Ch 40 Introduction to Health Care Law and Ethics

During fiscal year 2014, by catching submitted fraudulent claims, how much money was won or negotiated by the federal government? Multiple choice question. $523 million $1.9 billion $27.8 billion $2.3 billion

$2.3 billion

Which of the following is created by judicial decisions made during court trials? Multiple choice question. Common law Administrative law Statutes Executive orders

Common law

Select all that apply Which organizations recommend health care facilities to have a compliance program? Multiple select question. IRS DHHS CMS OIG

DHHS OIG

The Health Care Fraud and Abuse Control Program was created by: Multiple Choice DHHS. PHI. OIG. HIPAA.

HIPAA

Laws that are enacted by federal and state legislature is called ______ laws. Multiple choice question. statutory executive administrative common

Statuatory

Driving under the influence is considered _____. Multiple choice question. a civil crime a felony legal a misdemeanor

a misdemeanor

The term disclosure per HIPAA's Privacy Rule refers to the exchange of information between health care personnel Multiple Choice and the patient. in the same office. and family members. and health care personnel in other covered entities

and health care personnel in other covered entities

The intent of HIPAA's Privacy Rule is to Multiple Choice not interfere with the flow of information necessary for care. restrict health care professionals from doing their jobs. protect an individual's privacy and not interfere with the flow of information necessary for care. protect an individual's privacy.

protect an individual's privacy and not interfere with the flow of information necessary for care

When asked why you will not release patient information, one should ask nicely for the individual's ______. Multiple choice question. patience understanding privacy confidentiality

understanding

Medicare's CCI investigates claims that include Multiple Choice unbundling. the improper use of mutually exclusive codes. unacceptable reporting of CPT codes. All of these.

All of these

Which of the following statements is true? Multiple choice question. A coder only sees a patient's current diagnosis. A coder can discuss a friend's condition with coworkers. A coder sees patients' past and present health history. A coder only sees the physician's notes in the patent's medical record.

A coder sees patients' past and present health history

The two premier trade organizations for professional coding specialist are: Multiple Choice HIPAA and AAPC. OIG and AHIMA. AHIMA and AAPC. CMS and AHIMA.

AHIMA and AAPC

Laws that are created and monitored by administrative agencies are called ______ laws. Multiple choice question. administrative executive statutory common

Administrative

Select all that apply Who is responsible for ensuring that a facility or provider complies with the False Claims Act? Multiple select question. Billing clerk Coder Compliance officer Patient

Billing clerk Coder Compliance officer

Who mandates the reporting of infectious diseases?

CDC

Select all that apply Which of the following would allow for disclosure of PHI to the public without patient permission? Multiple select question. Experimental procedures Child abuse Communicable disease Domestic violence

Child abuse Communicable disease Domestic violence

Select all that apply Which of the following statements are true regarding compliance programs? Multiple select question. Compliance programs discourage fraud, waste, and abuse. Legal council should be consulted before corrective action is taken when fraud and abuse occurs. Compliance programs should have internal policies and audits to discover fraudulent activities. Compliance programs should create a culture of honesty and adherence with the laws.

Compliance programs discourage fraud, waste, and abuse. Compliance programs should have internal policies and audits to discover fraudulent activities. Compliance programs should create a culture of honesty and adherence with the laws.

If you discover that your PHI has been misused or disclosed without your permission, you can file a compliant with ______. Multiple choice question. Federal Register OIG CMS DHHS

DHHS

The regulation that went into effect January 1, 2007, which mandated a compliance program for all health care organizations receiving $5 million or more a year from Medicaid is the _________. Multiple choice question. False Claims Act Deficit Reduction Act Health Insurance Portability and Accountability Act Patient Protection and Affordable Care Act

Deficit Reduction Act

DHHS stands for Multiple Choice Department of Health and Human Services. Department of Home and Health Services. District of Health and HIPAA Systems. Division of Health and Health Care Sciences.

