PCMH CCE PRACTICE EXAM TEST QUESTIONS AND
ANSWERS GRADED A+
✔✔Critical Factor - ✔✔A factor identified as central to the concept being assessed
within particular elements and is required for practices to receive more than minimal or,
for some elements, any points. Critical factors are identified in the scoring section of the
element.
✔✔Care Plan - ✔✔A plan for day-to-day medical care and services. The plan can
include:
- A summary of medical information (history of hospitalizations, procedures, tests, etc.).
- A list of providers, medical equipment and medications for patients with special health
care needs.
- Obstacles to transitioning to an adult care clinician.
Arrangements for release and transfer of medical records to the adult care clinician.
✔✔De-identify - ✔✔Removal of individual identifiers. Under the HIPAA Privacy Rule,
protected health information is de-identified if all individual identifiers are removed.
✔✔Demographic Information - ✔✔Information that includes at least ethnicity, gender,
marital status, date of birth, type of work, hours of work and preferred language.
✔✔Diversity - ✔✔A meaningful characteristic of comparison for managing population
health that accurately identifies individuals within a non-dominant social system who are
underserved. These characteristics of a group may include, but are not limited to, race,
ethnicity, gender identity, sexual orientation and disability.
✔✔Documented Process - ✔✔Written statements describing procedures. Statements
may include protocols or other documents that describe actual processes or blank forms
the practice uses in work flow (referral forms, checklists, flow sheets, etc.). Documented
processes include an effective date.
✔✔Electronic Clinical Summary - ✔✔A summary of a visit that includes, when
appropriate, diagnoses, medications, recommended treatment and follow-up.
✔✔Emergency Admission - ✔✔An unscheduled medical or behavioral healthcare event
that results in either an emergency room visit or in hospital admission.
✔✔Evidence Based Guidelines - ✔✔Clinical practice guidelines based on scientific
evidence; or in the absence of scientific evidence, professional standards; or in the
absence of professional standards, expert opinion. See practice guidelines.
✔✔Example - ✔✔A document, report or prepared material that illustrates
implementation of systems or processes by the practice.
, ✔✔Factor - ✔✔A scored item in an element. For example, an element may require the
organization to demonstrate that a specific document includes four items. Each item is a
factor.
✔✔Legal Guardian or Health Care Proxy - ✔✔An individual designated by the patient or
family or by the courts to make health care decisions for the patient if the patient is
unable to do so.
✔✔Materials - ✔✔Prepared information that the practice provides to patients, including
clinical guidelines and self-management and educational resources such as brochures,
Web sites, videos and pamphlets.
✔✔Meaningful Use Requirements - ✔✔The CMS implementation of the American
Recovery and Reinvestment Act (ARRA) of 2009 (Recovery Act) provides incentive
payments to eligible professionals for adopting and demonstrating meaningful use of
certified EHR technology.
Criteria for meaningful use are electronically capturing health information in a coded
format, using the information to track key clinical conditions, communicating the
information for care coordination and reporting clinical quality measures and public
health information.
- Stage 1 has 13 Core Requirements that must be met and 9 Menu Requirements, 5
must be met.
- Stage 2 has 17 Core Requirements that must be met and 6 Menu Requirements, 3
must be met.
✔✔Multi-Site Group - ✔✔Three or more practice sites using the same systems and
processes, including an electronic medical record system shared across all practice
sites. For a multi-site group, NCQA reviews some elements once and applies the results
to all practice sites in the group.
✔✔Must Pass Elements - ✔✔Designated elements that a practice must pass at a score
of ≥ 50% to achieve NCQA Recognition.
✔✔No Show Appointments - ✔✔A scheduled appointment that is not kept,
unexpectedly and without notification.
✔✔No Show Rates - ✔✔A specific ratio that compares the number of appointments
scheduled versus no-show appointments.
Number of patients who did not keep their pre-scheduled appointments during a specific
period of time divided by the number of patients who were pre-scheduled to come to the
center for appointments during the same period of time.
