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Flashcards in Legal Deck (60):
1

According to the documentation requirements of the Center for Medicare and Medicaid Services
(CMS), which factor is not considered part of a patient’s History?

(a) Chief complaint
(b) Allergies
(c) Review of systems
(d) Social history

(b)
Evaluation and management coding (E/M) is the process by which physician-patient encounters are translated into to numeric codes to facilitate billing. Different E/M codes exist for different types of encounters, such as inpatient or outpatient encounters and new patient or established patient encounters. Documentation for E/M services is based on 3 key components, including (1) history, (2) physical exam and (3) medical decision-making. While a patient’s
allergy history is an important part of the evaluation, E/M coding does not credit this
documentation as part of a patient’s history. The history is comprised of the patient’s chief complaint, history of present illness, review of systems, and past medical, family, and social
history.

Reference: Department of Health and Human Services, Center for Medicare and Medicaid
Services, Medicare Learning Network fact sheet: Evaluation and management (E/M) services: Complying with documentation requirements

2013

2

A 57-year-old man with chronic low back pain is referred to see you. He has commercial medical insurance. The patient leaves radiologic films and medical records for review and also asks you to complete disability paperwork. That evening you review the films and records, fill out the paperwork, and call the referring physician. In addition to the charges for a New Patient
Consultation, what charges may you submit to the commercial medical insurance for these services?

(a) No additional charges, since all your services are covered by the New Patient
Consultation charge
(b) No additional charges to the commercial insurance, although you may charge the
disability insurance for completing the disability paperwork
(c) One additional charge for Prolonged Services, up to 60 minutes for the time needed to
complete all the additional services Page 12 of 23

(d) Two additional charges, one for radiology review and another for Prolonged Services, up
to 60 minutes for the time needed to complete the other services

Answer: (a)
Commentary: For outpatient services, Evaluation and Management (E/M) coding allows providers to bill based on time spent, as long as that time is spent face-to-face, and at least 50% of that time is used for patient counseling and education. Provider services that occur outside of the actual face-to-face encounter are assumed as part of the work necessary to complete the evaluation and management of the patient and may not be billed separately as “Prolonged Services.” Commercial and disability insurance companies are not obligated to reimburse providers to complete paperwork, and providers may opt to charge patients directly for completion of disability paperwork. Had this patient presented through the Workers’ Compensation (WC) system, some of these additional services may have been reimbursable, depending on the specific WC laws that are stipulated by each state.

Reference: American Medical Association. Current procedural terminology (CPT) 2012
professional edition. Chicago (IL) American Medical Association; 2011. P 8.

2013

3

A physiatrist assesses each of the following patients during hospitalization and determines that
each one is clinically appropriate for an admission to your acute inpatient rehabilitation unit.
Which patient does NOT qualify for the Center for Medicare and Medicaid Services (CMS) 60%
Rule (formerly known as the 75% Rule)?

(a) 28-year-old woman with multiple sclerosis exacerbation, status-post intravenous
methylprednisolone (Solu-Medrol)
(b) 60-year-old woman with active polyarticular rheumatoid arthritis, status-post left total
shoulder arthroplasty
(c) 63-year-old man with end-stage kidney disease, status-post kidney transplant,
complicated by sepsis
(d) 87-year-old man with end-stage osteoarthritis, status-post elective left total knee
replacemen

Answer: (c)
Commentary: Inpatient Rehabilitation Facilities (IRFs) must follow the Center for Medicare and Medicaid Services (CMS) criterion regarding admissions in order to receive payment. Previously known as the “75% Rule,” CMS changed the percentage to 60% in 2007. Currently, 60% of all admissions to an IRF must have 1 or more of 13 selected conditions that include stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, fracture of femur (hip fracture), brain injury, neurological disorders (including multiple sclerosis, motor neuron disease,
polyneuropathy, muscular dystrophy, Parkinson disease), and burns. Other conditions such asrheumatologic arthritides or osteoarthritis have additional stipulations. Patients undergoing elective hip and/or knee joint replacements must also meet 1 of 3 additional criteria, including (1)
bilateral joint replacement surgeries, (2) body mass index greater than 50, or (3) age 85 or older. The CMS criterion does not prohibit admission to an IRF if a patient does not have 1 of these 13 conditions, though IRFs must continually monitor compliance to ensure reimbursement. While the patient who underwent a kidney transplant may be able to participate in and benefit from 3 hours of interdisciplinary therapy daily and requires ongoing inpatient nursing and physician management, his diagnosis is not included in the 13 medical conditions recognized by the CMS criterion


2013

4

A 67-year-old man who had a stroke is being discharged from the hospital. His 32-year-old
nephew plans to care for him at home, but is unfamiliar with the Family Medical Leave Act
(FMLA). How does FMLA apply to the nephew?

(a) He does not qualify since he is not the spouse or an immediate family member.
(b) FMLA only applies to the patient, not to the caregiver.
(c) He will be paid 66% of his usual salary while he is taking FMLA.
(d) If he takes FMLA, he may lose his employer-sponsored health insurance

Answer: (a)
Commentary: The Family Medical Leave Act (FMLA) entitles eligible employees of covered
employers to take unpaid, job-protected leave for specified family and medical reasons with
continuation of group health insurance coverage. Eligible employees are entitled to 12 work
weeks of leave in a 12-month period for any of the following reasons:
1. the birth and care of the newborn child of an employee
2. the placement with the employee of a child for adoption or foster care
3. to care for an immediate family member (spouse, child, or parent) with a serious health
condition
4. to take medical leave when the employee is unable to work because of a serious health
condition Employees are eligible for leave if they have worked for their employer at least 12 months, have
worked at least 1250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles

2012

5

Injured workers with acute low back pain treated with high-dosage opioids compared to low-dose
or nonopioid medications demonstrated which outcome?

