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ABQUARP (HCQM) QUESTIONS WITH ALL CORRECT ANSWERS!!
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ABQUARP (HCQM) QUESTIONS WITH ALL CORRECT ANSWERS!!
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Name: Score:124 Multiple choice questions
Term 1 of 124
One Program Integrity-One PI
uses a systematic process, enhance performance. Looks at processes, not individual. ( ex
laparoscopy, less hospt stay)
provides integrated searchable database to Medicare claims across the IDR (Integrated
Data Base) Helps detect fraud, waste and abuse.
providers are paid on a capitated or discounted fee-for -service
HMO-IPA own office, use HMO docs, plan approves treatment and makes referals
no errors, degree of excellence, do the right thing and do it well. Meeting customers
expectations, exceed expectations.
Term 2 of 124
APSF- anesthesia patient safety foundation
national and regional data analysis to look for fraud and refer to prosecution. Focus on
Medicare A/B 18 PSC and 5 hot spot Zones and 2 other zones for 24 states.
1. Direct Health Care-IHS facility
2. Cotract health service -CHS
1.5mill lives
eligible- rec tribe, regarded as member in his community, tribal affairs
survey used to measure pt satisfaction and outcomes
Used for marketing and process improvement
public issues like smoking, DM, asthma, Ca
First org to develop just to improve pt safety
Dr. Pierce "40 y behind the mask" 1982
The Deep Sleep-6000 will dies was on 20/20 1982
,Definition 3 of 124
1996-Federal govt formed as a guide for quality mgt, esp for Medicare and Medicaid
-Designed to strengthen the efforts to protect and improve health and satisfaction to Medicare
and Medicaid enrollees
-clarifies responsibility in promoting quality
-promotes partnership
-develop coordinated quality oversight
-looks for new developments
HCQIA-health care quality improvement act
HIPAA-health information portability accountable act
HITECH Act -Health information technology for Economic and Clinical Health
QISMC- quality improvement for system of Managed Care
Term 4 of 124
PPO-Preferred Provider Org
goal is to improve health outcomes by developing and disseminating evidence based info
to pt, providers of different health treatment options.
correct past improper payments and implement actions to prevent future improper
payments. for Medicare
1991-in 3.7% of hospitalization
27.6% due to negligence
70.5% of adverse events gave disability of >6m,
2.6% permanent
13.6% death
providers offer discounted fee, in return for direction of pt to their office
can chose in our out of network
,Term 5 of 124
Adverse Events- stats:
no errors, degree of excellence, do the right thing and do it well. Meeting customers
expectations, exceed expectations.
1991-in 3.7% of hospitalization
27.6% due to negligence
70.5% of adverse events gave disability of >6m,
2.6% permanent
13.6% death
Focus on Outcomes, looks at transmission of illness to providers, staff and visitors. Reduce
risk of future infection
lack of consistency, emphasis on short term profits, eval of performanmce,job hopping,
excessive medical cost, excessive liability
Definition 6 of 124
1972-82 was physician controlled, nonprofit org that looked at Medicare IP, Utilization and quality.
Changed to PSRO in 1982 via the Tax Equity and Fiscal Responsibility act
PRO- peer review organization
Pqri-physician quality reporting initiative
Fsa- flexible spending account
Chap-community health accreditation prog
Term 7 of 124
6 major aims of health care
started standards and accreditations in early 20th century
analyzing a sentinel event, must assess the culture.
safe, effective, patient -centered, timely, efficient and equitable.
unrestricted choice of provider, more expensive, may have deductible
, Definition 8 of 124
standards by which health care prof may disclose protected health information ( PHI)
-may disclose to 3 party
-ensure the integrity and confidentiality of information and protect against unauthorized uses or
disclosures of information
HIPAA-health information portability accountable act
HITECH Act -Health information technology for Economic and Clinical Health
HCQIA-health care quality improvement act
Patient Protection and Affordable Care Act
Term 9 of 124
HMO Staff Model
Network Mgt, Quality control, Credentialing
Utilization value based
allows docs in rural areas to have ownership in clinical lab servicing rural communities.
central building, low prev co-payment cost, use doctors in the HMO, plan makes referral
and approves care
actual or presumed ability to engage in gainful activity is absent. No reasonable return is
expected.
Term 10 of 124
AAAHC accreditation assoc for ambulatory health care
accredits over 0k ambulatory health care orgs.
accredits over 5k ambulatory health care orgs.
accredits over 95k ambulatory health care orgs.
accredits over 4k ambulatory health care orgs.
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