Deck 12: Risk Management, Quality Management, and Utilization Management: Part A

Question 1

An incident report may be paper-based or in electronic form, and it is filed _____

A)in a section of the patient record
B)in court by the hospital attorney
C)securely at off-site storage
D)separately from the patient record

Answer 1

separately from the patient record

Question 2

Which is an outcome-based management function that implements measures to prevent or lessen the effects of risks at the lowest cost?

A)quality management
B)risk management
C)security management
D)utilization management

Answer 2

risk management

Question 3

Which is an important area of quality control that uses both patient records and non-patient records?

A)quality management
B)risk management
C)security management
D)utilization management

Answer 3

utilization management

Question 4

Which is an issue associated with HIPAA security?

A)Record destruction is not permitted during the ordinary course of business.
B)Requests for access to the patient record must be processed within one day.
C)The retention of records must be according to federal or state statutes and regulations.
D)The record must be unavailable to health care professionals treating the patient.

Question 5

With regard to importance, an incident report is _____.

A)equally significant for defendant's and plaintiff's attorney
B)more significant for defendant's attorney
C)of no significance for either defendant's or plaintiff's attorney
D)significant to the patient who gets a copy of the report

Question 6

Risk managers may report to various lines of authority, depending on the organizational structure of the health care facility, including the _____.

A)HIM department
B)IT security department
C)Outside legal counsel
D)Safety department

Question 7

When patient entries are completed in a timely and complete manner, authored and authenticated properly, they accurately reflect the _____.

A)care provided to the patient
B)charges listed on the UB-04
C)risk associated with provider liability
D)standard of care that was not met

Question 8

Information about disciplinary actions is reported to the _____ by hospitals, medical societies, licensing boards, prepaid medical practices, and other health care entities.

A)Healthcare Integrity and Protection Data Bank
B)Medical Information Bureau
C)National Practitioner Data Bank
D)Quality Improvement Organizations

Question 9

Which is the term for an unexpected occurrence involving death or serious physical or psychological injury?

A)data mining
B)patient outcomes
C)root-cause analysis
D)sentinel event

Question 10

Incident reports are covered by the _____ rule of evidence and business record exception, and they may or may not be admitted as evidence.

A)circumstantial
B)hearsay
C)statutory
D)tort

Question 11

Patient record documentation proves what did or didn't happen regarding patient care, and it establishes whether the _____ of care was met.

A)continuity
B)duty
C)network
D)standard

Question 12

Which is the general term for any event or circumstance not consistent with the normal routine operations of the hospital, its staff, or the routine care of a patient?

A)accident
B)error
C)incident
D)situation

Question 13

A properly documented patient record will _____ the health care facility's risks.

A)augment
B)heighten
C)increase
D)reduce

Question 14

The development, implementation, and enforcement of facility-wide patient confidentiality policies are significant in _____.

A)decreasing risk of breach of confidentiality
B)managing adverse risk management incidents
C)retaining health records according to statutes
D)the opportunity for providing nontechnical sources

Question 15

The clinical review of the appropriateness of admission and planned use of resources that can be and often is initiated prior to admission and conducted at specific time frames is called _____.

A)case management
B)quality management
C)risk management
D)utilization management

Question 16

The analysis and evaluation of all sentinel events that might be encountered by a health care organization is called _____.

A)enterprise risk management
B)medical staff disciplinary process
C)peer review analysis
D)traditional trending

Question 17

Which legislation is designed to improve the exchange of information about decisions relating to the professional competence and conduct of physicians, dentists, and other heath care practitioners?

A)American Recovery and Reinvestment Act
B)Freedom of Information Act
C)Health Care Quality Improvement Act
D)Health Insurance Portability and Accountability Act

Question 18

Which force influences the growth of risk management?

A)Decreased medical malpractice lawsuits resulted in high damage awards.
B)Implementation of the doctrine of charitable immunity via court decisions.
C)Joint Commission required hospitals to implement risk management programs.
D)State legislatures established no requirements for risk management programs.

Question 19

A risk manager would typically have a _____ background.

A)administration
B)billing
C)legal
D)monetary

Question 20

The health information manager's role in risk management is to _____.

A)chair the risk management committee
B)complete incident reports when requested
C)educate providers about patient safety
D)enforce patient record requirements