Health Insurance Portability and Accountability Act protects patients

Question 1

The Health Insurance Portability and
Accountability Act protects patients’ individually identifiable health
information by

A. prohibiting
release of information by electronic means.

B. requiring
appropriate authorization before its release.

C. allowing
insurers to deny coverage of related claims.

D. making
the receiver liable for any misuse of the information.
Question 2

When a parent’s religious convictions do
not permit a recommended medical treatment for a child, the state

A. will
ask the hospital’s ethics committee to intervene.

B. has
no role in medical decisions between families and physicians.

C. has
an interest in preserving life and protecting innocent third parties.

D. recognizes
that the constitutional guarantees of religious liberty prevail.
Question 3
A company has completed the financial
statements for the current year. The president looks over the balance sheet and
notices that the company building is recorded at $500,000. The company just
paid an appraisal firm to determine the value of the building for a loan
application and it was valued at $700,000. The president wants the building to
reflect this appraised value to make the company appear stronger for the loan
committee. Which of the following is correct according to generally accepted
accounting principles (GAAP)?

A. It
is a violation of the monetary value assumption to report the higher value.

B. It
is a violation of the full disclosure rule to report the higher value.

C. Reporting
the lower value would be expected under the historical cost principle.

D. Reporting
the lower value would be expected under the conservatism principle.
Question 4
A large truck has crossed the median of an
interstate highway and has collided with a school bus. Preliminary reports
indicate several minor injuries, a few children with multiple fractures, but no
fatalities yet noted.

Which phrase best describes the plan and
policy the hospital should adopt and routinely practice?

A. Manage
all injuries as EMS performs on-site triage, since one cannot know what to
expect.

B. Make
all discharge planners accelerate discharges to optimize the number of
available beds.

C. Send
a trauma team from the ER to the accident site to help provide improved
pre-hospital care.

D. Have
trauma teams, crisis intervention teams, logistical support teams and media
teams deploy immediately.
A patient who felt he was treated
negligently might bring a tort for

A. early
discharge.

B. violation
of ethics.

C. poor
health outcomes.

D. breach
of duty for care.
•
Question 6
A reward with valence is one that employees
perceive to be

A. fair.

B. of
value.

C. obtainable.

D. individualized.

Question 7
A supply-chain management system shared
among units of a healthcare enterprise and its strategic partners cannot be
maximally effective without which of the following characteristics?

A. Activity-based
costing

B. Lowest
cost providers

C. Unit
customization

D. Shared
infrastructure
Question 8
A “no prior condition†clause in the
current health reform law is likely to increase the number of enrollees in

A. group
health insurance markets.

B. individual
health insurance markets.

C. employer-sponsored
health insurance markets.

D. public
health insurance including, Medicaid and Medicare.
Question 9
Activation of an internal disaster plan for
a hospital is subject to the policies of that institution. A manager is working
as the house supervisor on the night shift and the local weather alert
indicates that a tornado has been spotted in the community.

What response below best describes the
manager’s actions?

A. Read
the policy manual for instructions.

B. Call
the local radio station for an update on the status of the tornado.

C. Announce
the proper code for a tornado over the intercom and notify the on-call
administrator.

D. Go
to each unit in the hospital and make sure the staff has taken precautions to
protect visitors and patients.
Question 10
Background:
Virtua Hospital is planning to introduce
Electronic Health Records (EHR) at its various practice locations whereas the
older physicians raise concerns about their ability to use the new system
efficiently, the younger physicians support the implementation of the EHR.
In order to ensure physician compliance
with electronic records what should be changed?