(a) Lower overall medical costs
(b) Same duration of disability
(c) Higher risk for surgery
(d) Shorter duration of opioid use

Answer: (c)
Commentary: Injured workers with acute low back pain who received higher dosages of opioids in early treatment had adverse outcomes compared to patients given no or low-dose opioids. In the high-dose opioid group, adverse outcomes included higher medical costs, prolonged disability, higher risk for surgery, and continued use of opioids. The high-dose opioid group was disabled 69 days longer than the non-opioid group, had a 3 times greater risk for surgery, and a 6-times-greater risk of receiving long-term opioids. The severity of the low back injury was a strong predictor of all outcomes

2011

6

For injured workers with chronic low back pain, which outcome is associated with better
performance during a functional capacity evaluation (FCE)?

(a) Shorter usage of temporary disability benefits
(b) Lower subjective reports of perceived disability
(c) Higher likelihood of sustainable work tolerance
(d) Fewer recurrences of low back pain over the next 12 months


Answer: (a)
 
Commentary: Functional capacity evaluations (FCEs) are commonly used to determine readiness
for return to work. These evaluations measure the injured worker’s functional abilities relative to
the physical demands required by the job. The clinical assumption is that workers who perform
better during FCEs will have a lower risk of reinjures and less pain exacerbation upon return to
work. One-year follow-up of patients with chronic low back pain whose FCE demonstrated
performance that met or exceeded physical job requirements did not demonstrate a reduction of
recurrent low back pain, improved occupational sustainability, or improved perception of
disability. Better FCE performance was mildly associated with faster return to work and shorter
duration of temporary disability benefits.

2011

7

A physiatrist assesses each of the following patients during hospitalization and determines that each one is clinically appropriate for an admission to your acute inpatient rehabilitation unit. Which patient does NOT qualify for the Center for Medicare and Medicaid Services (CMS) 60% Rule (formerly known as the 75% Rule)?
(a) 28-year-old woman with multiple sclerosis exacerbation, status-post intravenous methylprednisolone (Solu-Medrol)
(b) 60-year-old woman with active polyarticular rheumatoid arthritis, status-post left total shoulder arthroplasty
(c) 63-year-old man with end-stage kidney disease, status-post kidney transplant, complicated by sepsis
(d) 87-year-old man with end-stage osteoarthritis, status-post elective left total knee replacement

Answer: (c)
Commentary: Inpatient Rehabilitation Facilities (IRFs) must follow the Center for Medicare and Medicaid Services (CMS) criterion regarding admissions in order to receive payment. Previously known as the “75% Rule,” CMS changed the percentage to 60% in 2007. Currently, 60% of all admissions to an IRF must have 1 or more of 13 selected conditions that include stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, fracture of femur (hip fracture), brain injury, neurological disorders (including multiple sclerosis, motor neuron disease, polyneuropathy, muscular dystrophy, Parkinson disease), and burns. Other conditions such as
Page 17 of 23
rheumatologic arthritides or osteoarthritis have additional stipulations. Patients undergoing elective hip and/or knee joint replacements must also meet 1 of 3 additional criteria, including (1) bilateral joint replacement surgeries, (2) body mass index greater than 50, or (3) age 85 or older. The CMS criterion does not prohibit admission to an IRF if a patient does not have 1 of these 13 conditions, though IRFs must continually monitor compliance to ensure reimbursement. While the patient who underwent a kidney transplant may be able to participate in and benefit from 3 hours of interdisciplinary therapy daily and requires ongoing inpatient nursing and physician management, his diagnosis is not included in the 13 medical conditions recognized by the CMS criterion

2013

8

A 57-year-old man with chronic low back pain is referred to see you. He has commercial medical insurance. The patient leaves radiologic films and medical records for review and also asks you to complete disability paperwork. That evening you review the films and records, fill out the paperwork, and call the referring physician. In addition to the charges for a New Patient Consultation, what charges may you submit to the commercial medical insurance for these services?
(a) No additional charges, since all your services are covered by the New Patient Consultation charge
(b) No additional charges to the commercial insurance, although you may charge the disability insurance for completing the disability paperwork
(c) One additional charge for Prolonged Services, up to 60 minutes for the time needed to complete all the additional services
(d) Two additional charges, one for radiology review and another for Prolonged Services, up to 60 minutes for the time needed to complete the other services

Answer: (a)
Commentary: For outpatient services, Evaluation and Management (E/M) coding allows providers to bill based on time spent, as long as that time is spent face-to-face, and at least 50% of that time is used for patient counseling and education. Provider services that occur outside of the actual face-to-face encounter are assumed as part of the work necessary to complete the evaluation and management of the patient and may not be billed separately as “Prolonged Services.” Commercial and disability insurance companies are not obligated to reimburse providers to complete paperwork, and providers may opt to charge patients directly for completion of disability paperwork. Had this patient presented through the Workers’ Compensation (WC) system, some of these additional services may have been reimbursable, depending on the specific WC laws that are stipulated by each state

2013

9

The current workers’ compensation system in the United States is a “no fault” system. This
means that the

(a) employee does not have to prove that the employer is at fault for the injury.
(b) employer does not have to prove they are at fault for the employee’s injury.
(c) employee and employer do not have to prove that the other is at fault for the injury.
(d) employer does not have to prove that the employee is at fault for the employee’s injury

Answer: (c)
Commentary: In the United States workers’ compensation system the injured worker does not
have to prove that the employer is at fault for the employee’s injury. Similarly, the employer
does not have to prove that the injured worker is at fault for his/her injury. If the injury occurred
at work, the medical costs and partial payment of lost income are covered.

2010

10

A 67-year-old man who had a stroke is being discharged from the hospital. His 32-year-old
nephew plans to care for him at home, but is unfamiliar with the Family Medical Leave Act
(FMLA). How does FMLA apply to the nephew?
(a) He does not qualify since he is not the spouse or an immediate family member.
(b) FMLA only applies to the patient, not to the caregiver.
(c) He will be paid 66% of his usual salary while he is taking FMLA.
(d) If he takes FMLA, he may lose his employer-sponsored health insurance.

