FOL Final Exam Study Set
Printing electronic health records is seen as a __________.
. Negative because it raises questions as to the source of truth
Who has the legal right to refuse treatment? (Bloom's Level: 4) 1. Juanita, who is 98 years old and of sound mind 2. Christopher, who is 10 years old and of sound mind 3. Jane, who is 35, incompetent, and did not express her treatment wishes prior to becoming incompetent 4. Linda, who is 35, incompetent, and created a living will prior to becoming incompetent stating that she did not wish to be kept alive by artificial means
1 and 4
A secretary in the Nursing Office was recently hospitalized with ketoacidosis. She comes to the health information management department and requests to review her health record. Of the options below, which is the best course of action? a. allow her to review her record after obtaining authorization from her. b. refer the patient to her physician for the information. c. tell her to go through her supervisor for the information d. tell her that hospital employees cannot access their own medical records.
A
Employees in the Hospital Business Office may have legitimate access to patient health information without patient authorization based on what HIPAA standard/principle? a. minimum necessary b. compound authorization c. accounting of disclosures d. preemption
A
Mary Jones has been declared legally incompetent by the court. Mrs. Jones sister has been appointed her legal guardian. her sister is requesting a copy of Mrs. Jones health records. Of the options below, what is the best course of action? a. comply with the sister's request but first request documentation from the sister that she is Mary Jones level guardian. b. provide the information as requested by the sister c. require that mary jones authorize the release of her health information to the sister d. refer the sister to Mary Jones doctor
A
Carrying out the wishes stated in a living will applies to which of the following patients, who is incompetent due to an illness?
A 90-year-old man who created an advance directive while he was competent
When staff are instructed to create passwords, it should be recommended that they use ___
A combination of letters and numbers
Intentional confinement of an individual against his or her wishes may be legally defensible if __________.
A mentally ill patient is a danger to self and others
Which of the following is not an example of a red flag for a healthcare provider?
A question from a patient about scheduled surgery
Tort law addresses a wrong involving all of the following except one?
A wrong against society or public at large
The "custodian of health records" refers to the individual within an organization who is responsible for the following action(s). A) authorized to certify records B) supervises inspection and copying of records C) testifies to authenticity of records D) all of the above
ALL OF THE ABOVE
The concept of confidentiality applies to which of the following: A) all data and information systems B) automated, paper and verbal communications C) clinical, financial and business records D) all of the above
ALL OF THE ABOVE
What term best describes poor business practices which may result in inconsistencies with billing regulations?
Abuse
Integrity refers to the __________.
Accuracy and completeness of information
Which of the following acts protects individuals 40 years or older?
Age Discrimination in Employment Act
Jill has been asked to revise the health record retention policy for her organization. In particular, administration believes the current policy does not properly reflect the length of times that the records of minors should be retained. In conducting her research, Jill refers to the AHIMA best practices for record retention. Based on what she has researched, which of the following should she recommend to administration regarding retention of the health records of minors?
Age of majority plus statute of limitations
What governmental agency offers programs and services aimed at quality improvement programs?
Agency for Healthcare Research and Quality
A mental health professional cannot be compelled to testify or disclose protected health information without patient authorization in a judicial situation except in what situation? Health professional performs an examination under court order Patient brings up the issue of mental or emotional condition Protect patient from harming self or others
All of the above
Which of the following has the right to consent to treatment?
An 88-year-old woman
The most common place to find a firewall is between _________
An organization's internal network and the internet.
Which of the following is not a mechanism to control access to PHI?
Anti-virus software
Patients diagnosed with a mental illness and involuntarily committed:
Are not necessarily deemed incompetent by virtue of the illness
Which of the following would be the best tool to determine whether or not access to ePHI was appropriate?
Audit trail
Which of the following is not a form of transmission security?
Audit trails
What authority did the Equal Employment Opportunity Act of 1972 grant the Equal Employment Opportunity Commission?
Authority to sue in federal courts when there is reasonable cause to believe discrimination has occurred
Which of the following would not be a benefit to a provider for voluntarily disclosing self-discovered fraud?
Avoid potential sanctions
One outcome of a successful quality improvement program would be _______.
Avoidance of malpractice litigation
Tarasoff v. The regents of the University of California is a landmark case related to the release of psychiatric information without patient authorization. The healthcare provider must release such information based on what circumstance: a. admission of facts b. duty to warn c. involuntary commitment proceedings d. res judicata
B
The age of majority in most states is: a. 16 and older b. 18 and older c. 21 and older d. none of the above
B
When the HIM professional is considering the major departmental functions to include in a disaster plan for emergency operations, which of the following would be the least important?
Billing
If two healthcare professionals disagree about the course of treatment for a patient, how should this be documented in the health record?
Both professionals should record their opinions in the record independently of the other
The latest provisions to HIPAA include_________
Breach notification, enforcement and modifications to the privacy and security rules
Which of the following would provide the best support of an organization's efforts toward compliance with the security rule?