A. Documentation
on employee handbook updates

B. Documentation
on physician evaluations

C. Documentation
on patient feedback

D. Documentation
on cost containment

Question 11
Background:
A rural Medical Center rotates department
directors to present for 10 minutes at each Board Meeting. In December 2010,
the department director for the Surgical Services Department made a
presentation. The Surgery Director included a financial handout consisting of
surgical case volumes, revenue/expense statements, labor utilization reports
and patient satisfaction statements. The Power Point presentation was a
photographic tour of the department and the employees. A prominent surgeon at
the hospital is a Board member, and asked the Director to explain why there was
an increase in turnover with the surgical nursing staff in the past 8 months.
The Director was embarrassed and became defensive, stating that, “I put in a
lot of extra hours, all of the nurses are pushed to the limit, we don’t have
enough nurses to share all of the call time required, and I don’t know what you
really expect out of me; I try my best to make this a great work environment!â€

The Director of Human Resources quickly
spoke up and stated, “Yes, you do a very good job in managing your department,
and we can talk off-line about getting some additional help for the
department,†in an attempt to defuse the situation. The CEO stood up and
thanked the Surgery Director for a fine presentation and allowed the Director
to be excused from the rest of the meeting. During the Board meeting, the HR
Director apologized for the defensive nature of the Surgery Director and
assured the Board that the inappropriate behavior would be addressed the very
next day. The Chairman of the Board spoke up and stated that the potential for
burnout in a high stress area was understood and that both the turnover problem
and the Surgery Director’s inappropriate behavior should be addressed.

After the Board meeting, the HR Director
returned to the office and found the Surgery Director. The Surgery Director
apologized for the behavior in the meeting and stated that any corrective
action for the behavior would be accepted, but also added that the surgeon who
was present in the Board meeting is constantly overbearing and demanding. The
Surgery Director stated that there were several written complaints from nurses,
some who have quit, indicating that this particular surgeon is rude, demeaning,
and may be the cause of chronic turnover. The HR Director acknowledged the
contrite manner of the Surgery Director and stated they would get together at 2
PM the next day. The HR Director also told the Surgery Director to strongly
consider what can be done to improve performance.

The Surgery Director was at HR the next
day. The HR Director stated that the Surgery Director was now on a corrective
action plan. The Surgery Director and the HR Director created a plan that
addressed how the Surgery Director would change the behavior and attitude
toward the surgeon, including setting a time to meet with the surgeon and
finding out if there are training or equipment issues driving the surgeon’s
behavior. The Surgery Director must identify what is dissatisfying the surgeon
and the Director will assume autonomy to make decisive corrections in the
surgery department. The Surgery Director is also required to act appropriately
in public settings with Senior Leadership, the Board, patients and family
members. The HR Director required the Surgery Director to work with the ICU
Director, a skilled Management Coach, for 1 hour a week to help lead to success
with the plan. The HR Director reinforced the fact that the ultimate change was
up to the Surgery Director, and that the ICU Director’s role is to facilitate.

The plan included methods to report all
incidents and complaints by the staff, how HR would become involved to support
the Surgery Director with resolving complaints, and an opportunity to send the
Surgery Director to specific training on managing turnover. The Surgery
Director had 6 months to make significant change, at which time there would be
a re-evaluation. If the re-evaluation was positive, the Surgery Director would
have a clean record. If no improvement, the Surgery Director would be asked to
resign.
A collaborative style of conflict
resolution uses which of the following strategies?

Establishing
an experienced management coach with weekly meetings

Requiring
the Surgery Director to problem solve with the surgeon

Defusing
the inappropriate behavior at the Board meeting

Creating
a plan with both consequences and a positive outcome
QUESTION 12
Background:
A rural Medical Center rotates department
directors to present for 10 minutes at each Board Meeting. In December 2010,
the department director for the Surgical Services Department made a
presentation. The Surgery Director included a financial handout consisting of
surgical case volumes, revenue/expense statements, labor utilization reports
and patient satisfaction statements. The Power Point presentation was a
photographic tour of the department and the employees. A prominent surgeon at
the hospital is a Board member, and asked the Director to explain why there was
an increase in turnover with the surgical nursing staff in the past 8 months.
The Director was embarrassed and became defensive, stating that, “I put in a
lot of extra hours, all of the nurses are pushed to the limit, we don’t have
enough nurses to share all of the call time required, and I don’t know what you
really expect out of me; I try my best to make this a great work environment!â€

The Director of Human Resources quickly
spoke up and stated, “Yes, you do a very good job in managing your department,
and we can talk off-line about getting some additional help for the
department,†in an attempt to defuse the situation. The CEO stood up and
thanked the Surgery Director for a fine presentation and allowed the Director
to be excused from the rest of the meeting. During the Board meeting, the HR
Director apologized for the defensive nature of the Surgery Director and
assured the Board that the inappropriate behavior would be addressed the very
next day. The Chairman of the Board spoke up and stated that the potential for
burnout in a high stress area was understood and that both the turnover problem
and the Surgery Director’s inappropriate behavior should be addressed.

