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CHDA Domain 1 (Business Needs Assessment) Questions With Complete Solutions A clinical documentation improvement (CDI) program facilitates accurate coding and helps coders avoid: Correct Answers Using non-specific codes A drug interaction alert would be a typical function of a _______? Correct Answers Decision Support System (DSS) A hospital that is installing bedside monitoring devices that must feed data into the electronic health record (EHR) should be sure to conform to which of the following standards? Correct Answers DICOM (digital imaging and communications in medicine, develops standards for exchange of clinical images) A patient born with a neural tube defect would be included in which type of registry? Correct Answers Birth defects (these registries use a variety of criteria to determine which cases to include in the registry. Some registries limit cases to thos borth defects during within the first year of life while others include those children with a major defect that occurred in the 1-5 years of life. Still other registries include only children who were live- born or still-born babes with discernible birth defects.) A research instrument that is used to gather data and information from respondents in a uniform manner through the administration of a predefined and structured set of questions and possible responses is called a(n) ____. Correct Answers Survey (typically a questionnaire either written or online)
A set of standards that provides universal names and codes for laboratory and clinical results is ____? Correct Answers LOINC (logical observations identifiers names and codes) Activities of daily living (ADL) are components of ____? Correct Answers MDS (minimum data set) and OASIS (outcome and assessment information set) An example of a database that depends on standardized data definitions is ____. Correct Answers A statewide cancer data system (system used to provide data that can be used for surveillance, epidemiology, results, etc) Assume you are the manager of a 10-physician group primary care practice. The physicians are interested in contracting with an application service provider (ASP) to develop and manage patient records electronically. Which of the following statements in an indication that an ASP may be a good idea for this practice? Correct Answers The practice does not have the upfront capital or IT staff needed to purchase and implement a system from a health information systems vendor. Benchmarking may be used to ____. Correct Answers Determine areas of improvement The American Productivity and Quality Center (APQC) describes benchmarking as "the process of improving performance by continuously identifying, understanding and adapting outstanding practices and processes found inside and outside the organization" (APQC 1999; White 2013, 161).
not shared with other departments within the healthcare entity. After identifying procedural problems that contribute to the creation of the MPI errors, which department should the MPI manager work with to correct these procedural problems? Correct Answers Registration or patient access (registration goal is enrollment into records of the hospital; patient access goal is to educate and support individuals to obtain or deliver comprehensive quality healthcare) How do healthcare providers use the administrative data they collect? Correct Answers For regulatory, operational, and financial purposes (administrative data is coded information contained in secondary records such as billing records, describing patient identification, diagnoses, procedures, and insurance) If My Town Practice is looking for a way to justify higher compensation for the physicians that provide the highest level of resource intensity, which of the following metrics is the most appropriate? Correct Answers Number of RVUs (this is a measure of resource intensity required to deliver a service or procedure to a patient) If the total practice expense for a group is $1,500,000 and the total RVUs provided by that practice is 125,000, what is the break even conversion factor? Correct Answers $12 (break even conversion factor (BECF) can be used to create a fee schedule: total practice expenses/total RVUs) In long term care settings, the resident's care plan is based on data collected in the ____. Correct Answers MDS (assessing
the functional capacity of each patient via the resident assessment instrument (RAI) is a requirement of these nursing facilities; all RAIs include the MDS, resident assessment protocols (RAPs), and utilization guidelines) In long-term care, the resident's care plan is based on data collected in the ____. Correct Answers MDS In order to ensure a successful implementation of electronic health records, the organization must identify and define strategic planning roles. These planning roles may be defined in three categories: leadership, internal stakeholders, and external stakeholders. The governing body (board) is an example of which of the following? Correct Answers Leadership only In terms of grouping and reimbursement, how are the MS-LTC- DRGs and acute care MS-DRGs similar? Correct Answers Organized into MDCs (major diagnostic category) In which EHR database model is all of the healthcare entity's patient health information stored in one system? Correct Answers Centralized (most health record systems are organized according to one of two DB models: decentralized or distributed; or a hybrid of the two models; centralized DB model all of the organization's patient health information is stored in one system) In which form of the DB would data mining to support complex data analysis most effectively take place? Correct Answers Clinical data warehouse (when complex reporting and analytics
