Quality Assurance & Compliance Flashcards
7 cards from real CAS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Assurance & Compliance flashcards as text
A program director wants to measure client outcomes at 6 months post-discharge. Which approach best supports valid quality assurance data collection?
Answer: Use a standardized, validated instrument consistently across all discharged clients
Using standardized validated instruments consistently across all clients ensures reliable, comparable, and bias-free outcome data.
An addiction counselor is subpoenaed to testify about a client's treatment records. Under 42 CFR Part 2, the counselor should:
Answer: Provide records only after the court issues a special order that meets 42 CFR Part 2 requirements
42 CFR Part 2 requires a court order that meets specific criteria before SUD records can be disclosed pursuant to a subpoena.
Which of the following is an example of a structural measure in healthcare quality assurance?
Answer: Whether the facility employs licensed clinical staff
Structural measures assess the capacity and resources of a healthcare setting, such as whether qualified staff are employed.
A compliance officer discovers that a billing coder submitted claims for individual therapy sessions that were never documented in the medical record. This is an example of:
Answer: Healthcare fraud
Submitting claims for services not documented as rendered constitutes healthcare fraud and can result in criminal and civil penalties.
During an accreditation survey, a surveyor interviews a client who is unaware of their rights regarding grievances. This finding indicates a deficiency in which QA area?
Answer: Client rights and informed consent
Clients must be informed of their right to file grievances without fear of retaliation, and this information must be communicated at admission.
A substance use disorder agency wants to implement a Continuous Quality Improvement (CQI) program. Which of the following frameworks is most commonly used as a foundation for CQI in healthcare?
Answer: PDSA (Plan-Do-Study-Act) cycle
The PDSA cycle is the foundational framework for CQI in healthcare, providing a structured method for testing and implementing improvements.
A managed care organization denies authorization for a higher level of addiction care for a client. The client has the right to:
Answer: Request an internal appeal and, if upheld, an independent external review
Federal and state law require managed care organizations to offer internal appeals and external independent reviews for coverage denials.