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 Correct Ans – 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 Correct Ans – 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 Correct Ans – 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 Correct Ans – 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 Correct Ans – d. all of the above
These are aggravating factors that increase the culpability score under the
FSG.
See FSG chapter 8-C2.5 https:\/\/guidelines.ussc.gov\/gl\/%C2%A78C2.5
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 Correct Ans – 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\/customer.
The majority of fraud and abuse violations relate to irregularities in:
a. treatment
b. diagnosis
c. billing
d. scheduling Correct Ans – c. billing
Which of the following words best describe the approach to punishment of
the Federal Sentencing Guidelines:
a. case-specific
b. draconian
c. consistent
d. remedial Correct Ans – a. case-specific
FSG takes numerous factors into account when determining punishment.
The range of penalties that may be applied to a given violation is broad, and
organizations may affect the severity of their punishment with their
actions subsequent to the violation
Which of the following groups may request information from the
Healthcare Integrity and Protection Data Bank?
a. professional societies with formal peer review
b. quality improvements organizations
c. plaintiff’s attorneys
d. state agencies Correct Ans – d. state agencies
Other groups may include federal government, health plans, healthcare
practitioners. Researchers are only allowed to obtain statistical data form
the data bank.
Research suggests that the largest proportions of adverse events
attributable to negligence occur in the:
a. post-trauma unit<\/p>\n","protected":false},"excerpt":{"rendered":"
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