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utilization management

A person from this department works with case managers of insurance companies to determine the appropriateness of admissions.

utilization management

Committee concerned with appropriate use of resources for providing patient care.

utilization manager

Suzy Staff's job responsibilities include coordinating patient care to ensure that patients receive timely discharge or transfer. Her job title is:

professional standards review organizations, appropriateness, quality, outcomes, medicare, medicaid, maternal and child health

The utilization review process was strengthened in 1972 through the formation of the _______ to monitor the ____, ____, and ____ of services provided to beneficiaries of ____, ____, and _____ programs.

utilization manager

Responsible for coordinating patient care to ensure appropriate utilization of resources, delivery of health care services, and timely discharge or transfer.

case manager

A utilization manager is also known as a:

utilization management

Controls health care costs and the quality of health care by reviewing cases for appropriateness and medical necessity.

quality improvement organizations, quality control, utilization review of health care

In 2002, the CMS announced the establishment of ____ that would continue to perform ____ and _____ furnished to Medicare beneficiaries.

utilization management, costs

PAC (or preadmission testing) in managed care is part of the _______ to contain ______.

quality improvement organizations


quality improvement organizations

In 2002, PROs were replaced with _____?

free standing facilities

These types of facilities provide ambulatory surgery, clinical laboratory, imaging, infusion, pain management, rehab, primary care and neighborhood health care.


Hospitals that admit patients who are diagnosed with trauma or disease and need to learn how to function.


Which organization provides accreditation for rehabilitation?

hospice care

Provides comprehensive medical and supportive social, emotional, and spiritual care to terminally ill patients and their families.

palliative, curative

The goal of hospice is _______care rather than _______ care.

hospice care

A patient with end stage renal disease would be a candidate for _____.

palliative care

Hospice care provides comprehensive medical and supportive care to terminally ill patients and their families. Hospice provides ______.

residential care facilities

Which of the following does Medicare NOT reimburse: home health services, hospice care, residential care facilities, skilled care facilities.

continuing care retirement communities

Provide different levels of care based on the residents' needs from independent living apartments to skilled nursing care in an affiliated nursing facility.

skilled nursing

Facility that provides medically necessary care to inpatients on a daily basis that is performed by, or under the supervision of, skilled medical personnel.

acute care facilities

____________ provide the full range of services including critical care, emergency, surgery, obstetrics, and ancillary services

acute care

A hospital that provides health care services to patients who have serious, sudden, or acute illnesses or injuries and/or need surgeries is _____ facility.

cancer registrar

A ______ is responsible for ensuring the timely, accurate, and complete collection and maintenance of cancer data.

cancer registrars

These individuals use computerized registry software to conduct lifetime follow-up on cancer patients, electronically transmit data to state and national agencies, and generate reports and information for requesting entities.

cancer registrars

These individuals coordinate the national survey process through the ACS commission on cancer and arrange monthly or bi-monthly cancer committee meetings.

data, sources, cancer statistics, government, health care

Cancer registrars collect _______ from a variety of ______ and report _________ to ________ and ______ agencies.

cancer program development support, compliance, reporting standards, resource

Cancer registrars work closely with health care agencies to provide ______, ensure ________ with ________, and serve as a valuable _______ for cancer information.

National Cancer Registrars Association

What organization administers the CTR exam?


The assignment of numbers to diagnosis, services, and procedures based on patient record documentation.

diagnoses, services, procedures, reimbursement, research, statistical

A coding specialist ensures that all ____, ____, and _____ documented in patient records are coded accurately to ensure ____, and for ____ and ____ purposes.

coding specialist

The hospital's quality management department has determined that 10% of the medical staff is noncompliant regarding documentation issues affecting the appropriate assignment of diagnosis and procedure codes. Which professional would best provide in service training in this area?

health information managers

Experts in managing patient health information and medical records, administering computer information systems, and coding diagnoses and procedures.

quality health care

Health information managers organize, analyze, and maintain patient data to ensure delivery of ________.

patient health information, medical records, computer information systems, diagnoses, procedures

Health information managers are experts in managing _______ and _______, administering ________, coding _______ and _______ for health care services.

delivery, quality health care

Patient data is organized, analyzed and maintained by health information managers to ensure the ____ of _____.

risk management

Which committee ensures patient safety by analyzing trends of incidents and establishing priorities for dealing with high risk areas?