Mary Smith, RHIA, has been charged with the responsibility of designing a data collection form to be used on admission of patients to the acute-care hospital in which she works. What is the first resource she should use? Correct Answers UHDDS Medical severity diagnosis-related groups (MS-DRGs) represent a prospective payment system implemented by the CMS to reimburse hospitals a predetermined amount for services provided to ____. Correct Answers Inpatients (IPPS, UB- bills) OASIS data is used to assess the ____ of home health services. Correct Answers Outcomes (OASIS is a key component of Medicare's partnership with the home care industry to foster and monitor improved home healthcare outcomes; stands for Outcome and Assessment Information Set) Once all data has been posted to the patient's account, the claim can be reviewed for accuracy and completeness. Many facilities have an internal auditing system that runs each claim through a set of edits. This internal auditing is known as a ____. Correct Answers Scrubber (part of the auditing system that includes a set of edits specifically designed for that 3rd party payer; the goal of a scrubber is to detect and eliminate errors in billing codes, reducing the number of claims to medical insurers that are denied or rejected) One way to examine readmissions with a given time frame at your facility is to retrieve patient data for that time frame and look for duplicates of which attribute common in clinical data sets? Correct Answers Medical record number
One way to examine readmissions with a given time frame at your facility is to retrieve patient data for that time frame, and look for duplicates of which attribute common in clinical data sets? Correct Answers Medical record number (unique identifier assigned to each health record, used to ensure all information about the patient is entered in the correct record) Resource-based relative value (RBRVS) rates are calculated based on practice, expense, malpractice cost, and physician work and are then adjusted by a ____. Correct Answers Geographical practice cost index (GPCI; RBRVS fee schedule formula: [(RVUwGPCIw)+(RVUpeGPCIpe) +RVUmGPCIm)]CF = Payment) RVUs are used as the basis of Medicare payment for which type of provider? Correct Answers Physician (RVUs are assigned to CPT and HCPCS codes to determine the Medicare fee schedule payment) Standardized sets of valid, reliable, and evidence-based measures implemented by the Joint Commission are called ___. Correct Answers Core (performance) measures (set of care or treatment standards identified by CMS and/or Joint Commission (TJC) that have been shown through best scientific evidence to decrease the risk of complications, prevent recurrences, and improve patient clinical outcomes overall) The ambulatory payment classification (APC) system is based on the categorization of ____ services. Correct Answers Outpatient care (OPPS uses a grouping methodology called
The computer-based process of extracting, quantifying, and filtering discrete data that reside in a relational database is called ____. Correct Answers Data mining (practice of examining large DBs in order to generate new information) The federal initiative to collect data for research about the delivery and organization of healthcare in the US is called ____. Correct Answers HCUP (A major initiative for AHRQ has been the Healthcare Cost and Utilization Project (HCUP); HCUP uses data collected at the state level from either claims data from the UB-04 or discharge-abstracted data, including UHDDS items reported by individual hospitals in in some cases by free standing ambulatory care centers. Which data are reported depends on the state. Data many be reported by the facilities to a state agency or to the state hospital association depending on state regulations. The data are then reported from the state to AHRQ where they become part of the HCUP DBs) The federal law that directed the Secretary of Health and Human Services to develop healthcare standards governing electronic data interchange and data security is the ____. Correct Answers HIPAA The inpatient data set incorporated into federal law and required for Medicare reporting is the ____. Correct Answers Uniform Hospital Discharge Data Set (UHHDDS; implemented in 1974 originally an initiative of what is now HHS as a result of the founding Medicare program, allows for comparison between hospitals)
The leader of the coding performance improvement team wants all team members to clearly understand the coding process. What tool could help accomplish this objective? Correct Answers Flowchart (diagram that represents a workflow or process providing a step by step approach to solving a task) The nominal group technique gives each member of the team an opportunity to select the most important ideas from an affinity diagram. This technique allows groups to do which of the following? (nominal group technique steps are silent listing, recording each participant's list, discussing, and rank ordering the priority) Correct Answers Narrow the focus of discussion without extending involvement The physician fee schedule is based on what components? Correct Answers All of these The practice of using a code that results in a higher payment to the provider than the code that actually reflects the service or item provided is known as ____. Correct Answers Upcoding Total fees received by Physician Group A is $130,500. If the break-even conversion factor is $29,000 how many claims were paid? (BECF=Total Practice Expenses/Total RVUs) Correct Answers 4, Under RBRVS, which elements are used to calculate a Medicare payment? Correct Answers Work value and practice expenses Under the OPPS payment system, the payment is based primarily on ____. Correct Answers The weight of the APC
