Essential of Healthcare Compliance
Lab tests performed in any health care facility most probably will need a certificate under HIPAA. CMS. CLIA. HCFA.
CLIA.
Before policies and procedures can be written, the laws must be altered. analyzed. localized. appealed.
analyzed
Without a signed consent to treat, a health care professional might be charged with battery. an extra fee. penalties. failure to approve.
battery.
Bias during an audit ensures compliance. favors the best staff members. delays the truth from being revealed. protects the office from external audits.
delays the truth from being revealed.
In order to request documentation for an audit, the OIG or RAC must issue a subpoena. pay for the flight to Washington D.C. offically request the information. reimburse office staff for participating.
offically request the information
Internal audits should be conducted on a rare occasion. when suspicions arise. when someone gets fired from the department. on a regular basis.
on a regular basis.
After a policy is implemented, a facility should do a poll of employees. policy process review. due diligence. covert investigation.
policy process review.
When admitting a patient into the hospital, the physician must document all patient next-of-kin. potential tests and procedures. health insurance policies. present-on-admission signs, symptoms, and diagnoses.
present-on-admission signs, symptoms, and diagnoses.
Having a great skill or being excellent at preforming a task is suffice proficient compliance training
proficient
The audit reviewed 100 patient records and claim forms of the 2000 filed during the month of June. This statement indicates a sampling audit. comprehensive audit. external audit. concurrent audit.
sampling audit.
The disciplinary action should be more severe when there has been a confirmation of knowledge. series of violations. misspelling of terms. first offense.
series of violations.
Referring a patient to a specific imaging center might be a violation of Stark. False Claims Act. HIPAA. CERT.
Stark
The Federal Register lists all rules, proposed rules, and notices from the federal government. all licensed health care facilities. all licensed health care providers. all third-party payers approved to offer health care insurance.
all rules, proposed rules, and notices from the federal government.
Good communication skills are necessary to avoid writing policies that are ambiguous analytical clear and precise complaiant
ambiguous
Facilities should provide their staff with the written process for approving policies. opportunity to write their own policies. chance to vote for the policies they like. legislative report that created each law.
written process for approving policies.
If found quilty of fraud, an individual may be ordered to go to jail or prison pay restitution pay fines or penalties All of the above
All of the above
An example of an advance directive is a living will. DNR. health care surrogancy. all of the above.
all of the above.
Healthcare facilities that are exempt from fraud investigations include private physician practices clinics and short-term acute care facilities none; all facilities are subject to the law hospitals with more than 500 beds
none; all facilities are subject to the law
Creation of a compliance program for individual physicians' offices is mandatory. optional. voluntary. irrelevant.
voluntary
SMFCU are delegated to investigate providers of Medicare services Blue Cross Blue Shield services Medicaid services durable medical equipment
Medicaid services
A state's fiscal intermediary is in charge of processing claims for malpratice. Medicare. the Partnership Plan. the state's attorney general.
Medicare
The National Practitioner Data Bank was created to provide easier licensure check. medical malpractice history. clinical privileges. all of the above.
all of the above
Whenever physician's notes are ______, HIM must query the physician. incomplete ambiguous contradictory all of the above
all of the above
Project management software can help keep track of the status of activities. assignments of individuals. deadlines. all of the above.
all of the above.
A law is a (an) diagnostic statement act of obeying determination of the rules of behavior corporate policy
determination of the rules of behavior
Education of staff means optional training sessions. explanations and encouragement of compliance. distribution of a manual. maintaining a binder in the HR department.
explanations and encouragement of compliance.
The FSG Manual contains functional standards of government. federal sentencing guidelines. financial and structural guidelines. federal steps to guidance.
federal sentencing guidelines.
Intrgrity is a personal characteristicof someone who is good at math. understands diversity. is a leader. has high moral standards and professional ethics.
has high moral standards and professional ethics.
