Compliance Prof

Medicare overpayments must be returned to the Medicare program within days of discovery. Answer Choices A. 30 B. 90 C. 60 D. 365

C. 60

In order to bill for a surgical procedure, the teaching physician must.... Answer Choices A. be physically present for the entire procedure B. be physically present for all critical or key components of the procedure C. be immediately available for the entire procedure D. A and B E. B and C

E. B and C

Select the best answer: There are many types of payments that are reported as Open Payments. Which of these types of Open Payments is a consulting fee?

Payments made for advice about a medical product or treatment.

Select the best answer: A person of a different nationality is looking for medical help for their child. What do they need to say at a medical facility in order to get help?

They need to say that their child is sick and needs help.

The Anti-Kickback Statute has multiple safe harbors that protect certain types of arrangements. In order to be afforded legal protection under the safe harbor, the arrangement must

precisely and fully meet the applicable safe harbor

Select the best answer: A young child and an older adult need medical attention at a facility. Who should be given medical attention first?

the one whose medical needs are more urgent

For most Stark exception to apply, there are three key points that should be considered. They are... Answer Choices A. the agreement must be in writing B. medical staff membership C. any compensation must be consistent with fair market value D. there must be no consideration for the value or volume of referrals

A, C, D

Which of the following do third-party payers consider to be a documentation failure? Answer Choices A. Fill-in-the-blank documentation that does not reflect the individual patient's circumstances B. Sufficient or adequate documentation that supports a claim C. Documentation that includes who provided the service and when D. A and B

A. Fill-in-the-blank documentation that does not reflect the individual patient's circumstances

CMS does not allow physicians to order observation services until..... Answer Choices A. the physician has seen and evaluated the patient B. the patient has had an initial medical screening as required by EMTALA C. the patient has agreed to being placed in observation D. CMS has no prerequisites for ordering observation services

A. the physician has seen and evaluated the patient

To which government agency should a potential Stark violation be disclosed? Answer Choices A. OIG B. CMS C. DOJ

B. CMS

Which of the following represents potential fraud? Answer Choices A. Billing for services on the same day as rendered B. Misrepresenting a service or product rendered or provided C. Billing for Non-Physician Providers D. All of these

B. Misrepresenting a service or product rendered or provided

What is the primary purpose of documentation? Answer Choices A. To support claims billed B. To support the provision of high quality patient care C. To prevent claims denials D. None of the above

B. To support the provision of high quality patient care

Agreements must NOT..... Answer Choices A. set the aggregate compensation or include the value of any remuneration B. include compensation that exceeds fair market value or vary compensation based on the volume or value of referrals C. limit the services to be provided or define what is required D. fail to include documented legal review or approval

B. include compensation that exceeds fair market value or vary compensation based on the volume or value of referrals

Physical presence means the teaching physician..... Answer Choices A. is in the same facility or hospital as the patient and immediately available B. is in the same room or in the same partitioned or curtained area as the patient C. is on the same floor or unit as the patient and immediately available D. is on the campus of the facility and available

B. is in the same room or in the same partitioned or curtained area as the patient

Physicians who provide care to patients while lacking the training and competency levels to do so are committing a _____ offense. Answer Choices A. misdemeanor B. civil C. criminal D. minor

C. criminal

The definition of referral is..... Answer Choices A. the directing of a patient to a particular provider B. providing a list of qualified practitioners from which the patient chooses to receive care C. the acceptance of payment from another provider in return for directing patients to them for care D. anytime a physician does something that directs a patient to a provider or allows the patient to receive care or continue receiving care from that provider

D. anytime a physician does something that directs a patient to a provider or allows the patient to receive care or continue receiving care from that provider

Two exceptions allowable under Stark are.... Answer Choices A. physician recruitment arrangements B. continued medical education agreements C. office space and equipment rental agreements D. A and B E. A and C

E. A and C

Select the best answer: A healthcare provider wants to know if payments made to them count as Open Payments. To which of these listed roles does the Open Payments Program apply?

Nurse practitioners

True or False: Parties on both sides of a kickback arrangement are liable under the Anti-Kickback Statute.

True

According to the Affordable Care Act, repayment of overpayments must be made within ______ days.

60

Select the best answer: Which of these is an example of a payment that is reported for the Open Payments program?

A drug manufacturer pays a doctor for spending time on a drug research project.

