Healthcare Data Management and Quality Assurance

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Questions and Answers

What is the estimated percentage of physician and other clinicians who currently use electronic prescribing of medications?

Between 5 and 8% (correct)

Between 50 and 60%

Between 20 and 30%

Between 10 and 15%

What is the main purpose of the Accreditation Association for Ambulatory Health Care (AAAHC)?

To promote excellence in medicine and patient care (correct)

To develop medical coding systems

To classify morbidity and mortality information

To assign reimbursement amounts to providers

Which of the following is a medical coding system used to classify morbidity and mortality information?

COLA

Ninth Revision of the International Classification of Disease (ICD-9-CM) (correct)

Health Care Portability & Accountability Act (HIPAA)

Current Procedural Terminology (CPT)

What is the main purpose of the Health Care Portability & Accountability Act (HIPAA) of 1996?

To assist in the assignment of reimbursement amounts to providers Signup and view all the answers

Which organization is responsible for developing and maintaining the Current Procedural Terminology (CPT) coding system?

American Medical Association (AMA) Signup and view all the answers

What is the main purpose of the COLA accreditation program?

To promote quality laboratory testing and services Signup and view all the answers

What is the purpose of minimally-invasive procedures in healthcare?

To allow for the performance of surgeries without hospitalization Signup and view all the answers

What is the ultimate goal of accredited organizations in healthcare?

To promote quality care and patient safety Signup and view all the answers

What is the primary purpose of adjudication in a healthcare system?

To determine which payor pays which portion of the bill Signup and view all the answers

What is the benefit of editing claims prior to submission in an electronic system?

Avoiding further processing, costing, time, and money Signup and view all the answers

Why is it necessary to conduct eligibility checks for each instance of service?

To ensure clients have not changed insurance plans Signup and view all the answers

What is a benefit of using an electronic system in healthcare organizations?

Reducing the time spent finding and delivering charts Signup and view all the answers

What type of healthcare organizations can benefit from an electronic system?

A variety of healthcare organizations, including ambulatory clinics, surgery centers, and more Signup and view all the answers

What is a consequence of not editing claims prior to submission?

Further processing, costing, time, and money Signup and view all the answers

Why is it important to have formats that are legible and comply with legal regulations?

To ensure compliance with legal regulations Signup and view all the answers

What is a benefit of using an electronic system in ambulatory clinics?

Reducing the time spent finding and delivering charts Signup and view all the answers

What is the primary purpose of the Healthcare Common Procedure Coding System (HCPCS)?

To promote uniform reporting and statistical data collection of medical procedures, supplies, and services Signup and view all the answers

What is the role of the National Committee for Quality Assurance (NCQA)?

To assess and report on the quality of managed care plans Signup and view all the answers

What is the purpose of the National Drug Code (NDC)?

To identify pharmaceuticals in detail, including their packaging Signup and view all the answers

What is the role of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)?

To publish standards for healthcare organizations Signup and view all the answers

What is the primary purpose of nursing assessment in the electronic health record (EHR)?

To collect vital data and fundamental information necessary for the next process Signup and view all the answers

What is the purpose of nursing diagnosis in the electronic health record (EHR)?

To comprehend the patient's condition and responses Signup and view all the answers

What is the role of the electronic health record (EHR) in healthcare data analysis?

To store and retrieve data for statistical purposes Signup and view all the answers

What is the primary purpose of healthcare accreditation in healthcare organizations?

To ensure quality care and improve patient outcomes Signup and view all the answers

Study Notes

Accredited Organizations

National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization that assesses and reports on the quality of managed care plans.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) publishes Management of Information Standards for Ambulatory Care.
Accreditation Association for Ambulatory Health Care (AAAHC) is a private, not-for-profit organization that develops standards and conducts surveys to promote excellence in medicine and patient care.

Coding Systems

Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products, and services provided to Medicare beneficiaries and individuals enrolled in private health insurance programs.
National Drug Code (NDC) identifies pharmaceuticals in detail, including packaging.
Current Procedural Terminology (CPT) describes medical procedures performed by physicians and other health providers.
Ninth Revision of the International Classification of Disease (ICD-9-CM) is designed for the classification of morbidity and mortality information.

Electronic System Benefits

Reduction in the size of the record room
Reduced time spent finding and delivering charts
Increase in the privacy of data
Formats that are legible and comply with legal regulations

Ambulatory Care

Ambulatory clinics and surgery centers, single and multispecialty group practices, diagnostic laboratories, health maintenance organizations, independent physician associations, birthing centers, and college and university health services provide ambulatory care.
Estimates for the prevalence of chronic diseases, and the development of minimally-invasive procedures that can be performed without hospitalization.

The Health Care Portability & Accountability Act of 1996

Established regulations for electronic data interchange and security standards for health care data.

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Description

This quiz covers the role of organizations such as NCQA in assessing and reporting on the quality of managed care plans, as well as the use of healthcare coding systems for data storage and retrieval.