business records as a protective legal defense tool; most of the time this effort is performed in conjunction with other stakeholders like IT, compliance and risk management) Which code set would be utilized to create a report showing a hospital's case mix index? Correct Answers DRG Which code set would be utilized to create a report showing a hospital's CMI (case mix index)? Correct Answers DRG (diagnosis related group) Which data element would be used to verify if the present on admission coding was correct on a patient with an admitting diagnosis of decubitus ulcer (bed sore)? Correct Answers Skin exam (documented by a provider and can be used to verify POA coding) Which information found on the chargemaster describes payment codes for services or items, and usually a 3 or 4 digit number? Correct Answers Revenue code (nationally recognized four digit code that provides a general identification of what the line item charge represents. There are more than 500 revenue codes that represent categories like room and board, lab services, radiology services, pharmacy items, therapy services, supply items and surgical procedures) Which national database includes data on all discharged patients regardless of payer? Correct Answers Healthcare Cost and Utilization Project (HCUP; family of databases and related software tools and products developed through a federal-state- industry partnership and sponsored by AHRQ, derived from
administrative data and contain encounter-level, clinical and non clinical information including all listed diagnoses and procedures, discharge status, patient demographics, and charges for all patients regardless of payer) Which of the following activities is likely to occur in the analysis phase of the systems development life cycle (SDLC)? Correct Answers Examine the current system and identify opportunities for improvement. Which of the following are phases of SDLC? Correct Answers Analysis, design and implementation Which of the following basic services provided by a HIE (health information exchange) entity ensures that information can be retrieved as needed? Correct Answers Secure data transport Which of the following elements is found in a charge description master? Correct Answers Procedure or service charge (charge description master (CDM) is the DB of all billable items that go on patients' accounts; includes descriptions, revenue codes, department associations, alternate CPT/HCPCS codes by payer, and prices) Which of the following indexes and databases includes patient- identifiable information? Correct Answers Master population/patient index (MPI, patient master index, electronic database that holds demographic information on every patient who receives healthcare services; MPI aims to accurately match and link records by uniquely identifying individuals)
processes to ensure that IS priorities are congruent with the overall strategic plans of the entity. Which one of the following statements most accurately describes the optimal relationship between strategic planning and strategic IM planning in a healthcare entity? Correct Answers The two processes are clearly related. It is important for the CIO to be incolced in both processes to ensure that IS priorities are congruent with the overall strategic plans of the entity. Which RVU (relative value unit) component is best suited for measuring physician productivity? Correct Answers wRVU (work RVU assigned based on each patient examination or procedure performed, reflects relative time and intensity associated with providing a service) Which type of indicators measure the actual results of care for patients and populations, including patient and family satisfaction? Correct Answers Outcome (relate to recovery, restoration of functionality and survival of patients) Which work measurement tool uses random sample observations to obtain information about the performance of an entire department? Correct Answers Work sampling (technique of work measurement that involves using statistical probability to characterize the performance of the department and its functional work units) You are asked to write a report to capture patient injuries by diagnosis code. To determine which injuries happened while the
patient was in the hospital, you look to the present on admission indicator. Which indicator would show you the injuries occurring while the patient was in the hospital? (Y=yes, N=no, U=unknown, W=clinically undetermined) Correct Answers N (no diagnosis was not present at the time of inpatient admission) You have been asked to build a survey to measure patient health literacy to a given degree of precision. Which of the following statements accurately describes the relationship between variability in literacy levels, precision (as measure by CI), and the minimum number of patients you must survey to attain the precision? Correct Answers As variability in levels of literacy increases, the needed sample size increases Your CFO has contacted you because your facility's CMI increased last year. He wishes to hear your theory on why this is so. Among the options provided, which would best explain an increase in the CMI? Correct Answers Quality of clinical documentation improved Your chief financial officer has contacted you because your facility's CMI increased last year. He wishes to hear your theory on why this is so. Among the options below, which would be best to explain an increase in the CMI? Correct Answers The quality of clinical documentation improved.
