2. A provider has requested to go to block scheduling in an attempt to better manage his patient workflow. What does this mean?

Transcription

1 CPPM Chapter 13 Review Questions 1. Operational work flow refers to: a. Activities and processes that are performed in operating a medical practice b. Examining staffing ratios in a clinic c. The amount of patients that can legally flow through an office in an hour d. Identifying the amount of money that flows through an office every day 2. A provider has requested to go to block scheduling in an attempt to better manage his patient workflow. What does this mean? a. Time is blocked off on the schedule periodically to allow for catch up time b. Several patients are scheduled for a block of time and seen on a first come first serve basis c. Patients are scheduled in blocks based on their insurance d. Patients are provided a schedule to block of the amount of time needed for their appointment 3. There are consistent denials for subscriber not found. What processes in the business workflow would you review? a. Patient check-in, examination, charge entry b. Charge entry, payment entry, charge adjustments c. Scheduling, examination, payment entry d. Gathering of demographics, demographic entry, denial follow-up 4. Which statement is true regarding the billing office workflow? a. Financial security is mainly driven by added ancillaries and is not affected by the billing office workflow. b. Cash flow and financial security can fluctuate based on the workflow of the billing office. c. The workflow of the billing office is solely dependent on the type of visits seen in the office. d. The workflow of the billing office has minimal impact on the financial security of a practice. 5. The office is implementing a new automated telephone triage system. Which option would be best for an automated attendant? a. Limited options for most common reason calls are received, directions are simple and clear b. Options for every department in the clinic and separated by provider c. Complete explanation of each option choice d. Tiered automated system to ensure the caller gets to the correct place. 6. The receptionist in a clinic is having difficulty knowing when she can give information over the phone. How can the practice manager streamline this process? a. Have the receptionist get approval from the physician to release the information on a case by case basis. b. Have the receptionist transfer any call not related to scheduling to the nurses. c. Hire a medical assistant to answer the phones. d. Create protocols to define who can release what information.

2 7. When designing a reception area in a large medical practice, which option would be the best design? a. One check-in station to provide for privacy for each patient. b. Holding on to magazines for several years so the patients have plenty to choose from. c. Removing all forms of entertainment (TV, music, magazines) to give the perception the patient will not have any wait time before being seen. d. Providing a clean environment with subtle distractions to discourage patient from listening to other patients or staff conversations. 8. Employees can make a difference in the appearance of the office by: a. Picking up garbage and straightening up as possible b. Keeping conversations short with patients c. Not taking a lunch break and eating between patients d. Asking patients to help clean up the waiting room 9. When speaking of exam rooms, a pod: a. Needs to be watered every other day b. Is one exam room and one physician office c. Is where the waiting room is the center of the office surrounding by exam rooms. d. Has nurses, exam rooms, and physician offices all located in the same area 10. When constructing a new office, a break room should: a. Be away from clinical areas b. Be close to the waiting room for convenience c. Open, no door so staff can hear when they are needed d. Fully stocked with food, music, and appliances 11. A pediatrician s office continually has a completely booked schedule. Same day appointments are causing the providers to fall behind on their schedules and work extended hours. What can the office do to alleviate this problem? a. Allow less time for each patient on the schedule so additional patients can be seen b. Add more time slots to the physician s schedule so the physician knows how late he will be expected to work c. Create a schedule based on the patient s insurance carrier and the contracted payment rate d. Create an open access schedule which allows for blocks of time to be left open for same day appointments

3 12. An effective principle in the patient encounter workflow is: a. Have the patient complete as much of their history and review of systems as they can before being seen by the provider. b. Have the nursing staff do everything they are qualified to do and the physician doing the tasks only he or she can perform. c. Have the scheduling staff complete the history and review of systems at the time the appointment is scheduled. d. Have the nurse follow the provider so the nurse can complete the medical record documentation for the provider. 13. Pharmaceutical representatives require face to face time with physicians and signatures for drug samples they leave at the office. What would be an effective way to manage the time physicians spend with the pharmaceutical representative? a. Allow the pharmaceutical reps to come at a time convenient to them. b. Have scheduled times during the week that pharmaceutical representatives can see the physician. c. Tell pharmaceutical reps they cannot see the physicians but they can leave the samples at the front desk. d. Require the pharmaceutical representatives to meet with the physicians during the evening after office hours. 14. What would be an effective way to manage drug samples within an office? a. Have a closet where the sample are kept and allow open access by the physicians and nurses. b. Keep a drug sample closet that is locked and requires documentation of the samples provided to patients. c. Divide the samples available evenly between providers and require the provider to keep them in their office. d. Divide the samples available evenly between nurses and allow the nurse to determine who to give the samples to. 15. When building a new office, what should be considered during the construction? a. A large break room to allow for adequate space for employees to have privacy during their break and lunch times. b. Small waiting room/reception area to give the appearance of no waiting time before a visit. c. The insulation of the walls, or ways to dampen noise transfer between rooms to allow for patient privacy during exams. d. Closets located next to each exam room to store supplies for convenience during a patient exam.

