Which program provides consumers with quality of care information so they can make more informed decisions about health care options?
a. Hospital Inpatient Quality Reporting (Hospital IQR)
b. Medicaid Integrity Program (MIP)
c. Recovery Audit Contractor (RAC)
d. Zone Program Integrity Contractor (ZPIC)
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Q. 2) Patient mortality, infection and complication rates, adherence to living will requirements,
adequate pain control, and other documentation that describe end results of care or a measurable
change in the patient's health are examples of
A. outcome measures. C. sentinel events.
B. threshold level. D. incident reports.
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Q. 3) Which are assigned to the MAC jurisdictions (replacing Program Safeguard Contractors) to review billing trends and patterns, focusing on providers whose billings for Medicare services are higher than the majority of providers in the community?
a. hospital value-based purchasers
b. Recovery Audit Contractors
c. whistleblowers
d. Zone Program Integrity Contractors
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Q. 4) Which feature is a trademark of an effective PI program?
A. a one-time cureall for a facility's problems
B. an unmanageable project that is too expensive
C. a cost-containment effort
D. a continuous cycle of improvement projects over time
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Q. 5) Which program was implemented to find and correct improper Medicare payments paid to health care providers participating in fee-for-service Medicare?
a. Hospital Inpatient Quality Reporting (Hospital IQR)
b. Medicaid Integrity Program (MIP)
c. Recovery Audit Contractor (RAC)
d. Zone Program Integrity Contractor (ZPIC)
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Q. 6) The Utilization Review Coordinator reviews inpatient records at regular intervals to justify
necessity and appropriateness of care to warrant further hospitalization. Which of the following
utilization review activities is being performed?
A. admission review C. retrospective review
B. preadmission D. continued stay review
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Q. 7) Which established the Hospital IQR, RAC, and ZPIC programs?
a. Deficit Reduction Act of 2005
b. Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003
c. Patient Safety and Quality Improvement Act of 2005
d. Tax Relief and Health Care Act of 2006
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Q. 8) Needlesticks, patient or employee falls, medication errors, or any event not consistent with
routine patient care activities would require risk reporting documentation in the form of an
A. operative report. C. incident report.
B. emergency room report. D. insurance claim.
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Q. 9) Which is a hospital payment monitoring program that contains hospital-specific administrative claims data for a number of CMS-identified problem areas to compare their performance with that of other hospitals?
a. CERT
b. FATHOM
c. PEPPER
d. PERM
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Q. 10) Your hospital is required by the Joint Commission and CMS to participate in national
benchmarking on specific disease entities for quality of care measurement. This required
collection and reporting of disease-specific data is considered
A. an environment of care.
B. a group of sentinel events.
C. a series of core measures.
D. risk assessment.
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