After the Board meeting, the HR Director
returned to the office and found the Surgery Director. The Surgery Director
apologized for the behavior in the meeting and stated that any corrective
action for the behavior would be accepted, but also added that the surgeon who
was present in the Board meeting is constantly overbearing and demanding. The Surgery
Director stated that there were several written complaints from nurses, some
who have quit, indicating that this particular surgeon is rude, demeaning, and
may be the cause of chronic turnover. The HR Director acknowledged the contrite
manner of the Surgery Director and stated they would get together at 2 PM the
next day. The HR Director also told the Surgery Director to strongly consider
what can be done to improve performance.

The Surgery Director was at HR the next
day. The HR Director stated that the Surgery Director was now on a corrective
action plan. The Surgery Director and the HR Director created a plan that
addressed how the Surgery Director would change the behavior and attitude
toward the surgeon, including setting a time to meet with the surgeon and
finding out if there are training or equipment issues driving the surgeon’s
behavior. The Surgery Director must identify what is dissatisfying the surgeon
and the Director will assume autonomy to make decisive corrections in the
surgery department. The Surgery Director is also required to act appropriately
in public settings with Senior Leadership, the Board, patients and family
members. The HR Director required the Surgery Director to work with the ICU
Director, a skilled Management Coach, for 1 hour a week to help lead to success
with the plan. The HR Director reinforced the fact that the ultimate change was
up to the Surgery Director, and that the ICU Director’s role is to facilitate.

The plan included methods to report all
incidents and complaints by the staff, how HR would become involved to support
the Surgery Director with resolving complaints, and an opportunity to send the
Surgery Director to specific training on managing turnover. The Surgery
Director had 6 months to make significant change, at which time there would be
a re-evaluation. If the re-evaluation was positive, the Surgery Director would
have a clean record. If no improvement, the Surgery Director would be asked to
resign.
Which of the following statements best
describes the steps used in the performance plan to help the Surgery Director
manage the defensive tendency?

A. The
HR Director used feedback, minimized threats and was empathetic.

B. The
HR Director intervened at the board meeting and provided the Surgery Director
the time to cool off.

C. The
HR Director did not support the allegation that the surgeon was at fault.

D. The
plan offered the Surgery Director a chance to succeed.
QUESTION 13
Background:
A rural Medical Center rotates department
directors to present for 10 minutes at each Board Meeting. In December 2010,
the department director for the Surgical Services Department made a
presentation. The Surgery Director included a financial handout consisting of
surgical case volumes, revenue/expense statements, labor utilization reports
and patient satisfaction statements. The Power Point presentation was a
photographic tour of the department and the employees. A prominent surgeon at
the hospital is a Board member, and asked the Director to explain why there was
an increase in turnover with the surgical nursing staff in the past 8 months.
The Director was embarrassed and became defensive, stating that, “I put in a
lot of extra hours, all of the nurses are pushed to the limit, we don’t have
enough nurses to share all of the call time required, and I don’t know what you
really expect out of me; I try my best to make this a great work environment!â€

The Director of Human Resources quickly
spoke up and stated, “Yes, you do a very good job in managing your department,
and we can talk off-line about getting some additional help for the
department,†in an attempt to defuse the situation. The CEO stood up and
thanked the Surgery Director for a fine presentation and allowed the Director
to be excused from the rest of the meeting. During the Board meeting, the HR
Director apologized for the defensive nature of the Surgery Director and
assured the Board that the inappropriate behavior would be addressed the very
next day. The Chairman of the Board spoke up and stated that the potential for
burnout in a high stress area was understood and that both the turnover problem
and the Surgery Director’s inappropriate behavior should be addressed.