The _____ committee would be responsible for reviewing preoperative and pathologic diagnoses to determine the medical necessity for surgery.

credentials committee

The medical staff committee that reviews and verifies medical staff application data is the _____.

executive committee

This group reviews medical staff applications and recommendations, votes, and makes recommendations to Medical Staff.


Hospital ______________ are multidisciplinary and comprised of representatives from various departments.

risk management

A hospital committee that is responsible for analyzing trends of accidents and establishing priorities for dealing with high-risk areas is ___.

disaster control

Committee responsible for establishing a disaster plan.

health information

Committee responsible for ongoing review of patient records for timely completion and quality of documentation.

quality management

Committee concerned with the quality of care provided to patient.


Committee that meets as needed in order to discuss ethical problems.


Committee that acts on reports and recommendations from medical staff committees.


Members of the medical staff whose advancement to active category is being considered.


Which medical staff membership category includes physicians who deliver most of the hospital's inpatient medical services?


Highly qualified medical staff that provide expertise in an specific area


Medical staff who occasionally admits a patient to the hospital


Former medical staff held in high regard and honored with emerti status


The rules and regulations of the health care organization as guided by federal and state regulations and accreditation standards.


Medical staff policies that delineate medical staff responsibilities are called ____.

privacy officer

A health care professional who oversees the development, implementation, maintenance of, and adherence to the organization's policies that cover the safeguarding of patient health information is ______.

privacy, access, patient health information, federal and state laws

A privacy officer oversees the development, implementation, and maintenance of, and adherence to, and organization's policies and procedures covering _____ of and _____ to _____ in compliance with ______.


Diagnosis related groups begun in ____.

predetermined rate, discharge diagnosis

Diagnosis related groups required acute care hospitals to be reimbursed at a ______ according to ________.


This act established the first Medicare prospective payment system which was implemented in 1983. It allowed the implementation of Diagnosis Related Groups.

diagnosis related groups

IPPS uses __________ to classify inpatient hospital cases into groups expected to consume similar hospital resources.


Diagnosis-related groups were initially introduced by _______.

discharged, passed, transferred, outpatient facilities

Under DRGs, patients are _________ once acute phase of illness has _________. They are then ________ to other _________.


Mix of paper and electronic records


Patient record in paper format.


Computer based patient records

audit trail

Electronic health records will automatically create a list of all changes made to patient documentation. This is called an:


A periodic ______ of the file area should be done on a daily, weekly, or monthly basis.

periodic audit

This is done of the file area to review for misfiles and records that have not been returned within the time period specified by policy.

terminal digit filing

Type of filing systems used in facilities that assign six digit or longer patient numbers.

primary, secondary, tertiary

Terminal digit filing systems divide numbers into three parts: ______, ______, and _____.

right, left

In the terminal digit filing system, numbers are read from ______ to _____.


In the terminal digit filing system, the primary number is ______.


In the terminal digit filing system, the secondary number is ______.


In the terminal digit filing system, the tertiary number is _____.

100, 100, straight numerical order

In the terminal digit filing system, numbers are divided into _____ primary sections, _____ secondary sections, and then filed in ________ according to tertiary digits.

security, evenly, congestion, large gaps, record shifting, misfiling, transposition, inactive records

Advantages to the terminal digit and middle digit filing system include: (1) high degree of _____; (2) files expand _____; (2) eliminates ______ in file area; (3) ______, _______, _____, and _______ occur less frequently; (6) _______ are easily retrieved as new records are added.

lengthier, space, equipment

Disadvantages to the terminal digit filing system include: (1) training time ______; (2) more _____ and ______ will be needed to organize file area.

middle digit filing

Variation of the terminal digit filing system where the middle digits act as the primary number.


