PCMH CCE STUDY EXAM GUIDE QUESTIONS AND
ANSWERS GRADED A+
✔✔Walk-in Access - ✔✔An approach to patient appointment scheduling that allows
established patients to be seen by a member of the care team during regular office
hours, without prior notice.
✔✔ Advance Care Planning - ✔✔Practice guidance and documentation of patient/family
preferences for care at the end of life or for patients who are unable to speak for
themselves.
✔✔Advance Directive - ✔✔A document in which members can explain the type and
extent of health care services they prefer if they become unable to make medical
decisions. The document may identify another person who can make those decisions
on behalf of the individual. Advance directives are frequently called "living wills."
✔✔Adverse Reaction - ✔✔A noxious or unintended reaction to a drug that is
administered in standard doses by the proper route for the purpose of prophylaxis,
diagnosis or treatment.
✔✔Allergy - ✔✔An adverse reaction to a substance.
✔✔Alternative Type of Clinical Encounter - ✔✔A scheduled meeting between the
patient and a clinician, using a mode of real-time communication in lieu of an in-person
office visit; for example, standalone communication or a combination of telephone,
video chat and secure instant messaging.
✔✔Appointment Wait Times - ✔✔The period between the date/time a patient makes an
initial request for an appointment and the actual appointment date/time for both urgent
and routine care.
✔✔Care Coordination Measure - ✔✔A metric that uses an aspect of clinical
performance or patient experience to identify "better" performance or "worse"
performance, with respect to "the deliberate organization of patient care activities
between two or more participants (including the patient) involved in a patient's care to
facilitate the appropriate delivery of health care services."
✔✔Clinical Summary - ✔✔A summary of a visit that can be provided to
patients/families/caregivers through a personal health record, a patient portal on the
practice's Web site, secure e-mail, electronic media or a printed copy.
The summary, as defined by CMS, contains:
1. The patient's name
2. The provider's name and office contact information.
3. The date and location of the office visit.
, 4. The reason for the office visit.
5. A list of current problems.
6. A list of current medications.
7. A list of current medication allergies.
8. Procedures performed during the visit.
9. Immunizations or medications administered during the visit.
10. Vital signs taken during the visit.
11. Lab test results.
12. A list of diagnostic tests pending.
13. Clinical instructions.
14. Future appointments.
15. Referrals to other providers.
16. Future scheduled tests.
17. Demographic information maintained by CEHRT.
18. Smoking status.
19. Care plan fields, including goals and instructions.
✔✔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.
ANSWERS GRADED A+
✔✔Walk-in Access - ✔✔An approach to patient appointment scheduling that allows
established patients to be seen by a member of the care team during regular office
hours, without prior notice.
✔✔ Advance Care Planning - ✔✔Practice guidance and documentation of patient/family
preferences for care at the end of life or for patients who are unable to speak for
themselves.
✔✔Advance Directive - ✔✔A document in which members can explain the type and
extent of health care services they prefer if they become unable to make medical
decisions. The document may identify another person who can make those decisions
on behalf of the individual. Advance directives are frequently called "living wills."
✔✔Adverse Reaction - ✔✔A noxious or unintended reaction to a drug that is
administered in standard doses by the proper route for the purpose of prophylaxis,
diagnosis or treatment.
✔✔Allergy - ✔✔An adverse reaction to a substance.
✔✔Alternative Type of Clinical Encounter - ✔✔A scheduled meeting between the
patient and a clinician, using a mode of real-time communication in lieu of an in-person
office visit; for example, standalone communication or a combination of telephone,
video chat and secure instant messaging.
✔✔Appointment Wait Times - ✔✔The period between the date/time a patient makes an
initial request for an appointment and the actual appointment date/time for both urgent
and routine care.
✔✔Care Coordination Measure - ✔✔A metric that uses an aspect of clinical
performance or patient experience to identify "better" performance or "worse"
performance, with respect to "the deliberate organization of patient care activities
between two or more participants (including the patient) involved in a patient's care to
facilitate the appropriate delivery of health care services."
✔✔Clinical Summary - ✔✔A summary of a visit that can be provided to
patients/families/caregivers through a personal health record, a patient portal on the
practice's Web site, secure e-mail, electronic media or a printed copy.
The summary, as defined by CMS, contains:
1. The patient's name
2. The provider's name and office contact information.
3. The date and location of the office visit.
, 4. The reason for the office visit.
5. A list of current problems.
6. A list of current medications.
7. A list of current medication allergies.
8. Procedures performed during the visit.
9. Immunizations or medications administered during the visit.
10. Vital signs taken during the visit.
11. Lab test results.
12. A list of diagnostic tests pending.
13. Clinical instructions.
14. Future appointments.
15. Referrals to other providers.
16. Future scheduled tests.
17. Demographic information maintained by CEHRT.
18. Smoking status.
19. Care plan fields, including goals and instructions.
✔✔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.