After the Board meeting, the HR Director
returned to the office and found the Surgery Director. The Surgery Director
apologized for the behavior in the meeting and stated that any corrective
action for the behavior would be accepted, but also added that the surgeon who
was present in the Board meeting is constantly overbearing and demanding. The
Surgery Director stated that there were several written complaints from nurses,
some who have quit, indicating that this particular surgeon is rude, demeaning,
and may be the cause of chronic turnover. The HR Director acknowledged the
contrite manner of the Surgery Director and stated they would get together at 2
PM the next day. The HR Director also told the Surgery Director to strongly
consider what can be done to improve performance.

The Surgery Director was at HR the next
day. The HR Director stated that the Surgery Director was now on a corrective
action plan. The Surgery Director and the HR Director created a plan that
addressed how the Surgery Director would change the behavior and attitude
toward the surgeon, including setting a time to meet with the surgeon and
finding out if there are training or equipment issues driving the surgeon’s
behavior. The Surgery Director must identify what is dissatisfying the surgeon
and the Director will assume autonomy to make decisive corrections in the
surgery department. The Surgery Director is also required to act appropriately
in public settings with Senior Leadership, the Board, patients and family
members. The HR Director required the Surgery Director to work with the ICU
Director, a skilled Management Coach, for 1 hour a week to help lead to success
with the plan. The HR Director reinforced the fact that the ultimate change was
up to the Surgery Director, and that the ICU Director’s role is to facilitate.

The plan included methods to report all
incidents and complaints by the staff, how HR would become involved to support
the Surgery Director with resolving complaints, and an opportunity to send the
Surgery Director to specific training on managing turnover. The Surgery
Director had 6 months to make significant change, at which time there would be
a re-evaluation. If the re-evaluation was positive, the Surgery Director would
have a clean record. If no improvement, the Surgery Director would be asked to
resign.
Which of the following is an example of an
integration between individual, hospital and Board goals?

A. The
surgeon was allowed to voice concern on staff turnover at the Board meeting.

B. The
HR Director took charge of the situation at the Board meeting.

C. The
plan specified use of a coach from another department.

D. There
was agreement between the HR and Surgery Director on the scope of the
corrective action plan.
Question 14
Background:
An in-house counsel at a medical center is
reviewing notes from today’s activities and developing a work plan for
tomorrow. Since 7:00 a.m. this morning, the following priority issues have been
determined for resolution or advice. • A pregnant teenager arrived at the
emergency department (ED) only minutes before delivering a full-term infant.
Due to the urgent nature of her condition, no personal information was
collected from the mother before the delivery. While the infant was being taken
to the newborn nursery, the mother left the ED and cannot be located. The ED
administrative director reported the mother’s flight and abandonment of the
infant as required by hospital policy.
• A
patient discharged from the hospital 3 months ago came in to talk about the
security of health information. The patient recently saw a news report where a
breach of security in medical information used for a research study resulted in
identity theft for several hundred persons. The patient fears an increased risk
of identity theft because of data collected during the hospitalization. The
in-house counsel took time to explain to the patient the conditions under which
personal health information could have been released by the hospital, including
when express consent was required and when it was not. The in-house counsel
stressed the security policies employed by the hospital.
• An
87-year-old elderly woman was admitted through the ED with a broken hip
following a fall in her home. The fracture will require surgical fixation and
long-term post-surgical care for rehabilitation is expected. The woman lives
with a granddaughter although her son is her legal guardian. The physical exam
revealed that she has moderate dementia, is malnourished, and has several
bruises on her upper arms. The ED physician suspects the woman may be a victim
of neglect or even physical abuse.
If the discharged patient’s concerns about
inappropriate release of health information are not resolved, which of the
following statements explains the patient’s rights for further action under
HIPAA regulations?

