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

Question 1

The Darling vs.Charleston Community Memorial Hospital case established the precedent that _____.

A)Abolished the doctrine of charitable immunity
B)Hospitals are not liable for provider malpractice
C)Medicaid patients cannot file negligence lawsuits
D)Profit hospitals only are liable for employee negligence

Answer 1

Abolished the doctrine of charitable immunity

Question 2

The patient record documentation element that the health information manager can recommend to reduce risks to a health care facility is the _____.

A)complete documentation of a patient's condition
B)documentation errors as accurately as possible
C)ensuring that record entries do not interrupt patient care
D)omitting information that might result in a lawsuit

Answer 2

complete documentation of a patient's condition

Question 3

For which situation would an incident report be generated?

A)Decrease in blood pressure following a surgical procedure
B)Loss of a provider's parking spot to a hospital employee
C)Routine repair and maintenance of medical equipment
D)Visitor who slips and falls, but that results in no injury

Answer 3

Visitor who slips and falls, but that results in no injury

Question 4

Which is an example of a sentinel event?

A)Expected reaction to administered medications
B)Patient who reports being aware during surgery
C)Recovery following elective open heart surgery
D)Transfer of a patient to a tertiary care facility

Question 5

Before an incident report is admitted into evidence, the document must _____.

A)be reviewed by the plaintiff's attorney
B)comply with attorney work product privileges
C)overcome the application of privileges
D)produce desired results in a court of law

Question 6

An adverse incident is defined as a(n) _____.

A)Event inconsistent with normal routine operations
B)Medication error identified through quality review
C)Unexpected event involving a visitor
D)Unintended effect of a research protocol

Question 7

An incident report _____.

A)Is always discoverable as part of the official malpractice litigation process
B)May help determine patterns of healthcare activity that should be altered
C)Requires discussion with the plaintiff's legal team of malpractice attorneys
D)Should be included as a part of the patient's permanent medial record

Question 8

Automated databases in the context of risk management _____.

A)Decrease reliability of statistical analysis by making information less searchable
B)May be used to compile information in an effort to increase prevention of loss
C)Operate in the confines of health information management functions alone
D)Reduce risk of loss due to the large amount of stored sensitive information

Question 9

Which data mining technique associated with the electronic health record enhances security and reduces patient risk?

A)Education of employees and providers about searches
B)Identification of inconsistent patient record entries
C)Prevention of unauthorized access of sensitive information
D)Use of tracking software to locate breaches of confidentiality

Question 10

Which incident would be reported to the risk manager?

A)A patient visitor getting lost on the way to the hospital
B)Intravenous therapy resulting in reduced infections
C)Patient refusing to consent for an elective procedure
D)Surgical procedure performed on the wrong site

Question 11

How does risk management differ from quality management?

A)Quality management lessens effects of unavoidable risks.
B)Quality management processes are outcome oriented.
C)Risk management's primary focus is on improving clinical care.
D)Risk management identifies areas of operational and financial loss.

Question 12

What is the most important way to reduce an organization's risk due to loss or litigation?

A)audit trails
B)maintenance of electronic records
C)proper documentation
D)quality reviews

Question 13

To protect an incident report from discovery, _____.

A)It needs to be part of the patient's permanent medical record
B)Payers are required to have previously reviewed the incident report
C)There must be an established attorney-client relationship
D)Using the report during employee training and review is necessary

Question 14

Which a nontechnical measure that might be employed to enhance security controls related to healthcare records access?

A)Educating employees about how to properly handle information
B)Installing firewalls on all computers in the healthcare facility
C)Requiring employees to change their password every 90 days
D)Utilizing effective data mining techniques to access information

Question 15

If an incident report is inadvertently released during the discovery process along with the medical record, _____ applies

A)attorney work product privilege
B)Behringer Estate v.Medical Center at Princeton
C)business record exceptions
D)Federal Rule of Evidence 502

Question 16

HIPAA requires a covered entity to perform a risk analysis and implement standards to protect the institution's health information records.Which is one of those standards?

A)Definition of security measures that should be implemented and revised
B)Documentation of the entity's actions, which are to be maintained for 6 years
C)Specification of a step-by-step approach outlined in the HIPAA regulations
D)Statutory requirements that health information professionals be credentialed

Question 17

Admissibility refers to _____.

A)data that may be uncovered during investigation of an possible incident by the risk manager
B)information that is always entered into evidence by the plaintiff's attorney during a malpractice trial
C)the right of the healthcare facility to keep certain healthcare information confidential and private
D)whether information is pertinent and proper for a jury to consider when deciding legal issues

Question 18

Which is a legal consideration that applies to the retention of health care records?