Answer: (a)
Commentary: The Family Medical Leave Act (FMLA) entitles eligible employees of covered
employers to take unpaid, job-protected leave for specified family and medical reasons with
continuation of group health insurance coverage. Eligible employees are entitled to 12 work
weeks of leave in a 12-month period for any of the following reasons:
1. the birth and care of the newborn child of an employee
2. the placement with the employee of a child for adoption or foster care
3. to care for an immediate family member (spouse, child, or parent) with a serious health
condition
4. to take medical leave when the employee is unable to work because of a serious health
condition
Employees are eligible for leave if they have worked for their employer at least 12 months, have
worked at least 1250 hours over the past 12 months, and work at a location where the company
employs 50 or more employees within 75 miles.

2012

11

A 47-year-old woman with T8 ASIA A spinal cord injury (SCI) applied for a position as a store
clerk. She felt that she was being discriminated against because of her SCI. Under the Americans
with Disabilities Act (ADA), she may have a right to file a complaint if
(a) the employer requested a pre-employment physical to see if she qualified.
(b) the employer hired her, but then requested a pre-placement physical to determine the
most appropriate position for her.
(c) the job description required climbing ladders and working from heights.
(d) the employer did not make all accommodations to allow her to work from her wheelchair.

Answer: (a)
Commentary: The Americans with Disabilities Act (ADA) is a federal law designed to help
protect the rights of disabled citizens. Employers must not discriminate against hiring a disabled
applicant if that person is able to perform the key components of the job. Pre-employment
physicals are not allowed under the ADA, but a pre-placement physical can be used after an
individual is hired to help determine the most appropriate job for that person. An employer may
decline to hire a disabled individual if that person is unable to perform the essential functions of
the job, so long as the employer has attempted to make reasonable accommodations to allow the
disabled individual to perform these job functions. This individual would not be able to climb
ladders or work from heights because of her SCI, despite any accommodations.

2012

12

Two medical experts (Drs. A and B) have differing opinions in a medical-legal case. Dr. A
accuses Dr. B of citing “junk science,” and states that Dr. B’s testimony fails to meet the Daubert
standard. Which statement supports the opinion that Dr. B has not met the Daubert standard?
(a) Dr. B’s research experience and publications are less than Dr. A’s.
(b) Dr. B’s peer-reviewed references are all more than 10 years old
(c) Dr. B’s cited references did not have a known error rate.
(d) Dr. B’s opinions are not fully accepted by the medical community.

Answer: (c)
Commentary: The Daubert standard refers to a federal Supreme Court decision to prevent “junk
science” from influencing juries. Information given by expert testimony must meet certain
criteria, and if these criteria are not met the expert can be barred from testifying. The information
provided by medical experts must meet the following four criteria:
1. Generally well accepted in the medical community
2. Published in peer-reviewed literature
3. Have a scientific basis
4. Have a known error rate
In the scenario presented, Dr. B satisfied the Daubert standard except for his failure to provide a
known error rate in his research.

2012

13

A 47-year-old woman with secondary progressive multiple sclerosis is applying for Social
Security Disability Insurance (SSDI). She asks her primary care physician for help. His correct
response to her is that
(a) SSDI benefits and policies vary from state to state.
(b) SSDI benefits include medical insurance.
(c) he will make the final determination of disability and employability.
(d) she must satisfy non-medical criteria before medical factors are considered.

Answer: (d)
Commentary: The Social Security Administration (SSA) provides both Social Security Disability
Insurance (SSDI) and Supplemental Security Income (SSI). SSDI and SSI are federal programs
with identical benefits and policies from state to state. SSDI and SSI provide financial assistance
to disabled individuals, but do not provide medical insurance. Final determination of SSDI or SSI
is made by the SSA, not the treating provider. However, medical information is usually requested
from treating providers in order to make a determination of disability. An applicant must first
meet certain non-medical (eg, economic) criteria before medical factors are considered.

2012

14

Which statement about the Functional Independence Measure (FIM) is TRUE?

(a) The instrument is limited by its lack of evaluation of cognitive skills.
(b) It is used by inpatient rehabilitation programs to compare the outcomes of their patients
with regional and national outcomes.
(c) It uses a 5-point scale to rate the amount of assistance that an individual requires in
various functional areas.
(d) It is routinely applied only at discharge from an inpatient rehabilitation facility

Answer: B
Commentary: The Functional Independence Measure (FIM) is an outcomes measurement tool
used by inpatient rehabilitation facilities across the country. It enables inpatient rehabilitation
programs to compare their patients’ outcomes with regional and national outcomes. The FIM
measures an individual’s functional abilities and level of assistance required in 18 separate functional areas, including cognition and communication. The FIM instrument uses a 7-point
scale to rate the amount of assistance that an individual requires in each of these functional areas.
The FIM can be completed at any frequency, but is typically completed at least at the time of
admission and at the time of discharge from an inpatient rehabilitation facility.

2009

15

Continuous quality improvement (CQI) is a method of quality control widely used in the manufacturing industry to analyze and improve production processes. Applied to health care delivery, what is a general principle of CQI?

a. Systemization of care is preferred, although it may be perceived as a loss of provider autonomy.
b. Most errors are attributable to individuals, rather than to a system being suboptimal.
c. A negative medical event must occur in order to trigger the CQI process.
d. The increased cost of health care by implementing “best practices” is offset by the continued access to new technologies.

Option a is correct.

Continuous quality improvement (CQI) programs focus on both outcome and process of care. Quality improvement relies on a critical evaluation of current practice to develop process improvements, reduce practice variation, and optimize resource consumption. A work environment with needless variation increases the likelihood of medical errors by the health care personnel involved. Physicians often resist standardizing care, fearing a loss of autonomy or loss of their ability to provide individualized care. Frequently, an inherent tension exists between standardization to excellence and physician autonomy. That tension needs to be understood and confronted. CQI focuses on process or system improvement, rather than placing blame on individuals. A general principle behind CQI is that 85% of errors occur because of a suboptimal system, and only 15% of errors are attributable to individuals. Experts using CQI in health care believe it is possible to improve quality and save money at the same time. The objectives of quality improvement are to ensure access to new technology, good procedural outcomes, and patient satisfaction, while concurrently identifying opportunities that will reduce expense.