A. The
patient can request an accounting of hospital disclosures of personal health
information.

B. The
patient can specify that his/her record be placed on a global “do not release
to anyone†list.

C. The
patient can take custody of his/her own health record and remove it from the
hospital.

D. The
patient can deny authorization for his/her health record to be included in
aggregate statistical or research data bases.
Question 15
Background:
An in-house counsel at a medical center is
reviewing notes from today’s activities and developing a work plan for
tomorrow. Since 7:00 a.m. this morning, the following priority issues have been
determined for resolution or advice.
• A
pregnant teenager arrived at the emergency department (ED) only minutes before
delivering a full-term infant. Due to the urgent nature of her condition, no
personal information was collected from the mother before the delivery. While
the infant was being taken to the newborn nursery, the mother left the ED and
cannot be located. The ED administrative director reported the mother’s flight
and abandonment of the infant as required by hospital policy.
• A
patient discharged from the hospital 3 months ago came in to talk about the
security of health information. The patient recently saw a news report where a
breach of security in medical information used for a research study resulted in
identity theft for several hundred persons. The patient fears an increased risk
of identity theft because of data collected during the hospitalization. The
in-house counsel took time to explain to the patient the conditions under which
personal health information could have been released by the hospital, including
when express consent was required and when it was not. The in-house counsel
stressed the security policies employed by the hospital
• An
87-year-old elderly woman was admitted through the ED with a broken hip
following a fall in her home. The fracture will require surgical fixation and
long-term post-surgical care for rehabilitation is expected. The woman lives
with a granddaughter although her son is her legal guardian. The physical exam
revealed that she has moderate dementia, is malnourished, and has several
bruises on her upper arms. The ED physician suspects the woman may be a victim
of neglect or even physical abuse.
If the discharged patient’s concerns about
inappropriate release of health information are not resolved, which of the
following statements explains the patient’s rights for further action under
HIPAA regulations?

A. To
report the physician’s evaluation and assessment to designated authorities

B. To
request an evaluation from the hospital’s social services department

C. To
report suspected abuse to the patient’s legal guardian, her son

D. To
report the custodial granddaughter to the state welfare department
Question 16
Background:
Diane, one of Dr. Kahl’s patients is
dismayed at overhearing other visiting patients derogatively talk about her
recent medical procedure. On further inquiry, Diane discovers that these
patients were acquaintances of Dr. Kahl’s medical assistant who had earlier
disclosed private information regarding her procedure to them.
What legal principle did the medical
assistant violate?

A. Consent

B. Secrecy

C. Security

D. Confidentiality

Question 17
Background:
In a disaster, those involved in health
care need to make moral decisions that are beyond their normal medical
education and training. Routine methods and use of resources are not adequate
to serve the greater good and to save lives. The population to be served,
rather than the particular needs of the individual, must be the focus of the
provision of medical care. Unlike normal medical procedures, evaluations need
to be done quickly, and the severely injured should be treated after those with
less serious health issues. The goal should be to treat as many people as
quickly as possible, making the best of limited resources. This approach will
keep the unnecessary loss of life to a minimum.
What is the most important response for
medical facility staff in a disaster?

A. Treating
each casualty using standard medical procedures

B. Providing
treatment so the greatest number of people are served

C. Treating
the most severely injured first

D. Allocating
resources equally across the number of casualties
Question 18
Background:
John was admitted to the hospital with
chest pain. The pain lasted a few minutes and then stopped. John felt the pain
was similar to last week’s episode which was diagnosed as heartburn due to
gastritis. However John called his Doctor to tell him about the problem. The Doctor
said that the pain was most likely gastritis but advised him to go to the
Emergency Room “just to be on the safe sideâ€. John went to the Emergency Room,
was admitted to the hospital and discharged two days later after an expensive
workup leading to a diagnosis of gastritis.
As a consequence of financing of health
services by insurance companies, physicians tend to deliver additional and more
expensive services. Thus, they create an additional demand for healthcare
services. This phenomenon is an example of