ANSWERS GRADED A+
✔✔Critical Factor - ✔✔A factor identified as central to the concept being assessed
within particular elements and is required for practices to receive more than minimal or,
for some elements, any points. Critical factors are identified in the scoring section of the
element.
✔✔Care Plan - ✔✔A plan for day-to-day medical care and services. The plan can
include:
- A summary of medical information (history of hospitalizations, procedures, tests, etc.).
- A list of providers, medical equipment and medications for patients with special health
care needs.
- Obstacles to transitioning to an adult care clinician.
Arrangements for release and transfer of medical records to the adult care clinician.
✔✔De-identify - ✔✔Removal of individual identifiers. Under the HIPAA Privacy Rule,
protected health information is de-identified if all individual identifiers are removed.
✔✔Demographic Information - ✔✔Information that includes at least ethnicity, gender,
marital status, date of birth, type of work, hours of work and preferred language.
✔✔Diversity - ✔✔A meaningful characteristic of comparison for managing population
health that accurately identifies individuals within a non-dominant social system who are
underserved. These characteristics of a group may include, but are not limited to, race,
ethnicity, gender identity, sexual orientation and disability.
✔✔Documented Process - ✔✔Written statements describing procedures. Statements
may include protocols or other documents that describe actual processes or blank forms
the practice uses in work flow (referral forms, checklists, flow sheets, etc.). Documented
processes include an effective date.
✔✔Electronic Clinical Summary - ✔✔A summary of a visit that includes, when
appropriate, diagnoses, medications, recommended treatment and follow-up.
✔✔Emergency Admission - ✔✔An unscheduled medical or behavioral healthcare event
that results in either an emergency room visit or in hospital admission.
✔✔Evidence Based Guidelines - ✔✔Clinical practice guidelines based on scientific
evidence; or in the absence of scientific evidence, professional standards; or in the
absence of professional standards, expert opinion. See practice guidelines.
✔✔Example - ✔✔A document, report or prepared material that illustrates
implementation of systems or processes by the practice.
, ✔✔Factor - ✔✔A scored item in an element. For example, an element may require the
organization to demonstrate that a specific document includes four items. Each item is a
factor.
✔✔Legal Guardian or Health Care Proxy - ✔✔An individual designated by the patient or
family or by the courts to make health care decisions for the patient if the patient is
unable to do so.
✔✔Materials - ✔✔Prepared information that the practice provides to patients, including
clinical guidelines and self-management and educational resources such as brochures,
Web sites, videos and pamphlets.
✔✔Meaningful Use Requirements - ✔✔The CMS implementation of the American
Recovery and Reinvestment Act (ARRA) of 2009 (Recovery Act) provides incentive
payments to eligible professionals for adopting and demonstrating meaningful use of
certified EHR technology.
Criteria for meaningful use are electronically capturing health information in a coded
format, using the information to track key clinical conditions, communicating the
information for care coordination and reporting clinical quality measures and public
health information.
- Stage 1 has 13 Core Requirements that must be met and 9 Menu Requirements, 5
must be met.
- Stage 2 has 17 Core Requirements that must be met and 6 Menu Requirements, 3
must be met.
✔✔Multi-Site Group - ✔✔Three or more practice sites using the same systems and
processes, including an electronic medical record system shared across all practice
sites. For a multi-site group, NCQA reviews some elements once and applies the results
to all practice sites in the group.
✔✔Must Pass Elements - ✔✔Designated elements that a practice must pass at a score
of ≥ 50% to achieve NCQA Recognition.
✔✔No Show Appointments - ✔✔A scheduled appointment that is not kept,
unexpectedly and without notification.
✔✔No Show Rates - ✔✔A specific ratio that compares the number of appointments
scheduled versus no-show appointments.
Number of patients who did not keep their pre-scheduled appointments during a specific
period of time divided by the number of patients who were pre-scheduled to come to the
center for appointments during the same period of time.