4 CPPM Chapter 13 Review Questions Answer Key 1. Operational work flow refers to: a. Activities and processes that are performed in operating a medical practice Rationale: Workflow includes all activities within the practice performed to operate a medical practice. 2. A provider has requested to go to block scheduling in an attempt to better manage his patient workflow. What does this mean? b. Several patients are scheduled for a block of time and seen on a first come first serve basis Rationale: Block scheduling is a model where several patients may be scheduled for a block of time and patients are seen in the order they arrive. This model attempts to mitigate patients showing up late and disrupting the remainder of the appointment times 3. There are consistent denials for subscriber not found. What processes in the business workflow would you review? d. Gathering of demographics, demographic entry, denial follow-up Rationale: When a claim is denied as subscriber not found, the carrier is indicating they are unable to locate the subscriber in their system. This could be due to sending it to the incorrect carrier, transposing numbers during date entry, selecting the incorrect address to send claims to for that carrier/group, etc. 4. Which statement is true regarding the billing office workflow? b. Cash flow and financial security can fluctuate based on the workflow of the billing office. Rationale: Without efficient workflow in the billing office, cash flow and financial security can be weakened and stress to the business may result. However, good detailed workflow can provide confidence that clean claims are being submitted, proper follow up is performed, and processes are in place to protect the financial well being of the practice. 5. The office is implementing a new automated telephone triage system. Which option would be best for an automated attendant? a. Limited options for most common reason calls are received, directions are simple and clear Rationale: If a clinic uses an automated attendant, directions should be simple, clear, and limited in the number of options available. Long and drawn out telephone trees can be frustrating and can lead to patient frustration or ineffective use. However, an effective automated attendant can efficiently direct patients to scheduling staff, billing staff, clinical staff, and can handle prescription refills with limited frustration from patients.

5 6. The receptionist in a clinic is having difficulty knowing when she can give information over the phone. How can the practice manager streamline this process? d. Create protocols to define who can release what information. Rationale: Triage can be made easier if there are identified protocols established for how to address different requests. For example, if a patient calls requesting lab results and the established protocol is that for all normal labs the medical assistant relays the results, this will save time. The assistant will not have to ask the physician if it is OK to communicate the information, or the medical assistant will not have to delay, not knowing how to respond. 7. When designing a reception area in a large medical practice, which option would be the best design? d. Providing a clean environment with subtle distractions to discourage patient from listening to other patients or staff conversations. Rationale: A waiting room providing no form of entertainment encourages patients to focus on listening to other patients or staff conversations. 8. Employees can make a difference in the appearance of the office by: a. Picking up garbage and straightening up as possible Rationale: Besides general upkeep done with carpets, paint, and furniture, employees can make a big difference in the appearance of the reception area by paying attention and providing upkeep. Picking up magazines and ordering them nicely, picking up garbage, straightening chairs, wiping smudges off windows, etc. can make a big difference throughout a busy day. 9. When speaking of exam rooms, a pod: d. Has nurses, exam rooms, and physician offices all located in the same area Rationale: One concept used to promote efficiency for physicians and staff is a pod configuration. This idea aims at having a pod or area focused on having nurses, exam rooms, and even physician offices all located in the same area of the clinic. 10. When constructing a new office, a break room should: a. Be away from clinical areas Rationale: Break rooms are generally placed near the back of the clinic away from clinical areas. There are reasons for this. First, and probably most important, is a break room will generate lots of smells and food possibly disruptive to patients who are not feeling well. A break room is also a place where employees congregate and talk; placing it in the back of clinic can help limit noise from entering clinical areas.

6 11. A pediatrician s office continually has a completely booked schedule. Same day appointments are causing the providers to fall behind on their schedules and work extended hours. What can the office do to alleviate this problem? d. Create an open access schedule which allows for blocks of time to be left open for same day appointments Rationale: Open access scheduling is a scheduling model where enough time slots are left open each day that a patient can call the day of and get an appointment with a physician. Many mothers value a physician they can call and get an appointment for their children on the day a child is sick. If parents have to wait three days to have a crying child checked, they will most likely go elsewhere. 12. An effective principle in the patient encounter workflow is: b. Have the nursing staff do everything they are qualified to do and the physician doing the tasks only he or she can perform. Rationale: An effective principle in the patient encounter workflow is having the nursing staff do everything they are qualified to do and the physician doing the tasks only he or she can perform. 13. Pharmaceutical representatives require face to face time with physicians and signatures for drug samples they leave at the office. What would be an effective way to manage the time physicians spend with the pharmaceutical representative? b. Have scheduled times during the week that pharmaceutical representatives can see the physician. Rationale: Workflows detailing when reps are allowed to come into the office, how they are required to check in, what locations they are allowed to go in the clinic, and where they are to leave their samples are all critical things to consider in an effective workflow. Some clinics will only allow reps face time with their physicians during specified times each day and these times need to be scheduled. Other clinics are very loose and reps are allowed to just try to catch the physician between patients. 14. What would be an effective way to manage drug samples within an office? b. Keep a drug sample closet that is locked and requires documentation of the samples provided to patients. Rationale: It is recommended every time samples are left at the office, the amount and lot numbers are documented to identify what drugs have been left in the office. It is also important to document every time a sample drug is given to a patient in case of recalls and for effective management of the patient s treatment.

7 15. When building a new office, what should be considered during the construction? c. The insulation of the walls, or ways to dampen noise transfer between rooms to allow for patient privacy during exams. Rationale: When constructing exam rooms, consider insulation to dampen noise transfer between rooms. Without any insulation, it may be possible to hear conversations through walls, compromising confidentiality. An architect or contractor can provide suggestions on how to best dampen sound between rooms, including how insulation can be used and how walls can be framed.