Department of Health and Human Services

The daily journal of the U.S. federal government is called the ______. Multiple choice question. Federal Plan Working Papers Federal Register Bill of Rights

Federal Register

What is the highest law in the United States? Multiple choice question. Federal law State law City law Local law

Federal law

Which of the following is the hierarchy of law in the United States? Multiple choice question. Federal laws, state laws, local laws Local laws, state laws, federal laws State laws, federal laws, local laws Federal laws, local laws, state laws

Federal laws, state laws, local laws

Select all that apply Which of the following are types of infractions for criminal activity? Multiple select question. Violation Misdemeanors Conspiracy Felonies

Misdemeanors Felonies

Select all that apply Which of the following allows for depersonalized PHI to be released without patient consent? Multiple select question. Neglect Research Child abuse Public health statistics

Research Public Health Statistics

Which of the following terms refers to the sharing of information between individuals working for the same entity? Multiple choice question. Use Disclosure Privacy Relevance

Use

Knowing for a fact that the information is false is referred to as Multiple Choice disregard for the truth. willful ignorance. education. actual knowledge.

actual knowledge

CMS updates its National Correct Coding Initiative Coding Policy Manual for Medicare Services Multiple Choice monthly. quarterly. semi-annually. annually.

annually

To lessen fines and penalties from the OIG, it's best to uncover and correct coding and billing errors Multiple choice question. before auditors show up. after auditors show up. at the request of the OIG. during an OIG audit.

before auditors show up

Upcoding is an illegal practice in which coders Multiple Choice bill for services with no documentation. bill for services never provided. bill using several individual codes instead of one combination code. bill using a code for a higher level of service than what was actually provided.

bill using a code for a higher level of service than what was actually provided.

According to the AAPC Code of Ethical Standards, AAPC members shall pursue excellence through Multiple choice question. recruitment of AAPC members. continuing education applicable to profession. maintenance of AAPC membership. job advancement to coding director.

continuing education applicable to profession

You must code all conditions and complications that are relevant to the _____ encounter(s). Multiple choice question. previous current past 6 past 3

current

The False Claims Act's specific definition of claim states, "a _____ for money or property made directly to the Federal Government or to a contractor, grantee, or other recipient." Multiple choice question. demand bill call request

demand

When refusing to release information, it is best practice to ______. Multiple choice question. respond that it is standard office policy contact HIPAA to report an unauthorized request educate the individual why you cannot share the information take your time in responding to the individual

educate the individual why you cannot share the information

The term use per HIPAA's Privacy Rule refers to the exchange of information between health care personnel Multiple Choice in the same office. and health care personnel in other health care facilities. and the pharmacist. and family members.

in the same office

Federal False Claims Act governs punishment of anyone who knows, or should know, that there is _________________ information on any claim presented to the federal agency. Multiple Choice inaccurate accurate exact precise

inaccurate

The purpose of the Federal Register is to Multiple select question. inform citizens of their rights and obligations. provide a forum for public participation in the democratic process. inform healthcare providers of upcoming coding audits. document the actions of federal agencies.

inform citizens of their rights and obligations. provide a forum for public participation in the democratic process. document the actions of federal agencies.

Select all that apply Failure to adhere to the AAPC Code of Ethical Standards will result in _____. Multiple select question. loss of membership legal action loss of job loss of credentials

loss of membership loss of credentials

The official policies issued by the president of the United States is called executive ______. Multiple choice question. orders summons privilege laws

orders

One part of HIPAA is known as the Privacy Rule. This rule was written to Multiple choice question. protect patients' privacy while still allowing flow of information for treatment. protect patients' privacy by requiring their permission before information is shared for treatment. protect providers from lawsuits. allow patients access to their medical records.

protect patients' privacy while still allowing flow of information for treatment.

The Federal Sentencing Guidelines Manual provides a ___________ list of the components of an effective compliance program. Multiple Choice four-step five-step six-step seven-step

seven-step

Under HIPAA's Privacy Rule, which individuals have access to the patient record without the need for patient permission? Multiple select question. Coder Security Therapist Janitor

Coder Therapist

Select all that apply Which of the following must Notices of Privacy contain? Multiple select question. Hospital HIM Director contact information Full description of how the covered entity discloses PHI Statement about the hospital's responsibility to protect patient privacy Contact information for DHHS

Full description of how the covered entity discloses PHI Statement about the hospital's responsibility to protect patient privacy Contact information for DHHS

Congress included specifications for both civil and criminal penalties to be applied against any covered entity that fails to protect its patients' PHI. Those penalties include fines up to _______ and up to ____ in prison. Multiple choice question. $1 million; 25 years $500,000; 15 years $100,000; 5 years $250,000; 10 years