2014

16

Answer: D
Commentary: Nachemson measured the relative pressure changes within the third lumbar disc
with changes of position. Standing erect was the reference position and pressures decreased with
lying supine and increased in the seated position. Seated and flexed forward further increased disc
pressures. Several other positions were evaluated

Answer: B
Commentary: A benchmark is a target value or standard for comparison for a performance
indicator. Functional outcomes and efficiency of functional improvement during inpatient
rehabilitation admission are examples of performance indicators. The UDS-FIM database
provides a means by which individual rehabilitation units can compare their outcomes to other
centers across the nation. This process of comparing outcomes to a standard is referred to as
benchmarking.


2009

17

According to the American Medical Association Code of Ethics Opinion, which statement is
TRUE?

(a) Individual gifts of minimal value from pharmaceutical representatives to physicians are
permissible so long as the gifts are related to the physician's work.
(b) It is acceptable for physicians to request free pharmaceuticals for personal use or use by
family members.
(c) Subsidies to underwrite the costs of continuing medical education are permissible when
provided directly from the pharmaceutical company to the physician.
(d) Faculty presenting at conferences cannot accept honoraria and reimbursement for travel,
lodging, and meal expenses.

Answer: A
Commentary: According to the AMA Code of Ethics Opinion, individual gifts of minimal value
from pharmaceutical representatives to physicians are permissible, so long as the gifts are related
to the physician's work. It is not acceptable for physicians to request free pharmaceuticals for
personal use or use by family members. Subsidies to underwrite the costs of continuing medical
education are permissible when they are accepted by the conference's sponsor and are not
provided directly to the physician. It is acceptable for faculty at conferences to accept reasonable
honoraria and reimbursement for travel, lodging, and meal expenses.

2009

18

. In terms of continuous quality improvement, a sentinel event is defined as

(a) a benchmark event that sets the standard for patient care.
(b) an occurrence that requires dismissal of personnel.
(c) a single occurrence that is highly problematic or socially unacceptable.
(d) an event that results in the opening of a new hospital program

C

Commentary: In terms of continuous quality improvement, a sentinel event is defined as a single
occurrence that is highly problematic or socially unacceptable. Sentinel events will typically
trigger an in-depth root cause analysis to determine the cause of the event as well as potential
solutions. The focus of these investigations is to evaluate the processes and systems that are in
place rather than to focus blame on individual practitioners

2009

19

Disability as defined by the Americans with Disabilities Act (ADA) is

(a) a physical or mental impairment that substantially limits 1 or more major life activities.
(b) abnormality of the physiologic or anatomic structure or function.
(c) the barriers society places on the individual interacting in his/her community.
(d) a rating based on an independent medical examination.

Answer: A
Commentary: The Americans with Disabilities Act defines disability as a physical or mental
impairment that substantially limits 1 or more of a person’s major life activities. The person has a
record of such impairment, or is regarded as having such impairment. Impairment is the actual
physiologic, anatomic, or psychologic abnormality. Handicap refers to the barriers society places
on an individual to perform function in the community. A permanent disability rating is used to
determine financial compensation for an injury.


2009

20

How are mobility devices paid for through Medicare?

(a) The patient must make a 50% down payment, with the rest covered by Medicare upon
delivery of the device.
(b) Medicare part A pays 80% of the allowed purchase price and Medicare part B pays the
remaining 20%.
(c) Medicare will pay for purchase but not rental of mobility devices. (d) Medicare part B pays 80% of the allowed purchase price in one lump sum
(d) Medicare part B pays 80% of the allowed purchase price in one lump sum

Answer: D
Commentary: Medicare Part B pays 80% of the allowed purchase price in one lump sum payment
if the patient chooses to purchase the device. The patient is required to pay 20% of the allowed
purchase price. If the patient chooses to rent a wheelchair, Medicare part B will pay 80% of the
allowed rental price for months 1 through 10 and the patient will pay 20% of the allowed rental
charge

2009

21

Which structure is required by the American with Disabilities Act (ADA) to have adequate
accessibility for individuals with disabilities, so long as the modifications to it are readily
achievable?

(a) House of worship
(b) Physician’s office within a private residence
(c) Commercial airplane
(d) Residential private apartments

Answer: B
Commentary: If a publicly accessible office is present within a single family home, it is required to be accessible under the ADA, so long as the necessary modifications are readily achievable. Accessibility of commercial airplanes is covered under the Air Carrier Access Act, not the ADA. Access to houses of worship or strictly residential private apartments is not required under the
ADA

2009

22

A recent study of individuals undergoing a single knee or hip replacement surgery who were
treated at an inpatient rehabilitation facility (IRF) compared to those treated at a skilled nursing
facility (SNF) found that those treated in an IRF were more likely to

(a) need the use of a walker to ambulate.
(b) require home care services.
(c) be discharged home.
(d) ambulate a shorter distance

Answer: C
Commentary: Patients undergoing single knee or hip replacement surgery who were treated at an
IRF were more likely to be discharged home, less likely to require home care services upon
discharge, and were able to ambulate farther distances compared to those treated in an SNF.

2009

23

Which factor is associated with increased risk for occupational injury in an older individual?

(a) White collar occupation
(b) Female gender
(c) Impaired hearing
(d) Self employment

Answer: C
Commentary: Predictors of increased injury risk in an older worker include male gender, less
education, obesity, alcohol abuse, disability, self report of impaired hearing or sight, and several
specific job requirements. Service workers, mechanics, machine operators, and laborers are at
increased risk for occupational injury compared to people in white collar occupations. Individuals
who are self-employed have a lower risk of injury.


2009

24

Which abbreviation or symbol is acceptable to use when writing prescriptions, according to The
Joint Commission (JC)?

(a) QD for once daily
(b) U for units
(c) ml for milliliters
(d) cc for milliliters

Answer: C
Commentary: Of the options given the Joint Commission has only approved the use of the
abbreviation ml for milliliters. Using the abbreviation QD can be dangerous since it may be
mistaken for QID, which stands for four times per day

2009

25

A 47-year-old woman injures her back on the job. Her supervisor inquires about the injury and
creates a document with the employee’s name, outlining how the injury occurred and where the
employee is experiencing pain. The information in the document is protected by the

(a) Health Insurance Portability and Accountability Act (HIPAA).
(b) The Joint Commission (JC).
(c) Americans with Disabilities Act (ADA).
(d) United States Supreme Court.