A review of systems (ROS) inquires about the system(s).... Answer Choices A. directly related to the patient's symptoms B. identified in the history and physical and a limited number of additional systems C. directly related to the problem(s) identified in the HPI plus all additional body systems D. All of the above

A. directly related to the patient's symptoms

What does the term financial relationship include as defined in the Stark regulation? Answer Choices A. Neither direct nor indirect referring physician ownership or investment interest in an entity furnishing designated health services B. Direct or indirect compensation arrangements between a referring physician (or an immediate family member) and an entity furnishing designated health services C. Only direct referring physician ownership or investment interest in an entity furnishing designated health services D. Only direct compensation arrangements between a referring physician (or an immediate family member) and an entity furnishing designated health services

B. Direct or indirect compensation arrangements between a referring physician (or an immediate family member) and an entity furnishing designated health services

Documentation of evaluation and management services must support which of the following three key areas? Answer Choices A. Chief complaint, review of systems and family history B. Problem-focused history, problem-focused physical examination and medical decision-making C. Number of diagnoses, risk of complications and amount of data to review D. Description of symptoms, problems and conditions

B. Problem-focused history, problem-focused physical examination and medical decision-making

For most Stark exceptions to apply, _______ is required. Answer Choices A. an agreement, written or verbal, that is documented and verified B. a written agreement C. approval by legal counsel D. None of the above

B. a written agreement

Documentation is effective when..... Answer Choices A. it is dictated within twenty-four hours of the service performed B. it includes who provided the service, what service was provided, when the service was provided, where the service was provided and why the service was provided C. all consultations have been completed and documented D. all diagnostic testing has been completed and the physician has the data necessary to make a diagnosis

B. it includes who provided the service, what service was provided, when the service was provided, where the service was provided and why the service was provided

The Anti-Kickback Statute has multiple safe harbors that protect certain types of arrangements. In order to be afforded legal protection under the safe harbor, the arrangement must..... Answer Choices A. have a term of at least one year B. precisely and fully meet the applicable safe harbor C. must, at a minimum, embrace the safe harbor D. be approved by the OIG

B. precisely and fully meet the applicable safe harbor

The Stark Law primarily prohibits physicians from referring patients for designated health services to entities in which the physician or _______ has a financial interest. Answer Choices A. the physician's employee B. the physician's immediate family member C. the patient D. the hospital

B. the physician's immediate family member

Stark defines fair market value (FMV) as..... Answer Choices A. the commercial value as determined by legal counsel B. the value in an arm's-length transaction that is consistent with general market value C. the value generally accepted in a given region of the country D. what one pays or receives in transactions involving healthcare providers E. None of the above

B. the value in an arm's-length transaction that is consistent with general market value

A student is not considered a resident or intern by Medicare,..... Answer Choices A. but a teaching physician may reference a student's notes as if the student were a resident or intern B. therefore Medicare does not pay for a student's services C. but may provide billable services to patients D. but services provided by a student may be billed to Medicare if the student works independently

B. therefore Medicare does not pay for a student's services

The original intent of Stark remains. It is..... Answer Choices A. to ensure physicians do not double dip in Medicare funds B. to prevent abuse of the Medicare system by ordering unnecessary services C. to prevent the proliferation of physician-owned hospitals and other entities D. None of the above

B. to prevent abuse of the Medicare system by ordering unnecessary services

The Office of Inspector General has the authority to exclude individuals and entities from participation in the federal healthcare programs. For which offense(s) would enforcement action be taken against a provider? Answer Choices A. Failure to check the OIG's List of Excluded Individuals and Entities (LEIE) B. The provision of items or services to an excluded individual C. Hiring, contracting with or doing business in any way with an excluded person D. None of the above

C. Hiring, contracting with or doing business in any way with an excluded person

In a situation where a resident physician performs all the elements of an E/M service in the absence of the teaching physician, what must the teaching physician do in order that the service be billable? Answer Choices A. Document verification of key or critical parts of the service and reference the resident's notes to support medical necessity of the service B. Independently perform key or critical parts of the service, reference the resident's notes and verify agreement with the resident's medical decision-making C. Independently perform key or critical parts of the service, discuss with the resident, document personally performing those parts as well as participation in the management of the patient with reference to the resident's notes D. Document the resident's performance of the key or critical parts of the service and verify agreement with the resident's medical decision-making

C. Independently perform key or critical parts of the service, discuss with the resident, document personally performing those parts as well as participation in the management of the patient with reference to the resident's notes

The Anti-Kickback Statute prohibits offering or receiving anything of value or of perceived value in exchange for referrals. The statute also uses the term remuneration. What does remuneration mean under the Anti-Kickback Statute? Answer Choices A. Remuneration strictly means direct money deposits by a designated health services entity into a referring professional's bank account B. Remuneration means office space provided to a professional by a designated health services entity at fair market value without respect to referrals C. Remuneration means cash, gifts, discounts, grants, loans or anything else of value or perceived value that is not offered to others on an equitable basis D. None of the above

C. Remuneration means cash, gifts, discounts, grants, loans or anything else of value or perceived value that is not offered to others on an equitable basis