A)Available storage and methods of destruction
B)Decision made by the health information committee
C)Length of time required by statute and regulation
D)Policy established by the health care institution

Question 19

Which is characteristic of an incident report?

A)Documents circumstances to assess for the possibility of impending litigation
B)Guarantees that facility malpractice insurance premiums will be reasonable
C)Provides a method of defense against liability for actions of facility employees
D)Serves as a way to discipline the health care provider who perpetrated an error

Question 20

Charitable immunity is the _____.

A)ability for a nonprofit organization to avoid litigation for malpractice
B)implementation of Good Samaritan laws in all states in the country
C)shielding of health care institutions from liability for employee negligence
D)way a health care facility manages its quality management programs

Question 21

Peer Review Organizations (PROs) _____.

A)determine the amount of reimbursement for facilities
B)enact policies relative to risk management processes
C)monitor the appropriateness and quality of outcomes
D)take disciplinary actions against providers for malpractice

Question 22

State statutes regarding peer review activities _____.

A)Are well defined to protect the activities of a peer review committee
B)Cover the medical staff credentialing process in health care facilities
C)Expressly protect peer review activities performed by HMOs in all states
D)Protect peer review participants from liability unless they act in malice

Question 23

Medicare's inpatient prospective payment system _____.

A)Changed reimbursement per diem rates to predetermined rates
B)Defined APCs, APGs, DRGs, MS-DRGs, RBRVS, and RUGs
C)Established minimum reimbursement amounts for hospital stays
D)Provided payment to facilities in advance of inpatient admission

Question 24

The function of analyzing and evaluating all of the risks that affect an organization is called _____.

A)enterprise risk management
B)litigation support
C)quality review
D)root-cause analysis

Question 25

Information regarding the competence and conduct of health care practitioners and providers is _____.

A)does not include actions against a provider's license
B)excludes information regarding malpractice payments
C)maintained by individual states of the United States
D)reported to the National Practitioner Data Bank

Question 26

Quality management is described as a _____.

A)clinical function that seeks to define optimum performance
B)method of assessing individual patients at organizations
C)process of identifying sentinel and other events
D)way of increasing risk to a healthcare organization

Question 27

Which involved a combination of planned functions directed toward prudent allocation of medical resources and the administration of appropriate treatment?

A)managed care
B)physician credentialing
C)root-cause analysis
D)utilization management

Question 28

The Joint Commission's role in sentinel events includes _____.

A)Performing onsite reviews as the result of all sentinel events
B)Possibility of placing the organization on accreditation watch status
C)Requiring sentinel events to be reported within 45 days of an event
D)Withdrawing accreditation for reporting of sentinel events

Question 29

Which is an example of a utilization management function?

A)Emergency room triage
B)Gatekeeping
C)Preadmission testing
D)Research protocol screening

Question 30

Which is an example of a concern that may be addressed as the result of an enterprise risk management assessment?

A)Costs of private schooling at the healthcare facility
B)Nursing staffing that is adequate for patient needs
C)Percentage of uninsured patients seeking treatment
D)Risk management plan that is effective and working

Question 31

State legislatures have passed laws assigning a "privileged" status to peer review deliberations and review activities, an example of which includes _____.

A)Case management records, which facilitate post-discharge care of the patient
B)Liability for libel and slander, which are implicit if documented in patient records
C)Minutes of peer review committee, which are considered immune from discovery
D)Risk management files, which must be made accessible to patients and their families

Question 32

Utilization review is described as a(n) _____.

A)combination of activities aimed at loss prevention
B)legally unenforceable system that increases lawsuits
C)optional process to be implemented by healthcare facilities
D)required component of Joint Commission accreditation

Question 33

Which is an obstacle to peer review activities?

A)Administrative feedback and input
B)Fear of reprisals for candid criticism
C)Participation by healthcare providers
D)Resultant measures to improve care

Question 34

Peer review committees serve to _____ as part of the quality management process?

A)Conduct audits of patient information to compare against established guidelines
B)Evaluate, maintain, and monitor risk management functions of health care services
C)Manage the organization's employees and providers credentialing process
D)Prescribe disciplinary action against employees who violate policies and procedures

Question 35

Which an investigation into a serious event, including clinical and administrative review?

A)Discovery process
B)Incident reporting
C)Root-cause analysis
D)TPO procedures

Question 36

Which involves a combination of planned functions directed toward prudent allocation of medical resources and the administration of appropriate treatment?

A)case management
B)health information management
C)quality management
D)risk management