Answer: A
Commentary: Once the document was created by the supervisor and it contained individually
identifiable health information it became information that is protected by HIPAA. The term
'individually identifiable health information' means any information, including demographic information collected from an individual, that: (A) is created or received by a health care
provider, health plan, employer, or health care clearinghouse; and (B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an
individual, or the past, present, or future payment for the provision of health care to an individual, and identifies the individual

2009

26

A 50-year-old construction worker has received a 30% whole person impairment rating because of
his pericardial heart disease. According to the fifth edition of the American Medical Association
Guides to the Evaluation of Permanent Impairment, this worker’s status indicates that
(a) he is 100% disabled from performing his work activities.
(b) his general functioning and ability to perform activities of daily living is reduced by 30%.
(c) he has a 30% reduction in work capability.
(d) he should receive 30% of his future wages and benefits in a disability payment.

(b)
According to the AMA guides, a 30% whole person impairment rating indicates a 30% reduction in general functioning, excluding work. The whole person impairment rating does not directly correlate to the patient’s work abilities and it does not determine the disability compensation.

2008

27

In assisting patients returning to their previous level of work, work hardening programs can achieve return-to-work rates of
(a) less than 25%.
(b) 25%--49%.
(c) 50%--75%.
(d) more than 75%.

(d)
Return-to-work rates of 77% can be achieved with work hardening programs. Poor outcome was associated with an increased number of treatments before the program, an increased length of time off from work; the patient's having lower satisfaction with the program, and a lawyer being involved in the case.

2008

28

If a man injures his low back while on the job and is off work for 6 months, then the chance that he will return to work is
(a) 25%.
(b) 35%.
(c) 50%.
(d) 75%.

(c)
There is about a 50% chance of return to work when a worker who injures his low back on the job is off work for 6 months. The rate drops to 25% when the worker is off for 1 year, and is minimal is he is off for 2 years.

2008

29

According to current guidelines, for the injured factory worker with acute low back pain, what is the recommendation?
(a) >6
(b) 4-5
(c) 2-3
(d) <1

(d)
In a systematic review of patients with acute low back pain, resting in bed was found to be less effective than staying active.

2008

Ref: Hagen KB, Jarntvedt G, Hilde G, Winnem M. The updated Cochrane Review of bed rest, low back pain and sciatica. Spine 2005;30:542-6.

30

Which factor is most likely to be associated with the development of a work-related, repetitive-strain injury?
(a) Normal body weight
(b) Warm work environment
(c) Younger age
(d) Rheumatoid arthritis

(d)
Risk factors associated with a repetitive strain injury include obesity, cold temperature, older age, diabetes, smoking, pregnancy, rheumatoid arthritis, and psychologic stress.

2008

31

According to the Joint Commission on Accreditation of Hospital Organizations (JCAHO), what is the minimum number of patient identifiers needed before medications, blood products, or other treatments or procedures may be administered?
(a)1
(b)2
(c)3
(d)4

(b)
While more than 2 patient identifiers may be used, a minimum of 2 is required: first, a marker to identify the individual as the person for whom the service or treatment is intended; second, an identifier to match the service or treatment to that individual.

2008

32

According to the Joint Commission on Accreditation of Hospital Organizations (JCAHO) which abbreviation may be used when writing a prescription?
(a) U for units
(b) QD for once daily
(c) 2 mg for 2 milligrams
(d) MSO4 for morphine sulfate

(c)
The only listed expression that may be written on a prescription is 2 mg for 2 milligrams. JCAHO expects that the other abbreviations will not be used in writing drug prescriptions, since they can lead to errors. Davis' Medical Abbreviations cites U as "the most dangerous abbreviation" and says spell out "unit." The expression QD is too easily read as 4 times daily. Regarding MSO4, Davis also calls this as "a dangerous abbreviation."

2008

33

You see the significant other of a close friend in your office for knee pain. As part of her past medical history you note that she has a congenital heart defect. She says she has not yet told your friend that she has this condition. You decide to tell your friend about her congenital heart defect even though the patient did not give you permission to do so. What penalty do you face for knowingly disclosing individually identifiable health information, which is in violation of HIPAA rules?
(a)$50,000 and up to 1year of imprisonment
(b)No penalty
(c)$250,000 and up to 10 years imprisonment
(d)$100,000 and up to 5 years imprisonment

(a)
A person who knowingly discloses individually identifiable health information in violation of HIPAA faces a fine of $50,000 and up to a 1-year imprisonment. The criminal penalties increase to $100,000 and up to 5 years imprisonment if the wrongful conduct involves false pretenses, and to $250,000 and up to 10 years imprisonment if the wrongful conduct involves the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm.

2008

34

Under the Health Insurance Portability and Accountability Act (HIPAA) Protected Health
Information is data that

(a) a physician can withhold from a patient.
(b) a patient’s job supervisor can obtain from a physician.
(c) can be used to identify a patient.
(d) can be shared with family without permission.

(c) Protected Health Information includes individually identifiable health information. This is information,
including demographic data, that relates to any of the following particulars: the individual’s past,
present or future physical or mental health or condition; the provision of health care to the individual; or
the past, present, or future payment for the provision of health care to the individual. It can also be
information that identifies the individual or for which there is a reasonable basis to believe it can be
used to identify the individual. Individually identifiable health information includes many common
identifiers (e.g., name, address, birth date, Social Security Number).

2008

35

The process of developing and adopting quality standards for clinical practice

(a) is dependent on providers being mandated for reporting data.
(b) is ineffective in changing physician practice patterns.
(c) allows health insurance providers to deny reimbursement for care.
(d) helps to form expectations for safety among both providers and consumers

(d) The process of developing and adopting quality standards for clinical practice helps to form
expectations for safety among both providers and consumers.