In the middle digit filing system, the secondary digits are on _______.


In the middle digits filing system, the tertiary digits are on ______.

centralized filing

Type of filing system where patient records are organized in one central location under control of the health information department.

identified, equipment, supplies, space, personnel, one location, services, security

Advantages of the centralized filing system include: (1) responsibility for record keeping easily _______; (2) effective use of _____, _____, _____, and ______ is made; (3) patient records are located in _______; (4) consistent _____ provided to all users; (5) allows improved ______.

decentralized filing

Type of filing system where patient records are organized throughout the facility in patient care areas under control of the department that creates and uses them.

providers, extra space, filing, retrieval

Advantages of the decentralized filing system include: (1) records are located near ______ that create and use them; (2) no ______ is needed in the health information department; (3) providers control _____ and _____.

confusion, fragmented documentation, multiple locations, maintain, uniformity, consistency

Disadvantages of the decentralized filing system include: (1) ______ can occur as to where patient information may be; (2) _______ can result because information may be filed in _______; (3) providers may not know how to properly ______ records; (4) lack of _____ or ______ in record keeping.

30-50-06, 34-50-06, 84-39-20, 12-40-96

Arrange the following numbers in terminal-digit order: 30-50-06; 84-39-20; 12-40-96; 34-50-06

10-31-20, 84-39-20, 12-40-96; 54-40-96

Arrange the following numbers in middle-digit order: 12-40-96; 54-40-96; 84-39-20; 10-31-20

serial numbering

In this system, each time a patient is registered, a new patient number is assigned and a new patient record is created.

serial numbering

This type of filing system is usually used by facilities that don't use computerized ADT software.

different, multiple locations

A disadvantage of a serial numbering system is that records are filed in ______ locations in the filing system. _______ must be accessed to retrieve patient records

serial unit numbering

Type of numbering system where patients receive a new number each time they are registered by the facility and records from previous admission/encounter are reassigned to new number

most current folder, one

In a serial unit numbering system, all patient records are filed in the ______ in _____ location.

remain in, note identifying a new

In a serial unit numbering system, folders that contain previous patient records _______ file and a ________ number is inserted into the folder.

not needed, new, subsequent, previous, one, retrieved, refiled

Advantages to the serial unit numbering system include: (a) computer software is ______ to track assignment of patient numbers; (b) patient is assigned a _____ number for ______ visits and _____ number is brought forward; (c) patient records are filed in ______ location; (c) records are easily _____ and ______.

remain in, note, patient number, thick, cumbersome, multiple

Disadvantages to the serial unit numbering system include: (a) previous folders must ______ file with ______ providing new _______ information; (b) folders can become _____ and _____; (c) ______ folders may be needed to house all records

terminal digit

Sunny View Hospital is part of a large university hospital with a very active and congested file area. Records are filed an refiled throughout the day. Which filing system should be used to distribute the records equally in the file area?

terminal digit

In this type of filing system, the final two digits are the primary numbers.

numbers, patient

Sunny Valley Hospital uses the serial numbering system. The master patient index card should contain all the _____ issued to the ____.

straight numeric filing

Ms. HIM files the following records: 223345, 223346, 223347, 223348. Which system is being used?

02-345678, 05-345678

Happy hospital uses the family numbering system. Tom Short is considered the head of household and is assigned patient number 01-345678. What number would his wife and third born child be?


Sunny View Health Care Systems files the records for their clinics at the clinic sites, the ER records on the second floor, and the inpatient records on the fourth floor. The type of filing system used is

discharge orders

Final physician order documented to release a patient from a facility.

discharge order

A patient's record contains the following order: "Mary Black is stable and has no complaint of pain. Wound is healing. No fever or chills. No medications given and no restrictions. She can be released home in the morning. To be seen in my office in two weeks." This is an example of a

discharge progress note

A ______ must be written even if you have a discharge summary.

discharge notes

This is the final progress note that indicates the patient's discharge destination, discharge meds, and follow up plan.

routine order

Physician orders preapproved by the medical staff which are preprinted and placed on the patient's record.

routine, standing

Preprinted physician orders, known as _____ or _____ orders, are preapproved by the medical staff and placed on a patient's record, usually at the time of admission.

stop order

State law mandates, and in absence of state law facilities decide, for which circumstances preapproved standing physician orders are automatically discontinued.

telephone order

Verbal order dictated via telephone to authorized staff member.