$250,000; 10 years

The government rewards the person(s) reporting fraud with a percentage of the total amount recovered by the federal or state government as a result of a qui tam lawsuit. This reward can be _____. Multiple choice question. 15% to 30% 5% to 10% 25% to 50% 30% to 60%

15% to 30%

There are ______ premier trade organizations for professional coding specialists. Each has published a code of ethics to guide members of our industry on the best professional way to conduct themselves. Multiple Choice 1 2 3 4

2

Select all that apply Which of the following statements are part of the AHIMA Standards of Ethical Coding? Multiple select question. A coding professional should maintain confidentiality of PHI. A coding professional should apply accurate, complete, and consistent coding. A coding professional should query the provider for clarification and additional documentation when needed. A coding professional should change reported billing data to receive the highest reimbursement, regardless of physician documentation.

A coding professional should maintain confidentiality of PHI. A coding professional should apply accurate, complete, and consistent coding. A coding professional should query the provider for clarification and additional documentation when needed.

Which term refers to the process of coding diagnoses and procedures not based on the accuracy of the code, but instead based on what the insurance company will pay for? Multiple choice question. Patient-centered coding Upcoding Unbundling Coding for coverage

Coding for coverage

Select all that apply Which of the following statements are true regarding coding for coverage? Multiple select question. Coding for coverage means choosing codes based on what the insurance company will pay for. Coding for coverage does not allow patients to get treatment they need paid for by the insurance company. Coding for coverage is dishonest. Coding for coverage is considered fraud.

Coding for coverage means choosing codes based on what the insurance company will pay for. Coding for coverage is dishonest. Coding for coverage is considered fraud.

Select all that apply According to the AHIMA Standards of Ethical Coding, what should a coding professional do? Multiple select question. Collaborate with healthcare professionals in the pursuit of accurate, complete, and reliable coded data Participate in development of coding-related technology that is not designed in accordance with requirements Demonstrate behavior that reflects integrity Assign and report only codes that are clearly and consistently supported by the medical record documentation

Collaborate with healthcare professionals in the pursuit of accurate, complete, and reliable coded data Demonstrate behavior that reflects integrity Assign and report only codes that are clearly and consistently supported by the medical record documentation

Which of the following terms refers to the sharing of information with another physician at a different hospital? Multiple choice question. Sharing Privacy Disclosure Use

Disclosure

If additional services provided come to light AFTER the claim has already been filed, you must Multiple choice question. file an amended claim. write off the service charge. refile the same claim. file a new claim.

File an amended claim

Select all that apply In regards to federal statutes, which of the following statements are true? Multiple select question. HIPAA is an example of a federal law that provides flexibility for state law to be more exact. House and Senate vote on the law to "enact." State and local laws take precedence over federal statutes. Members of Congress are responsible for writing the law.

HIPAA is an example of a federal law that provides flexibility for state law to be more exact. House and Senate vote on the law to "enact." Members of Congress are responsible for writing the law.

Select all that apply Who is responsible for obeying the HIPAA Privacy Rule? Multiple select question. Health care clearinghouse Physician's office Insurance carrier Patient Dental office

Health care clearinghouse Physician's office Insurance carrier Dental office

Select all that apply Covered entities are divided into which of the following categories? Multiple select question. Health plans Health care clearinghouses Health care providers Business associates

Health plans Health care clearinghouses Health care providers

Select all that apply Which of the following are true regarding a Release of Information form? Multiple select question. Identifies organization that will be disclosing information Does not allow for retraction of authorization Contains an expiration date Written in plain language

Identifies organization that will be disclosing information Contains an expiration date Written in plain language

Which of the following is true of the FCA? Multiple choice question. Was enacted by President Bush Makes submission of all insurance claims easier Makes submission of a fraudulent claim to a federal agency illegal Makes submission of Medicare claims easier

Makes submission of a fraudulent claim to a federal agency illegal

HIPAA instructs all covered entities to create policies and procedures in regards to the use and disclosure of PHI is called ______ Multiple choice question. Notices of Privacy Compliance Plan Privacy Plan Federal Registry

Notices of Privacy

A formal compliance program has been strongly recommended by the _______ of the HHS to help all healthcare facilities establish their organizations' respect for the laws and their agreement to follow the direction from those laws. Multiple Choice CPT OIG OCR CCI

OIG

When is the OIG workplan released each year? Multiple choice question. December 31st January 1st October 1st June 15th

October 1st

Which of the following are required characteristics of a Release of Information form? Multiple select question. Specifically identifies person receiving information Written in legal language Has a definite expiration date Very specific to exactly what is to be released

Specifically identifies person receiving information Has a definite expiration date Very specific to exactly what is to be released

Codes indicated on the health claim form must represent the Multiple select question. supporting documentation. services actually performed. service with the most reimbursement. diagnoses used on previous claims.