According to the sample job descriptionsin Figures 2-1 through 2-5, most HIM compliance officers need a master's degree in compliance. license to practice law. knowledge off ICD and CPT. experience with the OIG.
knowledge off ICD and CPT.
Compliance procedures should mesh smoothly into daily job routines. be implemented by the court. be separate from regular job responsibilities. be the job of one person per department.
mesh smoothly into daily job routines.
Restitution is the order to pay penalities and late fees place someone in prison return all documents to their proper files pay back money received fraudulently
pay back money received fraudulently
The acronym PHI stands for patient hotline identification. protected health information. primary health insurance. protective health inservices.
protected health information.
Preliminarily, a compliance program should include all except protective systems. logically written policies and procedures. total implementation integrated in day-to-day systems. consistent enforcement of punishment for non-compliance.
protective systems.
Proper planning for a large project such as this includes all expect a contingency plan. regular back-ups. random rotation of assignments. cushion time built into deadlines.
random rotation of assignments.
Laws that are created and enacted by the legislature are called policies. administrative laws. statutes. regulations.
statutes
When delegating tasks, assign work according to team members' availability. strengths. convience. requests.
strengths
f the office manager tells the coder to do something fraudulently, and the coder does it because she doesn't want to lose her job only the office manager can be charged with fraud only the coder can be charged with fraud only the physician can be charged with fraud the coder is at the greatest risk for being charged
the coder is at the greatest risk for being charged
All policies should include all of these elements except a rationale. contingency behaviors. penalities for non-compliance. the date the policy was created.
the date the policy was created.
An allowance is an amount of money given to a health care facility from the government. a waiver of total liability. the performance of due diligence. the lessening of penalities for a companyfound guilty of fraud.
the lessening of penalities for a companyfound guilty of fraud.
The agency that oversees HIPAA and investigates violations is the RAC OCR OIG DOJ
OCR
Any of the following, except one, might occur when using an incorrect place of service code: Payment is sent to another facility. The claim may be deined. The claim is paid at an improper rate. An investigation for fraud may ensue.
Payment is sent to another facility.
_______ is a good example of a good source for compliance update information. WebMD The American Health Information Management Association. The New York Times. Health magazine.
The American Health Information Management Association.
Policies should be consistent. unambiguous. a and b open for interpretation.
a and b
A Certificate of Medical Necessity is used to justify payment for in-patient surgical events. outpatient surgical events. durable medical equipment. prescription medications.
durable medical equipment.
Internal reporting should always be discouraged. limited to management staff. encouraged. not permitted.
encouraged.
The Seven Steps of Due Diligence include standards of behavior that will foster criminal conduct. identification of those staff members with veracity. established monitoring systems. optional punishments for non-compliance.
established monitoring systems.
Results of audits should be evaluated and worked into a plan for improvement. placed in a file for future consideration. shredded so no one can read this privileged information. rewritten to make your department look good.
evaluated and worked into a plan for improvement.
Staff members that must abide by facility policies include everyone in the facility. only full-time employees. full-time and part-time employees. only clinicians.
everyone in the facility.
A subpoena duces tecum means that documentation is not to be disclosed. is to be read aloud in court. must be delivered to the court. should be destroyed immediately.
must be delivered to the court.
All policies should have known _____ for non-compliance. specific consequences vague statements occasional punishments employee-determined results
specific consequences
An employee who has violated a policy more than once should be considered for retraining. a promotion. termination. a raise.
termination.
Claims can be fraudulent when they are reported with too many modifiers. submitted for inpatient services. unsupported by documentation. sent by paper.
unsupported by documentation.
DRG creep is the hospital version of what other fraudulent activity? unbundling upcoding clustering balance billing
upcoding
Appeals processes _______ for public and private insurers. are the same require an attorney vary are contempt of court
vary
Retribution is the act of rewarding a good behavior. vengeance. promotion. retaking a certification exam.
vengeance.
Education required every year to keep a professional current on his or her industry Proficient Preformance Improvement Quality CEU (continuing education units).
CEU (continuing education units).
