Regulatory Compliance & Quality Improvement Flashcards
7 cards from real CMD practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Regulatory Compliance & Quality Improvement flashcards as text
Under the Quality Payment Program (QPP), Merit-based Incentive Payment System (MIPS) reporting for physicians working in long-term care primarily affects:
Answer: Individual physician Medicare Part B payment adjustments
MIPS adjusts individual physician Medicare Part B payment rates based on quality, cost, improvement activities, and promoting interoperability performance.
A fishbone (Ishikawa) diagram is used in quality improvement to:
Answer: Visually map potential root causes of a problem across multiple categories
Fishbone diagrams organize potential root causes into categories (people, process, equipment, environment) to facilitate systematic cause analysis.
Which of the following best describes 'tracer methodology' used by Joint Commission surveyors?
Answer: Following an individual patient's care experience through the system to evaluate care processes
Tracer methodology follows a patient's actual care journey through the facility to evaluate how systems and processes work together in practice.
The OIG (Office of Inspector General) Compliance Program Guidance for nursing facilities recommends that compliance programs include which element?
Answer: Designation of a compliance officer and open lines for reporting concerns without retaliation
OIG compliance program guidance emphasizes designating a compliance officer and establishing confidential reporting mechanisms with non-retaliation protections.
When reviewing a facility's fall prevention program as Medical Director, which outcome measure most directly indicates program effectiveness?
Answer: Rate of falls with major injury per 1,000 resident days
Falls with major injury rate per 1,000 resident days is a direct outcome measure of program effectiveness and is a CMS-reported quality measure.
Under federal nursing home regulations, the Medical Director is required to be licensed as:
Answer: A physician (MD or DO)
42 CFR 483.70(b) requires the Medical Director to be a physician (MD or DO); no specialty board certification is federally mandated.
The purpose of the Annual Wellness Visit (AWV) quality tracking in long-term care is most aligned with which regulatory goal?
Answer: Promoting preventive care, advance care planning, and comprehensive health assessment
AWVs support preventive care, personalized prevention plans, and advance care planning conversations, aligning with CMS goals for resident-centered care.