2008

36

The bulk of personal long-term care for most older individuals in the United States is provided by
(a) paid home health aides.
(b) extended care facilities.
(c) government agencies.
(d) family members

Answer: (d)
Commentary: In the United States, immediate and extended families provide the bulk (up to 90%) of personalized long-term care for their elderly disabled relatives. This includes personal care,nursing care, meals, housekeeping, transportation and shopping. Outside or alternative support
systems (friends and neighbors, government and agencies) supplement this care, and can becomeincreasingly important with advancing age.

2011

37

You are asked to provide a brief synopsis of workers’ compensation benefits to the hospital’s
case management department. Which statement about the benefits and services provided in the
workers’ compensation system is correct?
(a) The employer has to be at fault in order for the injured employee to seek medical care.
(b) Injured workers continue to receive their full wages as long as they are unable to work.
(c) Workers’ compensation programs are designed and administered by each individual state.
(d) Workers’ compensation is primarily financed by federal and state funds.

Answer: (c)
Commentary: Workers’ compensation provides benefits to workers who are injured on the job or
have a work-related illness, regardless of who is at fault for the injury or illness. Benefits include
medical treatment for work-related conditions and cash payments that partially replace lost
wages. In the event that symptoms do not completely resolve, financial compensation is also
provided. In exchange, an injured worker gives up the right to sue the employer because of a
work-related injury or illness. Workers’ compensation programs are designed and administered
by each state, and programs and policies vary from state to state. Workers’ compensation is
financed almost exclusively by employers, not federal or state funds

2011

38

A 42-year-old car mechanic with a 3-week history of low back pain and lower limb pain after lifting equipment at work is referred to you for management. He has been taking ibuprofen 800mg 4 times daily without improvement. He is unable to flex through the lumbar spine or sit without pain. Your recommendations to his employer regarding work include
(a) modified duty to allow no repetitive twisting or bending and no push/pull heavier than 20 lbs.
(b) return to sedentary work 8 hours daily for 1 week, and no push/pull heavier than 10 lbs.
(c) light duty to include no pushing/pulling, or lifting more than 25 lbs for 1 month.
(d) remain off work until lumbar flexion, sitting, and lifting are no longer painful

(a) Returning the employee to modified duty that fits the impairment and avoids provocative activities is important from several aspects. One, behavioral management with the employee allows early goals to be set, so that the employee can work with restrictions. It also establishes that simply being off work until pain free is not always a logical goal. Second, the employer can fully understand the employee’s capabilities during recovery. This management approach hones in on the employer to comply with the restrictions. Third, starting with reasonable restrictions allows the physician to guide the employee back to the work place by making adjustments as the worker’s rehabilitation progresses

2007

39

A 55-year-old paramedic is under your care for a work-related shoulder injury. She has completed physical therapy, no longer requires pain medications, and wants to return to work. She does not have full shoulder abduction and has some pain with overhead activities. Ideally, you recommend
(a) return to work without restrictions.
(b) work conditioning for 4 weeks.
(c) a week of work hardening.
(d) functional capacity evaluation

(d) The paramedic has a high demand job. A functional capacity evaluation would best determine the employee’s ability to return to her job. If deficits are noted, work hardening over a period of weeks will best ensure return to work. Work hardening for 1 week may not be sufficient. Work conditioning enhances aerobic fitness and conditioning but is not job specific. The paramedic is at high risk for recurrent injury. Returning the employee to work without testing the her ability to perform her job duties may precipitate premature return and reinjury

2007

40

Under the prospective payment system for inpatient rehabilitation facilities, which item is used in assigning a patient to a case-mix group?
(a) Mini Mental Status Examination
(b) Disability Rating Scale
(c) Previous hospitalization
(d) FIM instrument motor score

(d) The prospective payment system for inpatient rehabilitation facilities requires that all patients admitted for inpatient rehabilitation be assigned to an impairment group code category. Payment to the rehabilitation facility is further determined by the patient’s subclassification into a case-mix group. The FIM instrument motor score is used to help determine the case-mix group designation under the prospective payment system for inpatient rehabilitation facilities. None of the other options listed are used in this process

2007

41

The interdisciplinary approach to patient care emphasizes
(a) common patient and team goals.
(b) discipline-specific goals.
(c) concentration on specific clinical problems.
(d) treatment by multiple team members.

(a) The interdisciplinary approach to patient care emphasizes common patient and team goals rather than discipline-specific goals. The patient and family members should be included in the goal setting process. All team members must work in a collaborative way to facilitate achievement of goals. Team members must have an appreciation for all the issues that affect the patient rather than focusing on an isolated problem. Team communication is essential at all points in the rehabilitation process, not just when problems occur.

2007

42

A case manager comes to your office accompanying the injured worker you are managing. The front desk person asks if you will see the case manager with the patient. You respond that
(a) case managers inhibit patient care and you don’t wish to speak with them.
(b) as requested by the patient you will see the case manager following the interview and examination.
(c) you will speak with the case manager after the patient signs a release of information.
(d) the case manager should always be present at the time of the patient’s interview and examination despite the patient’s request to avoid the case manager.

(b) Case managers are shown to be beneficial liaisons between the physician and workers compensation carrier and their presence facilitates patient care. To be treated as a workers compensation case, the patient must give the carrier full access to his/her medical record. The employee treated under workers compensation cannot restrict the access of the case manager to the physician; however, discussions with the case manger should be done in the environment that the patient requests

2007

43

The purpose of the Health Insurance Portability and Accountability Act (HIPAA) is to
(a) ensure that a patient’s medical record is available to health care providers as directed by the patient.
(b) allow qualified physicians access to the patient’s medical record.
(c) allow a lawyer access to a medical record only if litigation is pending.
(d) prohibit the release of confidential health information to insurance carriers

(a) The purpose of the Health Insurance Portability and Accountability Act (HIPAA) is to ensure that a patient’s medical record remains private, but is available to health care providers as directed by the patient. A non-treating physician, lawyer, or insurance company may have access to the record with written authorization by the patient or guardian. There are no stipulations about a physician’s qualifications with regards to medical information access.

