CMAS Quality Control & Process Improvement 3

Question 1

In quality management, a 'process indicator' differs from an 'outcome indicator' in that it:

Accepted Answer

Evaluates steps taken during care delivery

Answer

Process indicators assess whether specific care steps were performed correctly, while outcome indicators measure the results of care.

Question 2

A medical administrative specialist is reviewing an audit that shows a 12% upcoding rate. This MOST directly indicates a problem with:

Accepted Answer

Coding and billing compliance

Answer

Upcoding — billing for a higher-level service than provided — is a compliance violation that must be corrected through coder education and process controls.

Question 3

Which statistical tool displays the frequency of different categories of problems to help prioritize improvement efforts?

Accepted Answer

Pareto chart

Answer

A Pareto chart bars categories by frequency in descending order, highlighting that roughly 80% of problems stem from 20% of causes.

Question 4

Patient satisfaction surveys are BEST classified as which type of quality measure?

Accepted Answer

Outcome measure

Answer

Patient satisfaction is an outcome measure because it reflects the result of the care experience from the patient's perspective.

Question 5

Which accrediting body uses the concept of 'tracer methodology' during on-site surveys of ambulatory care settings?

Accepted Answer

The Joint Commission (TJC)

Answer

The Joint Commission uses tracer methodology to follow a patient's care experience through the organization to evaluate compliance with standards.

(CMAS) Certified Medical Administrative Specialist Practice Test

(CMAS) Certified Medical Administrative Specialist Practice Test

CMAS Quality Control & Process Improvement 3