Quality Improvement and Compliance Flashcards
7 cards from real TRIVIUM 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 Improvement and Compliance flashcards as text
Under the False Claims Act, whistleblowers who report Medicare/Medicaid fraud may receive:
Answer: A percentage of the government's recovery as a reward
The False Claims Act's qui tam provisions allow whistleblowers to receive 15–30% of the government's recovery in successful fraud cases.
A healthcare organization's compliance program should include which of the following elements?
Answer: Written policies, training, auditing, and a reporting mechanism
An effective compliance program includes written standards, training, auditing/monitoring, and mechanisms for employees to report concerns.
Which statistical tool is commonly used in quality improvement to display variation in a process over time?
Answer: Control chart (run chart)
Control charts (also called run charts or Shewhart charts) plot data over time to distinguish normal process variation from special cause variation.
A patient's protected health information (PHI) can be disclosed WITHOUT patient authorization for which purpose?
Answer: Treatment, payment, and healthcare operations (TPO)
HIPAA permits disclosure of PHI without authorization for treatment, payment, and healthcare operations (TPO) activities.
A fishbone (Ishikawa) diagram is used in quality improvement to:
Answer: Identify and categorize potential causes of a problem
A fishbone diagram visually maps cause-and-effect relationships to identify all potential root causes of a quality problem.
The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard requires healthcare employers to:
Answer: Provide hepatitis B vaccination to at-risk employees at no cost
OSHA's Bloodborne Pathogens Standard mandates that employers offer hepatitis B vaccination free of charge to employees with occupational exposure risk.
Which term describes the systematic review of clinical records to ensure documentation supports the level of care billed?
Answer: Retrospective coding audit
A retrospective coding audit reviews medical records after care is delivered to verify that coding and billing accurately reflect the documented services.