RHIA Exam 2 questions with correct answers
Data |elements |for |emergency |department |systems |- |VERIFIED |ANSWER✔✔-DEEDS
Minimum |data |set |- |VERIFIED |ANSWER✔✔-MDS
Outcome |and |assessment |information |set |- |VERIFIED |ANSWER✔✔-OASIS
Uniform |ambulatory |care |data |set |- |VERIFIED |ANSWER✔✔-UACDS
Facility |- |VERIFIED |ANSWER✔✔-Owner |of |the |health |record |of |patients |treated |in |a |healthcare |
facility.
Precision |- |VERIFIED |ANSWER✔✔-This |dimension |of |data |quality |that |often |relates |to |numerical |data.
|It |donates |how |close |to |an |actual |size, |weight, |or |other |standard |a |particular |measurement |is.
Statutes |of |limitation |- |VERIFIED |ANSWER✔✔-The |time |period |in |which |a |lawsuit |may |be |filed, |must |
be |considered |in |establishing |a |retention |schedule
Longitudinal |health |record |- |VERIFIED |ANSWER✔✔-Maintains |information |throughout |the |lifespan |of |
the |patient, |ideally |from |birth |to |death
Problem |oriented |health |record |- |VERIFIED |ANSWER✔✔-Type |of |health |record. |A |method |of |
recording |data |about |the |health |status |of |a |patient |in |a |problem |solving |system. |It |preserves |the |data
|in |an |easily |accessible |way |that |encourages |ongoing |assessment |and |revision |of |the |health |care |plans
|by |all |members |of |the |health |care |team.
Principal |procedure |- |VERIFIED |ANSWER✔✔-The |procedure |that |was |performed |for |the |definitive |
treatment |(rather |than |the |diagnosis) |of |the |main |condition |or |a |complication |of |the |condition.
, Attending |physician |- |VERIFIED |ANSWER✔✔-The |physician |principally |responsible |for |the |patient's |
hospital |care |generally |dictates |the |discharge |summary.
Comorbidity |- |VERIFIED |ANSWER✔✔-The |simultaneous |presence |of |two |chronic |diseases |or |
conditions |in |a |patient.
Vocabulary |standard |- |VERIFIED |ANSWER✔✔-A |common |definition |for |medical |terms |to |encourage |
consistent |descriptions |of |an |individual's |condition |in |the |health |record
Migration |plan |- |VERIFIED |ANSWER✔✔-To |meet |meaningful |use |standards, |Anywhere |Hospital |is |
implementing |a |document |imaging |system |and |electronic |document |management |system. |This |is |an |
interim |step |before |full |implementation |of |computerized |provider |order |entry |and |point |of |care |
documentation. |This |step |by |step |process |is |part |of |the |hospital's...
Accession |number |- |VERIFIED |ANSWER✔✔-This |number |consists |of |the |first |digits |of |the |year |the |
patient |was |first |seen |at |the |facility, |with |the |remaining |digits |assigned |sequentially |throughout |the |
year.
H&P |- |VERIFIED |ANSWER✔✔-According |to |accreditation |standards, |which |document |must |be |placed |
in |the |patient's |record |before |a |surgical |procedure |may |be |performed?
Excludes |1 |- |VERIFIED |ANSWER✔✔-In |ICD |10 |CM |this |note |means |"not |coded |here"
Peer |review |- |VERIFIED |ANSWER✔✔-A |review |in |which |a |member |of |a |profession |assesses |the |work |
of |colleges |within |that |same |profession. |This |review |has |traditionally |been |at |the |center |of |quality |
assessment |and |assurance |efforts. |The |medical |profession's |______ |________ |efforts |have |
emphasized |the |scientific |aspects |of |quality. |Appropriate |use |of |pharmaceuticals, |postoperative |
infection |rates, |and |accuracy |of |diagnosis |are |among |the |measures |of |quality |that |have |been |used. |It |
is |a |requirement |of |both |CMS |and |the |JC.
Utilization |review |- |VERIFIED |ANSWER✔✔-The |critical |examination |(as |by |a |physician |or |nurse) |of |
health |care |services |provided |to |patients |especially |for |the |purpose |of |controlling |costs |(as |by |
identifying |unnecessary |medical |procedures) |and |monitoring |the |quality |of |care.
