Domain 4: Compliance

Which of the following laws created the Healthcare Integrity and Protection Data Bank? a. Health Information Portability and Accountability Act b. American Recovery and Reinvestment Act c. Consolidate Omnibus Budget Reconciliation Act d. Healthcare Quality Improvement Act

a. Health Information Portability and Accountability Act

To combat fraud and abuse in coding, one strategy is to: a. Use computer assisted coding (CAC) b. Unbundle codes c. Use best practices to write a query to clarify documentation d. Ensure the meaningful use incentive program

c. Use best practices to write a query to clarify documentation

Which of the following issues compliance program guidance? a. AHIMA b. CMS c. Federal Register d. HHS Office of Inspector General (OIG)

d. HHS Office of Inspector General (OIG)

Calling out patient names in a physician's office is: a. An incidental disclosure b. Not subject to the "minimum necessary" requirement c. A disclosure for payment purposes d. A HIPAA violation

a. An incidental disclosure

Messaging standards for electronic data interchange in healthcare have been developed by: a. HL7 b. IEE c. The Joint Commission d. CMS

a. HL7

In a joint effort of the Department of Health and Human Services (DHHS), Office of Inspector General (OIG), Centers for Medicare and Medicaid Services (CMS), and Administration on Aging (AOA), which program was released in 1995 to target fraud and abuse among healthcare providers? a. Operation Restore Trust b. Medicare Integrity Program c. Tax Equity and Fiscal Responsibility Act (TEFRA) d. Medicare and Medicaid Patient and Program Protection Act

a. Operation Restore Trust

A health information technician (HIT) is hired as the chief compliance officer for a large group practice. In evaluating the current program, the HIT learns that there are written standards of conduct and policies and procedures that address specific areas of potential fraud as well as audits in place to monitor compliance. Which of the following should the compliance officer also ensure are in place? a. Compliance program education and training programs for all employees in the organization b. Establishment of a hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation c. Adopt procedures to adequately identify individuals who make complaints so that appropriate follow-up can be conducted d. Establish a corporate compliance committee who report directly to the CFO

b. Establishment of a hotline to receive complaints and adoption of procedures to protect whistleblowers from retaliation

The Office of Inspector General's (OIG's) strategic plan includes four goals: a. Reduce risk, prevent criminal conduct, enforce laws and maintain ethics in health care. b. Fight fraud, waste and abuse; promise quality and safety, secure and advance future innovations in healthcare. c. Prevent criminal conduct; promulgate quality and safety; educate medical staff; and oversee disciplinary actions. d. Promote quality and safety, education for patients and clinical staff and advance pharmaceuticals' best use.

b. Fight fraud, waste and abuse; promise quality and safety, secure and advance future innovations in healthcare.

Each year the OIG develops a work plan that details areas of compliance it will be investigating for that year. What is the expectation of the hospital in relation to the OIG work plan? a. Hospitals are required to follow the same work plan and deploy audits based on that work plan. b. Hospitals should plan their compliance and auditing projects around the OIG work plan to ensure they are in compliance with the target areas in the plan. c. Hospitals must not develop their audits based on the OIG work plan; rather, they must develop their own and look for high-risk areas that need improvement. d. Hospitals must use the plan developed by their state hospital association that is specific to state laws and compliance activities.

b. Hospitals should plan their compliance and auditing projects around the OIG work plan to ensure they are in compliance with the target areas in the plan.

An effective compliance program should include some basic elements to comply with state and federal laws. These include policies, procedures and standards of conduct; the identification of a compliance officer and committee; education of staff; establishment of communication channels; performance of internal monitoring; corrective action when a problem is identified; and ________: a. Clinical documentation strategies b. Penalties for non-compliance of standards c. Improving the accuracy of health claims d. External audits

b. Penalties for non-compliance of standards

A coding compliance program should contain the same components as the organization's: a. Quality improvement process b. HIPAA rules c. Compliance plan d. Governing Board policies

c. Compliance plan

The OIG believes that compliance programs have benefits in addition to submitting accurate claims. This includes all of the following except ________. a. Demonstration of the organization's commitment to responsible conduct toward employees and the community b. Provision of a more accurate view of behavior relating to fraud and abuse c. Increased potential for criminal and unethical conduct d. Improvements in the quality of patient care

c. Increased potential for criminal and unethical conduct

A(n) ________ is considered the most innocent of improper payments because there is no intent to falsely receive a payment from the payer: a. Fraud b. Abuse c. Mistake d. Error claim

c. Mistake

In 2009, the HHS and DOJ created the _________ to prevent waste, fraud and abuse, reduce health care costs and improve the quality of care provided to Medicare patient: a. Office of Inspector General (OIG) b. Recovery Audit Contractor (RAC) c. Quality Improvement Organization and Enforcement (QIO) d. Health Care Fraud Prevention Team (HEAT)

d. Health Care Fraud Prevention Team (HEAT)

An accounting of disclosures must include disclosures ________. a. For use in law enforcement requests b. To any patient family member who makes a request c. To any individual who requested the information d. Made for public health reporting purposes

d. Made for public health reporting purposes

Which of the following programs has been in place in hospitals for years and has been required by the Medicare and Medicaid programs and accreditation standards? a. Internal DRG audits b. Peer review c. Managed care d. Quality improvement

d. Quality improvement