Reporting PQRI involves using ICD-9-CM codes. Category II codes. HCFA regulations. POA indicators.
Category II codes.
The code set used to report diagnoses and procedures are AHIMA and AAPC. ICD-9-CM and CPT. CPT and ICDR. HCPCS and DNR.
ICD-9-CM and CPT.
A Qui Tam lawsuit is also known as Premium recovery act Whistleblower statute Partnership provision Fraud control unit
Whistleblower
According to the professional code of ethics, compliance professionals should understand the details of the laws. assess the intent, or spirit, of the laws. have the education necessary to rewrite the laws. a and b only
a and b only
A disciplinary action should always be applied equally to all staff. documented. final. a and b only.
a and b only.
Governmental investigations may be motivated by internal audits. media reports. a patient's complaints after recieving an EOB. data glitches.
a patient's complaints after recieving an EOB.
nformal disciplinary actions should include a termination date. a demotion or suspension. the employee's written apology. a plan for improvement.
a plan for improvement.
The acronym ABN stands for authorized benifit notary. anterior bilateral neofusion. advance beneficiary notice. alternate beneficiary notation.
advance beneficiary notice.
Compliance in a health care organization is the responsibility of the physician the president the compliance officer all employees, volunteers, and interns
all employees, volunteers, and interns
Providing staff with advanced notification of an audit might make them to nervous to work. improve their productivity and quality. provide opportunity for a cover-up of bad behavior. b and c only.
b and c only.
When a sampling audit discovers an overpayment, the auditors may only get back the amount of the overpayment discovered. calculate the amount discovered to apply to the total. divide by twelve. multiply by five.
calculate the amount discovered to apply to the total.
Civil monetary penalties (CMP) can be assessed when civil violations have been discovered. criminal sanctions are not strong enough. the facility has been penalized before. there is no certified coder on staff.
civil violations have been discovered.
Reporting systems should be non-threatening. optional. publicly done. required to include evidence.
non-threatening.
When mixing education with work, often the best practice is one thing at a time multiple things only address current issues no structure is really needed
one thing at a time
An internal audit is instigated by the Internal Revenue Service. FI in your state. American Medical Association. organization's management.
organization's management.
Complying with mandatory report laws is _____ under HIPAA's Privacy Rule. permitted forbidden questionable permittedwith patient's signed consent
permitted
When a subpoena id received, HIPAA's Privacy Rule states release of information is forbidden. not permitted without written permission from the patient. permitted. mandated.
permitted.
Good compliance plans cost too much to write. protect the assets of the organization. endanger the staff by highlighting errors. are too complicated to implement.
protect the assets of the organization.
Punitive action might be termination. suspension without pay. request for retraining. a warning.
suspension without pay.
Updates to the compliance plan should come from all except the federal government. the state government. the Office of Healthcare Compliance. a fiscal intermediary.
the Office of Healthcare Compliance.
Informed consent is a principle that has been taken from the Patient Budget Law. HIPAA. the Law of Demand.
the Patient Self-Determination Act.
Creating a written compliance program is all that is required by law the first step to implementation a requirement of certification the responsibility of the facility's attorney
the first step to implementation
A warning is the lowest level of disciplinary action. sever punishment for serious infractions. evidence of wrongdoing. testimony in court.
the lowest level of disciplinary action.
Reporting several codes instead of one combination code is called upcoding. balance billing. unbundling. clustering.
unbundling.
Once written, the compliance plans should be updated every thirty days. six months. year. five years.
year.
Employees who are terminated after being found guilty of a wrongdoing should have no recourse. access to a published appeal process. one month's severance pay. three references.
access to a published appeal process.
Anyone falsifying health care information is subject to possible jail time possible monetary fines and penalties exclusion from program participation all of the above
all of the above
Fraud is investigated by the CMS. DOJ. IRS. all of the above
all of the above
Having staff sit in a hour long training session that has nothing to do with their job is a waste of time energy money all of the above
all of the above
Physician's offices can be investigated by agents from the OIG the FBI the IRS all of the above
all of the above
The manner in which training information is presented to your staff can be auditory visual hands-on all of the above
all of the above
Anyone reporting an occasion of non-compliance should be assured that they will not be harassed. be fired. be ostracized. all of the above.
all of the above.