This document the patient's chief complaint, history of present illness, past, family, and social history.

past history, social history, chief complaint, present illness, review of systems

What are the five major sections of a history?

physical exam

Assessment of the patient's body systems to determine diagnosis.

previous inpatient admission, 30 days, same condition

Documents a patient's history of present illness and any pertinent changes and physical finding that occurred since _______ if patient was readmitted within _____ after discharge for _____

interval history

A 74 year old was readmitted for pneumonia seven days following discharge for this condition. In this case an ____ would be acceptable.

physical exam

If a physician hears that the patient's lungs are congested, he would document it in the _____

clinical resume

A discharge summary is also known as a _________.

hospitalization, diagnoses, procedures, findings, treatment, condition, follow up

Discharge summary should contain the reason for ________, principle/secondary _____, principle/secondary _______, significant ______, type of ______ provided, _____ upon discharge, and instructions for _______.

discharge summary

This provides information for continuity of care and facilities medical staff committee review.

discharge summary

Documents the patient's hospitalization, including reasons for hospitalization; procedures performed; care, treatment, and services provided; patient's condition at discharge; and instructions.

attending physician

The JC requires the discharge summary to be completed by ______.

progress note

In lieu of a discharge summary, final ______ can be made if the patient is treated for minor problems (short stay).

reason for hospitalization, course of treatment, condition at discharge

A discharge summary includes which three things?

administrative, clinical

All patient records contain ________ and _______ data.


Data that includes demographics, socioeconomic, and financial information.


Data that includes all patient health information obtained throughout treatment and care of patient.


Patient name, martial status, place of employment, date of birth, insurance number, and third-party payer are what type of data?


Physical and history, operative records, lab reports, discharge summary, progress notes are what type of data?

administrative data

Face sheet, advance directives, informed consent, patient property, birth certificate, and death certificate are all ________.

patient registration form

In the physician record, this contains demographic, administrative, and financial data.

administrative data

An advance directive, informed consent, and patient property form are considered

financial, administrative

The patient's insurance information is considered ____ and _____ data.

clinical, case, demographic

Patient records contain _______, ______, and ______ information.

identification, financial, clinical

The face sheet should contain ________, ________, and ________ information.


This type of information includes admitting diagnosis, principal diagnosis, procedures, condition of patient at discharge, codes.


First-listed diagnosis is ______ data.


Data that includes all health care information obtained about a patient's care and treatment.


Insurance policy number is ______ data.

clinical data

An admission clerk enters "right lower abdominal pain" as the admission diagnosis on the face sheet. This information is known as

clinical data

An anesthesiology report is considered

clinical data

All patient information obtained through treatment and care of the patient is called ____

advance directive

Hospitals are required to notify patients age 18 and over that they have the right to have an ________.

patient self determination act

This required that hospital notify patients of their right to have an advance directive.


The patient self determination act was passed in ______.

advance directive notification form

Upon admission, the patient signs an _________ to document that the patient has been notified of their right to have an advance directive.

advance directive

A legal document in which patients provide instructions as to how they want to be treated in the event they become ill and there is no reasonable hope for recovery.

advance directives, implementation, advance directives

Facilities must inform patients, in writing, of state laws regarding ______ and facility policies regarding _______ of ________.

advance directive

The patient record must document whether the individual has executed an _______.

do not resuscitate order

Advance directive that indicates medical professionals should not perform cardiopulmonary resuscitation in the event that cardiac arrest occurs.

CPR, transfer

If the patient is at home or in a nursing home, a DNR order tells medical personnel to not perform _________ and not _______ the patient to hospital.

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