in her chart; who must sign off on these notes that were written?
A.   Resident of record
B.   Nurse practitioner of record
C.   Hospitalist of record
D.   Physician of record
Question #11
Which of the following may be included in the designated record set?
A.   Any group of records maintained by a covered entity
B.   History and physical reports
C.   All of these
D.   Medical and billing records
Question #12
Any records maintained by a covered entity that are used for patient care or to make payment decisions as defined by HIPAA are known as:
A.   designated record set.
B.   case management records.
C.   health records.
D.   medical records.
Question #13
Health records in the case of Mary Jones, whose primary care physician is Dr. Smith and insurance plan is Medicare, may be released to which party under the HIPAA designated record set regulation?
A.   Medical Mutual insurance plan
B.   Publisher's clearinghouse
C.   Dr. Smith
D.   Her husband
Question #14
The legal health record is the same as the:
A.   medical record.
B.   health record.
C.   official business record.
D.   designated record set.
Question #15
The legal health record should:
A.   document services provided in response to caregiver decisions.
B.   serve as the designated record set.
C.   support unbundled charge revenue.
D.   document alternative treatment facilities available to the patient.
Question #16
A health insurance company that reimburses for medical care in all or in part is known as a:
A.   health plan.
B.   designated provider.
C.   claim adjudication.
D.   health clearinghouse.
Question #17
A service that processes data into a standardized billing format and checks for errors prior to submitting a claim is a:
A.   health plan.
B.   health adjudicator.
C.   health clearinghouse.
D.   none of these.
Question #18
A review of documentation to ensure that it is complete, thorough, and accurate is:
A.   precertification.
B.   qualitative analysis.
C.   substantiation analysis.
D.   quantitative analysis.
Question #19
Which of the following is NOT an example of a qualitative health information review process?
A.   Checking for the presence of progress notes
B.   Identifying patterns of upcoding for pneumonia patients
C.   Tracking duplicate patient entries in the MPI
D.   Reviewing laterality of documentation in orthopedic cases
Question #20
Quality assessment programs are:
A.   required by the CMS.
B.   required by TJC.
C.   all of these.
D.   external and internal in scope.
Question #21
The review and management of the appropriateness of admissions and facility services is referred to as:
A.   peer review.
B.   utilization management.
C.   professional standards review organization.
D.   precertification review.
Question #22
Mary Smith is online reviewing the level of facility cleanliness among the three community-based hospitals in her city of residence before her admission for an elective cholecystectomy. She is most likely:
A.   completing a peer review.
B.   chatting with a quality improvement organization.
C.   browsing Hospital Compare data.
D.   reviewing the scope of work for the facilities.
Question #23
Comparing the ratio of Medicare spending per patient is a function of the:
A.   current scope of work.
B.   none of these.
C.   Hospital Compare and the Meaningful Use programs.
D.   peer review and Hospital Compare.
Question #24
Collecting data on common focused areas of review in all facilities upon patient discharge to measure core elements of quality may include:
A.   all of these.
B.   abstracting the date of pneumococcal vaccine in patients with pneumonia.
C.   indicating the number of years of tobacco use in cancer patients.
D.   recording the history of myocardial infarctions in patients with heart failure.
Question #25
A Joint Commission initiative used to measure the quality and safety of healthcare is:
A.   accountability measures.
B.   scope of work.
C.   CARF.
D.   core measurement system.

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