Information on the Joint Commission website applies only to hospitals. physicians' offices. long term care facilities. all of the above.
all of the above.
Most states require health care professionals to report suspicion of domestic violence. child abuse. neglect of children or the elderly. all of the above.
all of the above.
Should a false claim be filed, the person culpable under the federal False Claims Act is the physician. the coder. the biller. all of the above.
all of the above.
The False Claims Act, like many health care laws, identifies the guilty party as one who knowingly makes a false record. causes a false record to be made. should know a false record is being made. all of the above.
all of the above.
The audit results may affect the processes in the way the physican documents encounters. coders interpret documentation. billing is submitted. all of the above.
all of the above.
Compliance officers must do all except create a detailed compliance program report to the governing board file lawsuits against non-compliant staff members investigate allegations of violations
file lawsuits against non-compliant staff members
Health information professionals are responsible for following the law doing as directed by the physician or manager getting the facility paid above all else getting claims out quickly
following the law
An offical policy should include the name of the person who wrote the policy. legal reason for the policy. number of words in the written policy. address for Congress.
legal reason for the policy.
The Fourteenth Amendment of the U.S. Constitution supports the right to free medical care. refuse medical treatment. home health car. know all diagnoses of one's spouse.
refuse medical treatment.
A subpoena ad testificandum means the individual receiving this order must deliver documentation. testify in court. obtain a national certification. pay an additional fine.
testify in court.
The Partnership Plan includes state auditors working with the OIG FBI DOJ CMS
OIG
The actual location of the training program should be somewhere in the office so people don't have to travel. in a restaurant. at a resort. at the most appropriate location for the topic and length of time needed.
at the most appropriate location for the topic and length of time needed.
The NPI on the claim form should be that of the primary care physician who referred the patient. attending physician who performed the procedures. consulting physician who recommended the procedures. facility where the procedures were preformed.
attending physician who performed the procedures.
Auditory learners prefer presentations that are primarily hands-on, interactive sessions. lecture-based. examples and illustrations. book or manual-based.
lecture-based.
The audit report indicates that Filene has been coding for coverage on claims she submits for her friends woh come to this clinic. This is an alleged ethical violation. legal violation. moral violation. human error.
legal violation.
Fraud can occur in many ways, including all except overt. covert. manifested. occult.
manifested.
Organizational skills are important due to the requirement to file patient records. governmental paperwork. massive amounts of information. need to keep your office neat.
massive amounts of information.
CMS' Quarterly Provider Update includes all except regulations currently under development. new or revised manual instructions. new pricing information. regulations completed or cancelled.
new pricing information.
Rodman Clinic has an average of 43 percent of their submitted claims denied. This is an _______ indicator of problems in this facility. overt covert occult none of the above
overt
PRA stands for permission for retrospective audits. proper remittance advisory. provider remittance advice. physican radiological audits.
provider remittance advice.
Repercussions for non-compliance should be decided by a commitee. based on the individual. published in the policy manual. different based on senority.
published in the policy manual.
A suit filed by private citizens on behalf of the government is called a due diligence lawsuit. fiscal intermediary. supeona duces tacum. qui tam lawsuit.
qui tam lawsuit.
The purpose of external audits is to reclaim overpayments. identify the competencies of nurses. increase health insurance coverage. avoid paying taxes.
reclaim overpayments.
From April 5 through April 7, the auditors reviewed all claims filed by the south side office between March 1 and March 15. This statement indicates a sampling audit. concurrent audit. retrospective audit. external audit.
retrospective audit.
External audits performed by agencies, such as OIG, occur retrospectively. concurrently. internally. comprehensively.
retrospectively.