Build security into software and systems
An employer has contacted the HIM department and requested health information on one of his employees. Of the options below, what is the best course of action? a. provide the information requested b. refer the request to the attending physician c. request employee's written authorization for release of information d. request the employer's written authorization for release of the employee's information
C
Dr. Smith, a member of the medical staff, asks to see the medical records of his adult daughter who was hospitalized in your institution for a tonsillectomy at age 16. The daughter is now 25. Dr. Jones was the patient's physician. Of the options below what is the best course of action? a. allow Dr. Smith to see the records because he was the daughter's guardian at the time of the tonsillectomy b. call the hospital administrator for authorization to release the record to Dr. Smith since he is on the medical staff c. Inform Dr. Smith that he cannot access his daughter's health record without her signed authorization allowing him access to the record. d. Refer Dr. Smith to Dr. Jones and release the record if Dr. Jones agrees.
C
Minors are basically deemed legally incompetent to access, use or disclose their health information. What resource should be consulted in terms of who may authorize access, use or disclose the health records of minors? a. HIPAA because there are strict HIPAA rules regarding minors b. Hospital attorney since they know the rules of the hospital c. state law since HIPAA defers to state laws on matters related to minors d. none of the above
C
Mr. Smith was admitted to University Hospital by Dr. Collins. Mr. Smith's hospital bill will be paid by Blue Cross Insurance. Upon discharge from the hospital, who owns the health record of Mr. Smith? a. mr. smith b. blue cross c. university hospital d. dr. collins
C
St. Joseph's Hospital has a psychiatric service on the sixth floor of the hospital. A 31 year old male has come to the HIM department and requested to see a copy of his medical record. he indicated he was a patient of Dr. Schmidt, a psychiatrist, and that he was on the sixth floor of St. Joseph's for the last two months. These records are not psychotherapy notes. Of the options below, what is the best course of action? a. prohibit the patient from accessing his record, as it contains psychiatric diagnoses that may greatly upset him b. allow the patient to access his record c. allow the patient to access his record if, after contacting his physician, his physician does not feel it will be harmful to the patient d. deny access because HIPAA prevents patients from reviewing their psychiatric records.
C
The Uniform Health Care Decision Act (UHCDA) refers to: a. medicaid and medicare funding priorities b. requiring the selection of a guardian for an incompetent adult c. selecting an individual to make healthcare decision for a competent adult d. use of CPT and HCPCS for reporting healthcare claims
C
What two federal agencies work closely together to identify best practices for the management of diseases and injuries that may affect employees in the workplace?
CDC and OHSA
A staff person at Thompson Laboratories received a request from Mrs. Blake to receive a copy of her lab results. What legislation enables the laboratory to release Mrs. Blake's lab results directly to her?
CLIA
Personal health records_________.
Can be beneficial to both patients and providers
Describe how patient rights and quality improvement programs are linked.
Central to providing quality healthcare is ensuring that patients are fully aware of their rights not only related to clinical quality of care but also other aspects of their healthcare.
The negligent tort of malfeasance refers to which of the following statements?
Characterized by the performance of a wrongful act that may be unlawful
Elaine has moved to a new state to assume the director of HIM in a large community hospital. In her previous position, reporting of trauma injuries was required by state law. However, in her new position it is apparent that the hospital is not reporting traumatic injuries. Which of the following is the most appropriate action for Elaine to take?
Check state law to determine if reporting of trauma injuries is required
Data are sent in encrypted form from one computer to another. Which of the following terms describes the data after the encryption algorithm has been applied to it?
Ciphertext
Dr. Smith engaged in wrong doing by upcoding the diagnoses of patients seen in his office over a three-year period. As a result, the US Inspector General of HHS has the right to exclude Dr. Smith from future Medicare payments. What act enables the inspector general to enforce this exclusion?
Civil Monetary Penalties Ac
When a medical staff practices economic credentialing, __________.
Clinical performance issues may be given less emphasis
In this negligent case, Dr. Smith was found to be 50 percent responsible for the patient's health problem, but the jury also found that the patient was 50 percent responsible for his problem and thus was awarded 50 of the damages. What defense doctrine is applied in this situation?
Comparative negligence
A physician has been found to have breached his contract with a patient through abandonment. As a remedy, the court may order that the physician continue to treat the patient until the patient can find a new provider. In this case, the remedy is __________.
Compensatory damages
Which of the following is not a mechanism to detect external medical identity theft? the following are Request a driver's license to verify identity Take a photograph of the patient at the time of registration Compare current patient signature with that from a previous encounter
Conduct a background check on prospective employees
At its most basic level, patient rights addresses_________.
Conduct between a healthcare provider and a patient
What is the legal term used to define the protection of health information in a patient-provider relationship? A) access B) confidentiality C) privacy D) security
Confidentiality
What law provides employees the opportunity to purchase health insurance for a given period of time after they have been laid off?