Supporting documentation Services actually performed

Under what condition(s) might a patient request for information be denied? Multiple choice question. Patients are always granted access to their own PHI When medical records are closed When it relates to treatment, payment, or operations When there is doubt the patient can deal with the medical fact

When there is doubt the patient can deal with the medical fact

Select all that apply Which of the following empowers private citizens to file a lawsuit on behalf of the federal or state government against a facility for noncompliance? Multiple select question. Whistleblower Statute False Claims Act Health Information Portability and Accountability Act Qui tam provision

Whistleblower Statute Qui tam provision

Which of the following statements is true? Multiple choice question. Verbal permission to release PHI is always best. It's easier to ask for written permission to release PHI. It doesn't matter if the patient gives verbal or written permission to release PHI. Written permission to release PHI is in your best interest.

Written permission to release PHI is in your best interest.

Protected health information (PHI) is Multiple Choice a listing of diagnosis codes. current procedural terminology. any health information that can be connected to a specific individual. covered entity employee files.

any health information that can be connected to a specific individual.

Unbundling is an illegal practice in which coders Multiple Choice bill using several individual codes instead of one combination code. bill using a code for a higher level of service than what was actually provided. bill for services with no documentation. bill for services never provided.

bill using several individual codes instead of one combination code

As coders, we are obligated to abide by the Codes of Ethics, put forth for members of Multiple Choice AHIMA. AAPC. both AHIMA and AAPC. Neither of these.

both AHIMA and AAPCA

An individual who files a false claim can be charged for violations by Multiple Choice federal law. Filing a false claim is not a violation of law. state law. both federal and state law.

both federal and state law

According to the federal sentencing guidelines manual, all of the following are components of the seven steps to due diligence for an effective compliance program except Multiple Choice cease disciplinary sanctions. assign overall responsibility to specific high-level individual(s). establish compliance standards and procedures. utilize monitoring and auditing system to detect noncompliant conduct.

cease disciplinary sanctions

Laws that govern the relationships between people and between businesses is known as ______ law. Multiple choice question. administrative criminal common civil

civil

Violation of a patient's confidentiality is prohibited by what? Multiple choice question. Criminal law Civil law Common law Administrative law

civil law

A demand for money or property made directly to the Federal Government is known as a(n) _____. Multiple choice question. liability acquisition claim requisition

claim

Changing a code from one that is most accurate to one you know the insurance company will pay for is called Multiple Choice unbundling coding for packaging. coding for coverage. double billing.

coding for coverage

Select all that apply The Health Care Fraud and Abuse Control Program is under the direction of _____. Multiple select question. federal and state law enforcement the secretary of the DHHS the Office of Inspector General the attorney general

the secretary of DHHS the attourney general

If you resubmit a claim that has been lost, identify it as a(n) _____ to avoid double billing. Multiple select question. tracer new second submission unbundled claim

tracer second submission

According to HIPAA's rules and regulations, a covered entity's workforce includes Multiple Choice volunteers, trainees, and employees, part time and full time. business associates' employees. only paid, full-time employees. only licensed personnel working in the office.

volunteers, trainees, and employees, part time and full time.

If you should know, due to your job position, training, or responsibilities but purposely ignore the falsity of information, this is called Multiple Choice disregard for the truth. willful ignorance. Correct education. actual knowledge.

willful ignorance

Which of the following is also referred to as deliberate ignorance? Multiple choice question. Willful ignorance Actual knowledge Disregard Qui tam provision

willful ignorance

As a coder, you should not use a code on a claim form Multiple choice question. without ensuring the nurse has informed the patient. without ensuring the supporting documentation is present. without verifying with the patient. without confirming test results.

without ensuring the supporting documentation is present