Should a health care facility recieve an overpayment from a third-party payer, they must apply the funds to a future service. return the funds. give the money to the patient. give the money to the facility general fund.
return the funds.
Training your staff on compliance may cost a great deal of money. save the facility money by reducing liability. waste time because employees should already know the material. be too difficult to schedule.
save the facility money by reducing liability.
Health information management departments do not require their own compliance officer do not have specific laws with which to comply should have a dedicated HIM compliance officer should have their own attorney
should have a dedicated HIM compliance officer
The HIM compliance officer should sit on the corporate compiance committee. report directly to the stockholders. be a member of the board of directors. be responsible for the hotline reporting system.
sit on the corporate compiance committee.
Programs held during off-hours will require no additional compensation. time-and-a-half at their regualr pay rate. baby-sitting services. some type of compensation.
some type of compensation.
If an investigation must be completed to determine employee guilt or innocence, it is recommended that the employee be suspended with pay. suspended without pay. told to clean out the inventory closet. terminated.
suspended with pay.
Training programs should include the following except who should attend. what the topic should be. that lunch is paid for by the company. where the meeting will be held.
that lunch is paid for by the company.
Most staff members need to know this first: Where the session will be? How much will you pay me to attend? Who else will be there? what's in it for me?
what's in it for me?
Periodically, the project coordinator should perform content reviews. reassignment of components to second-tier participants. adjustments to timelines. verbal feedback.
content reviews.
Details in patient records help get publicity for the facility. get reimbursement for treatment plans. advertise new services at your facility. liven up the office holiday party.
get reimbursement for treatment plans.
The first step in creating a compliance program is investigation of all circumstances of non-compliance. performance of regularly scheduled audits. effective education of staff. identification of all applicable laws.
identification of all applicable laws.
One type of patient consent is obligatory consent. statutory consent. implied consent. inferred consent.
implied consent.
Policies, as discussed in this text, are designed to direct budget consideration. resourse allotment. individual behaviors. organizational structure.
individual behaviors.
Virtually every law includes the phrase admits to knowing knows or should know proven to be known may know
knows or should know
The Office of Civil Rights is the best source for correct information on Medicare compliance. HIPAA compliance. coding information. patient safety regulations.
HIPAA compliance.
_____ is another good example of a good source for compliance update information. The American Academy of Family Physicans The Good Health Source Nutritional Guidelines USA Sun City Nursing Homes.
The American Academy of Family Physicans
he manager of Dr. Oppenheim's office hired a professional to come in and perform a coding review of claims. This is a(n) ______ audit. internal external multi-focused retrospective
internal
A complaint froma patient should immediately cause the action of termination. suspension. investigation. appeal.
investigation.
Audits performed by the OIG review coding practices. documentationrequirements. accounting practices. a and b only.
a and b only.
Statistics pulled from patients records may be used to allot facility resourses. support research proposals for funding. a and b. none of the above.
a and b.
Appealing a Notification of Error from CMS is not permitted. a five-level process. only permitted for hospitals. only permitted for physicans.
a five-level process.
An example of upcoding would be reporting a motorized wheelchair when a cane was provided. three different vaccine injections when one combination vaccine was given. a treatment provided to a patient who was never actually treated. a procedure performed by non-physician professional.
a motorized wheelchair when a cane was provided.
Refusing to follow a subpoena may result in fines. jail or prison time. a or b none of the above.
a or b
Corrective action strategies may be developed from the results of internal audits. external audits. staff and patient input. all of the above.
all of the above.
Credible sources for educating employees include professional organizations. governmental agencies. local colleges. all of the above.
all of the above.
Employees may get their education on the internet. at a convention. from a book. all of the above.
all of the above.
Enforcement of consequences for non-compliance is a key component of legal compliance. ethical compliance. an organizational attitude of honesty. all of the above.
all of the above.
Health care facilities subject to externals audits include hospitals. long-term care facilities. physicans' offices. all of the above.
all of the above.