Limited professional courtesies are an exception allowed under Stark. The amount allowed for professional courtesies is determined and published annually by..... Answer Choices A. the General Accounting Office (GAO) B. the Office of Inspector General (OIG) C. the Centers for Medicare and Medicaid Services (CMS) D. the Department of Justice (DOJ)

C. the Centers for Medicare and Medicaid Services (CMS)

For certain time-based services, such as critical care, anesthesia or psychotherapy, the teaching physician must be present for..... Answer Choices A. the key portion of the service B. the beginning and the end of the service C. the total period of time for which payment is sought D. None of the above

C. the total period of time for which payment is sought

Under Stark, any agreement must NOT take into account... Answer Choices A. the bona fide business intent of the agreement B. fair market value C. the volume and/or value of referrals D. the amount of business generated

C. the volume and/or value of referrals

In order to bill for incident-to services, the service must be.... Answer Choices A. commonly rendered without charge or included in the physician's bill B. under a physician's direct supervision C. in a hospital setting D. A and B E. B and C

D. A and B

Identify the ways in which the Anti-Kickback Statute differs from the Stark Law. Answer Choices A. While the Anti-Kickback Statute applies to all federal healthcare programs, Stark Law applies to Medicare and Medicaid only B. The Stark Law applies to physicians and designated health services only, while the Anti-Kickback Statute applies to anyone and any services or items paid by the federal healthcare programs C. The basis of the Stark Law lies with inappropriate referrals based on a financial interest, while the Anti-Kickback Statute has no referral obligation D. A and B

D. A and B While the Anti-Kickback Statute applies to all federal healthcare programs, Stark Law applies to Medicare and Medicaid only. The Stark Law applies to physicians and designated health services only, while the Anti-Kickback Statute applies to anyone and any services or items paid by the federal healthcare programs.

The Medicare Inpatient-Only Procedure list..... Answer Choices A. lists those procedures that must be performed on an inpatient basis B. lists those procedures for which a higher inpatient reimbursement is available C. can assist in determining the admission status of a patient D. A and C

D. A and C

When is a patient's authorization to disclose his or her PHI NOT necessary? Answer Choices' A. For treatment, payment or healthcare operations purposes B. When disclosing for non-TPO purposes C. In other, certain situations such as law enforcement purposes or reporting to state public health authorities D. A and C only E. A and B only

D. A and C only

A financial relationship may include a direct or indirect compensation arrangement involving . Answer Choices A. a physician B. a physician's family member C. a DHS entity D. All of the above

D. All of the above

Examples of designated health services (DHS) are..... Answer Choices A. inpatient hospital services, outpatient hospital services, physical therapy and occupational therapy B. DME, prostheses and parenteral nutrition support C. radiation therapy, radiology services and speech pathology D. All of the above

D. All of the above

Under Stark regulations, government sanctions may include..... Answer Choices A. Nonpayment of claims involving violations B. Civil monetary penalties (CMPs) for knowing violations C. Exclusion from the Medicare and Medicaid programs D. All of the above

D. All of the above

Under the Anti-Kickback Statute, physicians and hospitals should be wary of their relationships with other healthcare-related businesses because..... Answer Choices A. there is potential for Anti-Kickback violations B. such relationships can cause a conflict of interest C. such relationships can influence decision-making with regard to drugs, devices and/or other items used in patient care D. All of the above

D. All of the above

9 In documenting the need for intensity of services, what questions should a physician address? Answer Choices A. Are medical necessity criteria met? B. Does treatment require an acute care setting? C. Can treatment be safely performed in an alternate, lower level of care setting? D. All the above

D. All the above

Healthcare providers and entities are advised to perform background checks prior to new hire employment or vendor contract implementation by checking . Answer Choices A. Office of Inspector General's List of Excluded Individuals and Entities B. state exclusion lists C. General Services Administration D. All the above

D. All the above

To meet an exception under Stark, there must be compliance with all conditions of the exception. However, the exception is invalid unless there is also compliance with..... Answer Choices A. state laws B. federal laws C. the Anti-Kickback Statute D. All the above

D. All the above

Violators of the Anti-Kickback Statute are subject to both civil and criminal penalties. If convicted, such penalties may include..... Answer Choices A. heavy fines and ten years in prison per violation B. exclusion from the federal healthcare programs and False Claims Act liability C. substantial civil monetary penalties, per violation D. All the above

D. All the above

With regard to safe harbors and how they differ from exceptions in the Stark Law, which of the following statements is true? Answer Choices A. A safe harbor is a payment or business practice that is not treated as an offense under the Anti-Kickback Statute B. A payment or business practice that fails to fit within a safe harbor does not necessarily violate the Anti-Kickback Statute C. Safe harbors are voluntary D. All the above E. A and C only

D. All the above

Always billing the same code for similar patient visits, tests or diagnostic conditions expose providers to which type of billing fraud? Answer Choices A. Duplicate billing B. False cost reports C. Billing for services not rendered D. Assumption billing