2007

44

In order to appropriately follow Medicare regulations for teaching physicians, when caring for a patient with a resident physician, the attending physician must
(a) review the chart and personally document his/her level of involvement in patient care, separate from documentation performed by the resident.
(b) examine the patient with the resident and co-sign the resident note.
(c) examine the patient and review the resident’s medical record documentation.
(d) examine the patient, review the resident’s documentation, and personally document involvement in the history, exam, and medical decision-making.

(d) In order to appropriately follow Medicare regulations for teaching physicians, when caring for a patient with a resident physician, the attending physician must see the patient, review the medical record documentation of the resident, and personally document involvement in key aspects of the history, exam, and medical decision-making. Documentation from the resident alone does not confirm the level of attending physician involvement. The attending physician documentation combined with the resident documentation can be used to determine the level of care provided and the appropriate level of billing.

2007

45

Professionalism is the basis of medicine’s contract with society. Which item is a fundamental principle of medical professionalism?
(a) Social justice
(b) Physician paternalism
(c) Patient disclosure
(d) Free enterprise

(a) According to the Charter on Medical Professionalism, there are 3 fundamental principles of medical professionalism. They are (1) the primacy of patient welfare, (2) patient autonomy, and (3) social justice

2007

46

Preventable medical errors are
(a) rarely associated with significant morbidity.
(b) most commonly a result of individual human error.
(c) associated with no impact on patient satisfaction.
(d) associated with patients’ loss of trust in the health care system.

(d) Preventable medical errors can result in lower levels of patient satisfaction and loss of trust in the health care system. Preventable medical errors often result in significant morbidity and even mortality. Estimates are that 44,000 to 98,000 people die each year as a result of medical errors that could have been prevented. These errors are frequently the result of system type errors rather than individual human error

2007

47

Practice-based learning and improvement is considered by the Accreditation Council of Graduate Medical Education (ACGME) to be an aspect of medical practice in which all physicians need to achieve and maintain competency. Which characteristic is NOT a key aspect of practice-based learning and improvement?
(a) The ability to locate, appraise, and assimilate evidence from scientific studies related to their clinical practice
(b) The ability to access and use information technology to support their own education
(c) The ability to apply knowledge of study designs and statistical methods to the appraisal of medical literature
(d) The ability to advocate for quality patient care and assist patients in dealing with system complexities

(d) All of the options listed are key aspects of practice-based learning and improvement, with the exception of the ability to advocate for quality patient care and assist patients in dealing with system complexities. This statement is a key aspect of systems-based practice as defined by the Accreditation Council of Graduate Medical Education

2007

48

The Commission on Accreditation of Rehabilitation Facilities (CARF)
(a) requires mandatory surveys of all inpatient rehabilitation facilities.
(b) provides accreditation status that confers a preferred status with payors.
(c) provides accreditation status that signifies the rehabilitation facility holds itself to the highest standards in the field.
(d) provides accreditation for comprehensive inpatient rehabilitation programs, but not specialty programs in areas such as spinal cord injury.

(c) The Commission on Accreditation of Rehabilitation Facilities (CARF) provides accreditation status that signifies the rehabilitation facility holds itself to the highest standards in the field. CARF accreditation is voluntary and not all inpatient rehabilitation facilities participate. Accreditation by CARF does not confer any preferred status with payors, and CARF provides accreditation in general comprehensive inpatient rehabilitation as well as specialty programs such as spinal cord injury and traumatic brain injury.

2007

49

Which statement is TRUE regarding the way the Centers for Medicare and Medicaid Services
currently reimburses inpatient rehabilitation facilities (IRFs) based on a prospective payment system
(PPS)?
(a) Reimbursement is determined according to the patient’s severity of disability and his/her
required use of resources.
(b) Assignment of patients to a specific rehabilitation impairment category (RIC) is based
primarily on their medical co-morbidities.
(c) Early transfer of patients from an IRF to a skilled nursing facility does not affect
reimbursement to the IRF.
(d) Assignment of patients to specific case-mix groups (CMGs) is determined by the rehabilitation
diagnosis and the patient’s premorbid functional status.

(a) The Center for Medicare and Medicaid Services currently reimburses inpatient rehabilitation
facilities (IRF) based on a prospective payment system (PPS) according to the patient’s severity of
disability and his/her required use of resources. The rehabilitation impairment category is based on
the primary rehabilitation diagnosis, and the case-mix group is determined in part by the patient’s
co-morbid medical conditions.

2006

50

Medical error reporting systems are designed to
(a) ensure that patients and families are notified when a medical error has occurred.
(b) assist patients and families in reporting activities that they perceive as an error.
(c) discipline staff who report that an error has occurred.
(d) encourage staff to report errors without fear of punishment

(d) Medical error reporting systems are designed to encourage staff to report sentinel events, adverse
events, and close calls without fear of punishment. If these issues are recognized, then further review and action can be initiated. Review may include a root cause analysis to determine the exact cause of the problem and strategies for prevention. When a medical error has occurred, staff are encouraged to recognize the issue and report the issue immediately

2006

51

You are managing the care of an injured worker with a working diagnosis of C6 radiculopathy. Your
assistant informs you that the case manager is in the room with the patient. You next ask the
(a) case manager to leave, because case managers represent only the interest of the company.
(b) worker if he prefers to have the case manager present throughout the exam.
(c) worker if he prefers you recommend to the case manager that he be placed in a new job.
(d) case manager to show evidence that the worker is malingering

(b) Case managers work as medical liaisons between the company and medical care team to facilitate
communication of and approval for diagnostic tests and treatment. They have been shown to improve timeliness of care. It is important to ask the patient’s preference regarding the case manager’s presence and to ensure patient confidentiality. The physician is to determine if the patient can return to work based on objective and subjective evidence. It is not the case manager’s job to provide the treating physician with evidence regarding validity of the worker’s condition

2006

52

You are admitting a 48-year-old woman to your rehabilitation unit following a subarachnoid
hemorrhage. She is married and has 2 teenage children. She has severe memory and cognitive
impairments. She is unable to provide consent. To whom can you legally give information
regarding the patient’s medical condition?
(a) Anyone authorized by the attending physician
(b) Anyone who identifies themselves as direct family members
(c) Anyone authorized by the patient’s husband
(d) Anyone who is available for caregiver training

(c) The husband is the patient’s legal next-of-kin. Because the patient is unable to provide consent for
medical decision making, the husband is the primary contact person and has the medical power of
attorney for medical decision making. The husband would have to consent to allow other
individuals to receive medical information regarding the patient

2006

53

Which condition is a proven barrier for the injured worker to return to a modified work position?
(a) The employee has no incentive to return to modified work.
(b) Employee and employer cannot agree on the job assigned.
(c) The employee’s education does not match work requirements.
(d) The employer must pay a fee to the carrier to implement modified work.