Health documentation is used for continuity of care. patient safety. public safety. all of the above.
all of the above.
The federal False Claims Act only applies to services provided in a hospital. ambulatory care center. physician's office. all of the above.
all of the above.
Updates to the compliance plan may come from government agencies. insurance carriers. national health care organizations. all of the above.
all of the above.
Documentation requested by an external investigator may not be released without patient written consent. violate HIPAA's Privacy Rule. be submitted late, depending upon patient load. be submitted by the deadline, or a penalty may be assessed.
be submitted by the deadline, or a penalty may be assessed.
Billing "incident to" means that the service was performed at the scence of an accident. after a global period. by a non-physician clinician under the supervision of a physician. by a second physician during the course of another treatment plan.
by a non-physician clinician under the supervision of a physician.
Charging for the release of imformation is based on whatever the facility wishes to charge. forbidden by HIPAA. calculated from actual cost. only permitted by authorized vendors.
calculated from actual cost.
From April 5 through April 7, the auditors reviewed all claims filed by the south side office between March 1 and March 15. This statement also indicated a sampling audit. comprehensive audit. external audit. concurrent audit.
comprehensive audit.
All claims created in Madison Hospital for services performed this month are sent to an auditor for review prior to being forwarded to the third party payer. This is a(n) _____ audit. sampling retrospective concurrent external
concurrent
The law requires the reporting of any disease or condition considered to be genetic. hereditary. contagious. chronic.
contagious.
Evidence in the due process evaluation of Filene's violation will include a statement from her friends. copies of the patient record and claim forms. Filene's pay stubs. all of the above.
copies of the patient record and claim forms.
The investigation identified that 81 percent of claims filed last month were undercoded. This is an ______ indicator of problems in this facility. overt covert occult none of the above
covert
Investigations into fraud and abuse are also referred to as health care innovators. health care oversight activities. HCUP. restoration.
health care oversight activities.
The notice of due diligence to Filene should include her right to a lawyer. her right to defend herself. her date of employement. her last promotion.
her right to defend herself.
A finding of negligence indicates the auditor believes the errors were human errors. willful ignorance. criminal. reckless disregard of the law.
human errors.
Exit interviews are most productive when performed when an individual gives their notice. in a non-threatening manner. with those who have been fired. on the individual's last day.
in a non-threatening manner.
Express consent means consent was given quickly. in a same-day surgery center. by a legal guardian. in writing.
in writing.
The local laboratory sent Dr. Frune two tickets to the basketball game as a thank you for referring patients to its testing center. This is a violation of the False Claims Act. Anti-Kickback. medical necessity. the Langdon Act.
Anti-Kickback.
The policy must include a clear explanation of the bonuses for compliance. promotion time frames. consequences for non-compliance. names of all employees involved.
consequences for non-compliance.
When a patient signed a DNR, it means they refuse medications. transfer to a nursing home. CPR. a second opinion.
CPR
A compliance officer should have the authority to assess penalties for violations. adjust financial reports. send an individual to prison. hire and fire anyone in the facility with no exceptions.
assess penalties for violations.
Penalities for non-compliance should be the same for all violations. be progressive, so the punishment can fit the crime. never be implemented. be different for each employee.
be progressive, so the punishment can fit the crime.
The law that prohibits the exchange of money or benefits for referrals of health care services is the federal False Claims Act. EMTALA. Federal Anti-Kickback Statue. Stark.
Federal Anti-Kickback Statue.
Facilities excluded from the need to create a policy manual are hospitals with more than 200 employees. clinics with fewer than 30 employees. facilities that do not charge patients (i.e., a free clinic). No facilities are excluded.
No facilities are excluded.
Clinicians must ensure that patient documentation is all of the following except complete. timely. accurate. collated with lab reports.
collated with lab reports.
The National Procurement Fraud Task Force prosecutes alleged violations of licensing and certifications conflict of interest Joint Commission standards embezzlement
conflict of interest
PFSH should be included in encounter notes. This acronym stands for Patient Friendly Strategic Healthcare. Present Filing System Holograms. Past, Family, and Social History. Portable Financial Strata Healthcare.
