At which level of the Medicare Part A or B appeals process is the appeal reconsidered by a qualified independent contractor? a. first level appeal b. second level appeal c. third level appeal d. fourth level appeal: b. second level appeal There are five levels of appeal. First level entails a redetermination of claim; second level involves reconsideration by a qualified independent contractor; third level includes a hearing overseen by admin law judge; fourth level is a review of Medicare Review Council; and fifth level is a judicial review in federal court.
If an at-risk patient is left unattended and has an adverse response to medication, this is known as: a. sentinel event b. initiator c. latent outcome d. slip: a. sentinel event Sentinel event is an adverse occurrence that is not in the normal progression of a patient’s illness. In this scenario, an adverse drug event is considered a sentinel event. AND whenever a sentinel events is confirmed, the facility should perform a Root Cause Analysis (RCA). A Latent Outcome – less apparent failures of organization or design that contributed to the error/patient harm. A Slip – can be a fall or an everyday risk at hospitals.
A behavioral health specialist notices a particularly high number of restraint deaths at a facility. An analysis of the root causes of these events is most likely to indicate problems with: a. Equipment b. Staff orientation and training c. Staffing levels d. Alarm systems: b. Staff orientation and training Equipment, staffing levels, and alarm system can also be culpable in restraint deaths, but problems with orientation and training are much more likely.
Which piece of legislation established a new set of standards for corporate responsibility? a. sarbanes-oxley act b. united states patriot act c. foreign corrupt practices act d. stark law: a. sarbanes-oxley act Sarbanes-oxley act was passed after a series of high-profile financial scandals in early 2000s to protect shareholders, improving corporate governance and accountability setting new set of standards for corporate responsibility.
According to the Federal Sentencing Guidelines, which of the following factors could increase the punishment of an organization? a. obstruction of justice b. violation of direct court order c. prior history of violations d. all of the above: d. all of the above These are aggravating factors that increase the culpability score under the FSG. See FSG chapter 8-C2.5
When a hospital official notes that most errors are occurring at the “sharp end” she means that: a. they involve surgical tools or knives b. they occur in clusters c. they occur during the interactions between caregivers and patients d. they are most likely to occur during busy periods: c. they occur during the interactions between caregivers and patients. The “sharp end” and “blunt end” are used by quality management professionals to describe areas of practice. “Sharp end” is all of the operations that involve direct contact with patient/client/customer. “Blunt end” is all actions that take place outside awareness of patient/client/cus- tomer.
The majority of fraud and abuse violations relate to irregularities in: a. treatment b. diagnosis