(c) Return-to-work barriers proven to date include the following: lack of knowledge regarding
modified work, negative attitudes of employees, difficulty changing the work tasks and
organization of the work, and a mismatch between the employee’s education level and the requirements of the modified job

2006

54

Which action is NOT required of a certified physiatrist to maintain certification?
(a) Obtain continuing medical education credits.
(b) Maintain active medical license.
(c) Complete a recertification examination every 10 years.
(d) Publish at least 1 article in a scientific journal every 10 years

(d) Once a physician is certified by the American Board of Physical Medicine and Rehabilitation, he or
she must continue to fulfill certain requirements in order to maintain certification status.
Publication of an article in a peer-reviewed journal every 10 years is not a requirement for
maintenance of certification. All the other options listed are required

2006

55

Decision-making capacity is a requirement for providing informed consent and participating in
treatment decisions. Of the abilities listed, which one is NOT considered central to an individual’s
decision-making capacity?
(a) Ability to express a choice, either verbally or nonverbally
(b) Ability to understand specific information related to treatment decisions
(c) Ability to seek advice from other health care providers
(d) Ability to appreciate of the significance of information as it applies to their condition

(c) Central to determining an individual's decision-making capacity are the individual's ability toexpress a choice, his/her ability to understand specific information related to treatment decisions,
and his/her ability to appreciate the significance of information as it applies to their condition and
circumstances. The individual's ability to seek advice from other health care providers is not a
central part of the individual's decision-making capacity

2006

56

As the medical director of an inpatient rehabilitation program, you become concerned because you
have recently noticed an increased number of urinary tract infections in the patients on your service.
Which action would NOT be considered a reasonable initial management strategy?
(a) Discuss the issue with the rehabilitation center’s Quality Improvement Committee and
examine the rate of urinary tract infections over the past year.
(b) Perform a literature review examining the incidence and prevalence of urinary tract infections
in an inpatient rehabilitation setting.
(c) Immediately order that a urine culture be obtained on every patient at the time of admission to
the rehabilitation service.
(d) Provide an educational inservice to the nursing staff regarding catheter and bladder
management

(c) Continuous quality improvement should be a part of each physician's clinical practice. All the options listed would be appropriate to consider with the exception of immediately ordering a urine culture on every patient at the time of admission to the rehabilitation service. This would not be an appropriate option without gathering more information and understanding the implications of this
intervention strategy.

2006

57

The Commission on Accreditation of Rehabilitation Facilities (CARF) defines program evaluation as
a
(a) systematic procedure for measuring the outcomes of care.
(b) method for preventing medical complications.
(c) routine means of building team relations.
(d) procedure to develop new programs for rehabilitation

(a) The Commission on Accreditation of Rehabilitation Facilities (CARF) defines program evaluation
as a systematic procedure for measuring the outcomes of care. Program evaluation is a way to measure the effectiveness and efficiency of rehabilitation services. The other options listed are not
the primary focus of program evaluation.

2006

58

In terms of continuous quality improvement, a sentinel event is defined as
(a) a benchmark event that sets the standard for patient care.
(b) an occurrence that requires dismissal of personnel.
(c) a single occurrence that is highly problematic or socially unacceptable.
(d) an event that results in the opening of a new hospital program.

(c) In terms of continuous quality improvement, a sentinel event is defined as a single occurrence that
is highly problematic or socially unacceptable. Sentinel events will typically trigger an in-depth
root cause analysis to determine the cause of the event as well as potential solutions. The focus of
these investigations is to evaluate the processes and systems that are in place, rather than to focus
blame on individual practitioners

2006

59

What effect did the Omnibus Budget Reconciliation Act of 1993 (Stark II legislation) have on
medical practice?
(a) It made referrals to medical specialists more profitable for primary care physicians.
(b) It legalized referrals to a physician-owned physical therapy practice, so long as the physician
owns less than 50% of the practice.
(c) It made illegal physician self-referral to physical therapy, durable medical equipment
suppliers, and certain other entities owned by the physician except for certain safe harbors.
(d) It made illegal physician referral to another physician for specialty care, if the physicians are in
the same practice.

(c) The Omnibus Budget Reconciliation Act of 1993 (Stark II legislation) made physician self-referral
to physical therapy, durable medical equipment suppliers, and certain other entities owned by the
physician illegal, except for certain safe harbors.

2006

60

You have been asked to evaluate a 60-year-old man who sustained a left internal capsule ischemic stroke 3 days ago. He is currently hospitalized, and he has been deemed by his primary care provider to be medically stable for transfer to an inpatient rehabilitation program. The patient has a
right hemiparesis and dysarthria. On your assessment, cognition appears intact. You agree that the patient is an appropriate candidate for admission. You discuss the benefits of inpatient rehabilitation with the patient and his family, but the patient elects to go home with home health services instead of
being admitted for inpatient rehabilitation. The ethical principle followed in abiding by the patient’s
wishes is the principle of
(a) beneficence.
(b) autonomy.
(c) paternalism.
(d) social justice.

(b) The ethical principle in this case, where the physician concedes to the patient’s desires and decisions, is the principle of patient autonomy. The principle of beneficence refers to a moral obligation to help other people and refrain from harming them, while the principle of autonomy
involves respect for the values and beliefs of other people. There is often tension between these 2 principles when patients refuse to accept information and advice from their health care providers. With a paternalistic approach, the physician or other health care provider is the decision maker and the patient takes on a more passive role of accepting the decision of the health care provider. Social justice involves the provision, rationing, and distribution of health care resources

2006