Data |elements |for |emergency |department |systems |- |VERIFIED |ANSWER✔✔-DEEDS
Minimum |data |set |- |VERIFIED |ANSWER✔✔-MDS
Outcome |and |assessment |information |set |- |VERIFIED |ANSWER✔✔-OASIS
Uniform |ambulatory |care |data |set |- |VERIFIED |ANSWER✔✔-UACDS
Facility |- |VERIFIED |ANSWER✔✔-Owner |of |the |health |record |of |patients |treated |in |a |healthcare |
facility.
Precision |- |VERIFIED |ANSWER✔✔-This |dimension |of |data |quality |that |often |relates |to |numerical |data.
|It |donates |how |close |to |an |actual |size, |weight, |or |other |standard |a |particular |measurement |is.
Statutes |of |limitation |- |VERIFIED |ANSWER✔✔-The |time |period |in |which |a |lawsuit |may |be |filed, |must |
be |considered |in |establishing |a |retention |schedule
Longitudinal |health |record |- |VERIFIED |ANSWER✔✔-Maintains |information |throughout |the |lifespan |of |
the |patient, |ideally |from |birth |to |death
Problem |oriented |health |record |- |VERIFIED |ANSWER✔✔-Type |of |health |record. |A |method |of |
recording |data |about |the |health |status |of |a |patient |in |a |problem |solving |system. |It |preserves |the |data
|in |an |easily |accessible |way |that |encourages |ongoing |assessment |and |revision |of |the |health |care |plans
|by |all |members |of |the |health |care |team.
Principal |procedure |- |VERIFIED |ANSWER✔✔-The |procedure |that |was |performed |for |the |definitive |
treatment |(rather |than |the |diagnosis) |of |the |main |condition |or |a |complication |of |the |condition.
, Attending |physician |- |VERIFIED |ANSWER✔✔-The |physician |principally |responsible |for |the |patient's |
hospital |care |generally |dictates |the |discharge |summary.
Comorbidity |- |VERIFIED |ANSWER✔✔-The |simultaneous |presence |of |two |chronic |diseases |or |
conditions |in |a |patient.
Vocabulary |standard |- |VERIFIED |ANSWER✔✔-A |common |definition |for |medical |terms |to |encourage |
consistent |descriptions |of |an |individual's |condition |in |the |health |record
Migration |plan |- |VERIFIED |ANSWER✔✔-To |meet |meaningful |use |standards, |Anywhere |Hospital |is |
implementing |a |document |imaging |system |and |electronic |document |management |system. |This |is |an |
interim |step |before |full |implementation |of |computerized |provider |order |entry |and |point |of |care |
documentation. |This |step |by |step |process |is |part |of |the |hospital's...
Accession |number |- |VERIFIED |ANSWER✔✔-This |number |consists |of |the |first |digits |of |the |year |the |
patient |was |first |seen |at |the |facility, |with |the |remaining |digits |assigned |sequentially |throughout |the |
year.
H&P |- |VERIFIED |ANSWER✔✔-According |to |accreditation |standards, |which |document |must |be |placed |
in |the |patient's |record |before |a |surgical |procedure |may |be |performed?
Excludes |1 |- |VERIFIED |ANSWER✔✔-In |ICD |10 |CM |this |note |means |"not |coded |here"
Peer |review |- |VERIFIED |ANSWER✔✔-A |review |in |which |a |member |of |a |profession |assesses |the |work |
of |colleges |within |that |same |profession. |This |review |has |traditionally |been |at |the |center |of |quality |
assessment |and |assurance |efforts. |The |medical |profession's |______ |________ |efforts |have |
emphasized |the |scientific |aspects |of |quality. |Appropriate |use |of |pharmaceuticals, |postoperative |
infection |rates, |and |accuracy |of |diagnosis |are |among |the |measures |of |quality |that |have |been |used. |It |
is |a |requirement |of |both |CMS |and |the |JC.
Utilization |review |- |VERIFIED |ANSWER✔✔-The |critical |examination |(as |by |a |physician |or |nurse) |of |
health |care |services |provided |to |patients |especially |for |the |purpose |of |controlling |costs |(as |by |
identifying |unnecessary |medical |procedures) |and |monitoring |the |quality |of |care.