A. Moral
hazard

B. Supply
side rationing

C. Provider
induced demand

D. Demand
side rationing
Question 19
Background:
John was admitted to the hospital with
chest pain. The pain lasted a few minutes and then stopped. John felt the pain
was similar to last week’s episode which was diagnosed as heartburn due to
gastritis. However John called his Doctor to tell him about the problem. The
Doctor said that the pain was most likely gastritis but advised him to go to
the Emergency Room “just to be on the safe sideâ€. John went to the Emergency
Room, was admitted to the hospital and discharged two days later after an
expensive workup leading to a diagnosis of gastritis.
John promptly agreed to go to the emergency
room because he knew his out-of-pocket expense was zero. If he had to pay a
portion of his hospital bill, it is possible he would have been reluctant to go
to the hospital. This is an example of

A. Moral
hazard

B. Moral
reasoning

C. Medical
rationing

D. Demand
side rationing
Question 20
Background:
The CEO of a large non-profit hospital also
owns a consulting firm. The hospital has contracted with the consulting firm
numerous times for architectural work but the services were never performed.
Each time, the CEO made sure the hospital paid the consulting firm to retain
their services. Various reasons are always given for why the work is not
completed. The CEO has never disclosed to other hospital administrators or the
hospital’s governing board that he has an ownership stake in the consulting
firm.
Which of the following best describes the
ethical dilemma the CEO has with operating the hospital and owning the consulting
firm?

A. Confidentiality

B. Honesty

C. Conflict
of interest

D. Mistrust

Question 21
Background:
The CEO of a large non-profit hospital also
owns a consulting firm. The hospital has contracted with the consulting firm
numerous times for architectural work but the services were never performed.
Each time, the CEO made sure the hospital paid the consulting firm to retain
their services. Various reasons are always given for why the work is not
completed. The CEO has never disclosed to other hospital administrators or the
hospital’s governing board that he has an ownership stake in the consulting
firm.
The hospital’s governing board has what
type of relationship with the hospital?

A. Client

B. Fiduciary

C. Operational

D. Consultant

Question 22
Background:
The chief executive officer (CEO) of ACME,
a publicly traded corporation is facing decisions regarding the handling of
ACME’s relationship with MAC, a special purpose entity that helps ACME to share
the risk of a new project with other investors. ACME holds a 40% stake in MAC.
ACME’s chief financial officer (CFO) has expressed interest in becoming the
general manager of MAC, which is a paid position, while remaining ACME’s CFO.

ACME has a provision in its code of ethics
that prohibits employees from obtaining personal gain from relationships
outside of ACME that might interfere with fulfilling their duty to ACME. The
board of directors is considering waiving this provision for the CFO.
How would the Sarbanes-Oxley Act of 2002
apply to a request for a waiver of a code of ethics provision?

A. A
waiver of a code of ethics provision is allowed if the board of directors
approves it.

B. A
waiver of a code of ethics provision is allowed if the board’s audit committee
approves it.

C. A
waiver of a code of ethics provision is allowed if the waiver is disclosed in
the annual report.

D. A
waiver of a code of ethics provision is allowed if it is not material.
Question 23
Background:
The state board of health annual report
showed that there were strikingly high incidences of post operative infections
in St. Mary’s Hospital. In response to this, the governing body asked the
director of operation theatre to develop and implement a strategy to reduce
post-operative infections. More detailed aseptic protocols were implemented in
all the operating rooms.
Which of the following would be an
appropriate strategy to decrease the number of post-operative infections?

A. Writing
a letter to the state with the latest statistics about post-operative
infections

B. Rewarding
physicians and staff with the lowest infection rates

C. Increasing
patient turnaround times

D. Building
a new operating theatre
Question 24
Background:
The state board of health annual report
showed that there were strikingly high incidences of post operative infections
in St. Mary’s Hospital. In response to this, the governing body asked the
director of operation theatre to develop and implement a strategy to reduce
post-operative infections. More detailed aseptic protocols were implemented in
all the operating rooms.
Before holding medical personnel
accountable for the new aseptic protocols on performance reviews, what should
occur?

A. Employee
training on the new protocols

B. Employee
discussion on the new protocols

C. Updates
to the employee handbook

D. Updates
to the employee evaluation form

25
Virtua Hospital is planning to introduce
Electronic Health Records (EHR) at its various practice locations whereas the
older physicians raise concerns about their ability to use the new system
efficiently, the younger physicians support the implementation of the EHR.
Which