Past, Family, and Social History.
The act that ensures that a patient will recieve written notice of their right to refuse medical treatment is the HCFAC. Whistleblower statute. Patient Self-Determination Act. Health Care Quality Improvement Program.
Patient Self-Determination Act.
Deadlines should be set to create a harmonized flow or work. to have all compoments finished by the same date. for each stage of the project. a and c only.
a and c only.
Keeping EHR secure will require that all individuals with access have a thorough background check. high-speed internet. a password based on a formula. computer certification.
a thorough background check.
Under HIPAA, all covered entities must get a signed registration form. insurance policy waiver. acknowledgement of notice receipt. benefits approval.
acknowledgement of notice receipt.
When an agency of the government creates rules, these are also called policies. administrative laws. statutes. regulations.
administrative laws.
CLIA certifies laboratory facilities. lab tests performed in a physicians office. lab tests performed in a hospital. all of the above.
all of the above.
One reason a health care facility would need to create offical policies is to educate staff members. to provide directives for employee behavior. to protect the interests of the organization. all of the above.
all of the above.
Penalties may include fines. jail or prison time. termination. all of the above.
all of the above.
Superconfidential information includes diagnosis of: pregnancy (in minors). sexually transmitted disease. alcohol addiction. all of the above.
all of the above.
The primary responsibilities of an HIM compliance officer include good written communication skills. strong oral communication skills. excellent analytical skills all of the above.
all of the above.
Writing policies may be the responsibilty of the manager. compliance director. board of directors. any of the above.
any of the above.
A health care surrogate must be anyone. a blood relative. a spouse or child. a member of the facility staff.
anyone
Violation of HIPAA can result in civil penalties. crimal penalties. exclusion. a and b only.
a and b only.
Before agreeing to a procedure, a patient should be told the length of time for recovery. length of time for the procedure. potiential risks of having the procedure. a and c only.
a and c only.
A formal compliance program may lessen fines and penalties get in the way of good patient care cost more money than it is worth increase liability
lessen fines and penalties
All of these are components of a compliance program except methods for reporting alleged violations. mitigating circumstances for department managers. repercussions for non-compliance. plans for corrective actions.
mitigating circumstances for department managers.
A contingency behavior is one that addresses circumstances outside of the usual. during an audit. involving patients without insurance. that are day-to-day.
outside of the usual.
The individual named reponsible for compliance of a certain policy is in charge of verification. report statistics. oversight. maximization.
oversight
Balanced billing may be illegal when done by a participating provider. hospital. billing service. free-standing dianostic laboratory.
participating provider.
Informed consent forms should include the patient's diagnosis. patient's address. patient's insurance policy identification. patient's next-of-kin.
patient's diagnosis.
The joint commission does not accredit physicians' offices. hospitals. ambulatory care centers. long-term care centers.
physicians' offices.
Blue Cross Blue Shield's Participation Programs and Responsibilities is an example of policies. administrative laws. statutes. regulations.
policies
To disclose PHI, it is often required to get the patient to sign a release of information form. credit card approval notice. consent for treatment form. ABN.
release of information form.
An HIM compliance officer is responsible for implementation of the compliance program responsible for all staff members becoming certified responsible for firing employees who step out of line responsible for the entire facility
responsible for implementation of the compliance program
Every project assignment should include the general deadline. specific definitions of quality measures. open and nondescript guidelines. a complete list of approved resourses.
specific definitions of quality measures.
HIPAA is an example of a policy. admininstrative law. statute. regulation.
statute
Qui Tam is also known as HCFAC. the whistleblower statute. the Patient Self-Determination Act. Health Care Quality Improvement Program.
the whistleblower statute.
Abbreviations may be used in the patient record as long as they are on the approved list. the entire word is also written every time. every workstation has a medical dictionary. the physician wrote it.
they are on the approved list.