D. Assumption billing

Stark covers designated health services that are reimbursed by..... Answer Choices A. all federal and private insurance programs B. Medicaid C. Medicare D. B and C

D. B and C

With regard to fair market value (FMV), industry best practice suggests that you _____ in order to better withstand government scrutiny. Answer Choices A. obtain the valuation from legal counsel B. obtain a certified valuation from an expert, third party C. conduct an in-house valuation D. B and C

D. B and C

Misrepresentation is a serious form of healthcare fraud. Which form is commonly called upcoding? Answer Choices A. Misrepresentation of medical credentials B. Misrepresentation of the efficacy of a product or service C. Providing substandard health services D. Billing for the same product or service, but at a higher level than what was performed

D. Billing for the same product or service, but at a higher level than what was performed

Documentation of history consists of up to four components: history of present illness; review of systems; past, family and social history; and..... Answer Choices A. hereditary risk factors B. previous diagnoses C. associated symptoms D. chief complaint

D. chief complaint

Macros are computerized commands that generate predetermined text in the medical record that is not edited by the user. When is use of a macro in medical record documentation acceptable? Answer Choices A. When either the resident or teaching physician, but not both, employ its use B. When, in addition to the macro, documentation is customized to support medical necessity C. When both the resident and the teaching physician employ its use D. B and C E. A and B

E. A and B When either the resident or teaching physician, but not both, employ its use When, in addition to the macro, documentation is customized to support medical necessity

To avoid conflict with the Anti-Kickback Statute, agreements should be crafted to satisfy any specific requirements. These may include that the agreement. Answer Choices A. be written and have a term of at least one year B. specify bona fide services and define requirements C. be commercially reasonable D. A and C E. A, B and C

E. A, B and C

What activities are required of the teaching physician in order to bill for services in which a resident physician has participated? Answer Choices A. Be physically present during the critical or key part of the procedure or service B. Directly participate in the management of the patient C. Make sure documentation of his or her physical presence and management participation is accurate and complete in the medical record D. Be in the general vicinity of the patient and available to assist E. A, B and C

E. A, B and C Be physically present during the critical or key part of the procedure or service Directly participate in the management of the patient Make sure documentation of his or her physical presence and management participation is accurate and complete in the medical record

False Claims Act liability is implicated when a provider knew or should have known of..... Answer Choices A. the submission of a false claim for payment to the government B. causing a false claim to be submitted to the government C. falsification of a record to get a false claim paid by the government D. avoidance of an obligation to pay money due to the government E. All the above

E. All the above

For an inpatient admission, what questions involving severity of illness information should be addressed in your documentation? Answer Choices A. Is the patient expected to be hospitalized over two midnights? B. What brought the patient to the hospital? C. Does the patient's condition require an acute care setting? D. Has outpatient treatment failed for this patient? E. All the above

E. All the above

Which of the following is unacceptable documentation of a follow-up visit by teaching physicians? Answer Choices A. "Agree with above," followed by legible written or electronic countersignature or identity B. A legible written or electronic countersignature or identity alone C. "Discussed with resident. Agree," followed by legible written or electronic countersignature or identity D. "Patient seen and evaluated," followed by legible written or electronic countersignature or identity E. All the above

E. All the above

The consequences of Stark violations include..... Answer Choices A. the loss of licensure to provide patient care services B. civil monetary penalties C. False Claims Act liability D. potential exclusion from the federal healthcare programs E. B, C and D

E. B, C and D

True or False: Residents given a faculty position when participating in a fellowship program can bill Medicare as a teaching physician.

False

Fill in the blank: Section 1557 of the Affordable Care Act (ACA) applies to all healthcare facilities. This section of the ACA

Reinforces other civil rights laws to make sure people get the care they need

The Anti-Kickback Statute prohibits offering or receiving anything of value or of perceived value in exchange for referrals. The statute also uses the term remuneration. What does remuneration mean under the Anti-Kickback Statute?

Remuneration means cash, gifts, discounts, grants, loans or anything else of value or perceived value that is not offered to others on an equitable basis

Select the best answer: Where can a healthcare provider go to manage what was reported about them in the Open Payments database?

The Centers for Medicare & Medicaid Services (CMS) website (CMS's Center for Program Integrity manages the Open Payments program)

Select the best answer: The Open Payments program gathers and publishes data that includes payments from companies to healthcare providers. Why is it important to publish this information for everyone to see?

The payments could be conflicts of interest.

Select the best answer: How can a healthcare facility make it easier for people with disabilities to get care?

design facilities to allow people to enter more easily.

Fill in the blank: When a person with limited English proficiency (LEP) visits a facility, they should be offered help with translation __________.

in person, over a phone or computer, or in writing