CEHRS Regulatory Compliance and Quality Assurance 3 — Questions and Answers
Question 1: Which regulation requires clinical laboratories to maintain quality control records and participate in proficiency testing?
- HIPAA Privacy Rule
- Clinical Laboratory Improvement Amendments (CLIA) (Correct answer)
- Joint Commission standards
- CMS Conditions of Participation
Correct answer: Clinical Laboratory Improvement Amendments (CLIA)
CLIA establishes quality standards for all laboratory testing to ensure accurate and reliable test results regardless of where the test is performed.
Question 2: When conducting an internal audit of EHR documentation, which metric best measures the completeness of medical records?
- Average length of stay
- Deficiency rate per record (Correct answer)
- Coder productivity per hour
- Claims denial rate
Correct answer: Deficiency rate per record
The deficiency rate per record measures how frequently medical records are incomplete, directly indicating documentation completeness quality.
Question 3: A patient requests an amendment to their medical record because they believe information is incorrect. Under HIPAA, the covered entity may deny the request if:
- The patient lacks medical knowledge to judge accuracy
- The record was not created by that covered entity (Correct answer)
- More than 30 days have passed since treatment
- The amendment would extend the record
Correct answer: The record was not created by that covered entity
A covered entity may deny an amendment request if the information was not created by that entity, as the creator is best positioned to evaluate its accuracy.
Question 4: Which standard defines the electronic format for submitting HIPAA-covered healthcare claims from providers to payers?
- ASC X12 837 (Correct answer)
- HL7 FHIR R4
- NCPDP SCRIPT
- ASC X12 835
Correct answer: ASC X12 837
The ASC X12 837 transaction set is the HIPAA-mandated standard electronic format for submitting healthcare claims from providers to payers.
Question 5: In quality management, a fishbone (Ishikawa) diagram is used to:
- Track patient satisfaction scores over time
- Identify root causes of a quality problem (Correct answer)
- Map the flow of patients through a department
- Monitor key performance indicators
Correct answer: Identify root causes of a quality problem
A fishbone diagram visually organizes potential causes of a problem into categories, helping teams identify root causes during quality improvement investigations.
Question 6: The Stark Law (Physician Self-Referral Law) primarily prohibits physicians from:
- Accepting speaking fees from pharmaceutical companies
- Referring Medicare patients to entities in which they have a financial relationship (Correct answer)
- Billing for services not personally performed
- Owning more than one practice location
Correct answer: Referring Medicare patients to entities in which they have a financial relationship
The Stark Law prohibits physicians from referring Medicare and Medicaid patients to entities providing designated health services in which the physician has a financial interest.
Question 7: Which element is required in a valid authorization for release of protected health information under HIPAA?
- Witness signature
- Treating physician approval
- Expiration date or event (Correct answer)
- Insurance company verification
Correct answer: Expiration date or event
A valid HIPAA authorization must include an expiration date or expiration event that relates to the individual or the purpose of the use or disclosure.
CEHRS Regulatory Compliance and Quality Assurance 3
Which regulation requires clinical laboratories to maintain quality control records and participate in proficiency testing?