Consolidated Omnibus Budget Reconciliation Act
Health information privacy protection has been established in all but one of the following ways. A) Constitutional Right B) Court Decisions C) State Laws D) Federal Laws
Constitutional Right
With respect to patient rights, the Joint Commission standards:
Contain a provision regarding the review of patient complaints
All of the following are security rule physical safeguard standards except______
Contingency planning
A patient is treated in the Emergency Room for severe laceration of the foot. The patient is given written instruction by the physician to have the sutures removed in three days, which the patient fails to do. A severe infection ensues resulting in permanent damage to the patient's foot. The patient sues the surgeon for negligence, and the surgeon uses the ER record to prove __________.
Contributory negligence
What document may the OIG require of a healthcare organization as a condition of settling a fraud and abuse investigation?
Corporate integrity agreement
If a hospital is held liable in its own right for the harm that the physicians on its medical staff caused to a patient, the legal theory being applied is
Corporate negligence
Most state laws deem adoption records to be confidential and allow their release only under what circumstance?
Court order
An error in a paper health record should be __________.
Crossed out so that it can be seen but not relied on
Esther is an 86-year-old patient of Dr. Brooks. When taking into consideration that Esther views the physician-patient relationship differently because of her age, Dr. Brooks is exhibiting_________.
Cultural competence
What is the term used most often to describe the individual within an organization who is responsible for protecting health information in conjunction with the court system? A) administrator of record B) custodian of record C) director of record D) supervisor of record
Custodian of Record
A competent adult female has a diagnosis of ovarian cancer and while on the operating table suffers a stroke and is in a coma. Her son would like to access her health records from a clinic she recently visited for pain in her right arm. The patient is married and she lives with her husband and two grown children. According to the Uniform Health-Care Decision Act (UHCDA) who is the logical person to request and sign an authorization to access the woman's health records from the clinic? a. adult child making request b. oldest adult child c. patient d. spouse
D
In the situation of behavioral healthcare information a healthcare provider may disclose health information on a patient without the patient's authorization in which of the following circumstances? a. court order b. duty to warn c. involuntary commitment proceedings d. all of the above e. none of the above
D
Securing the authorization of the attending physician, in addition to the patient's authorization, for the release of information to the patient's insurance company is: a. a legal requirement under privileged communication statute. b. a legal requirement under common law c. necessary only if the patient is a minor d. is not legally required
D
The baby of a mother who is 15 years old was recently discharged from the hospital. The mother is seeking access to the baby's health record. Who must sign the authorization for release of the baby's health record? a. both mother and father of baby b. maternal grandfather of baby c. maternal grandmother of baby d. mother of the baby
D
Mary Jackson is 95 years old. While an inpatient at General Hospital, she agrees that she does not want to be resuscitated if she would have a cardiopulmonary arrest. She signs a form and the physician documents it in the record. This best describes a(an) __________.
DNR Order
What landmark case resulted in healthcare governing boards assuming responsibility for reviewing the qualifications of their medical staff through medical staff qualifications?
Darling v. Charleston Community Memorial Hospital
Reporting of births by state law is allowable for which of the following reasons?
Data are necessary to identify trends.
Which of the following are required components of a HIPAA-compliant disaster plan?
Data back-up, data recovery, and emergency mode of operations
The best source for obtaining primary information on addressing the HIPAA Security Rule would be which of the following sources?
Department of HHS
Which of the following elements is not included in the OIG recommendations for compliance programs?
Development of billing edits
Helpful University Health System has a laptop sharing program which allows users to request laptop computers to use for short-term projects. Many of the projects involve the use of ePHI. When the laptops are returned to the office, they are often immediately recirculated to another user in the system. This is an example of a violation of which of the following aspects of the security rule?
Device and media controls
Which portion of a security program would ensure that ePHI is not stored on recycled equipment?
Device and media controls
What statement best addresses disclosure of information about abortions?
Disclosed based on required reporting statutes
What is the term used to denote the sending a monthly claim until payment is received?
Duplicate billing
The RAC program was designed to reduce improper Medicare payments through detection of overpayments related to non-covered services, incorrectly coded services and_________.
Duplicate services
What rights does a competent individual have in regard to his or her healthcare? a. right to consent to treatment b. right to refuse treatment c. right to access his or her own PHI d. a and c e. all of the above
E
The Uniform Guidelines on Employee Selection Procedures is supported by what federal agency and for what purpose?
EEOC to assist employers in hiring process
Examples of tort reform for malpractice actions include all except which one of the following?
Economic and punitive damages
The Patient Self-Determination Act requires healthcare providers to __________.
Educate staff and community about advance directives, Document the presence or absence of an advance directive in a patient's health record, Inform patients of their right to create advance directives
Eleanor has refused life-saving treatment. Which of the following is true?
Eleanor has the right of self-determination to refuse treatment The hospital may not refer this decision to a court Eleanor does not have the right to refuse treatment
The best mechanism to protect patient information during transit is ___
Encryption
The security rule's five sections includes all of the following except________
Encryption requirements
What federal agency was created and implemented as part of the Civil Rights Act for the purpose of enforcing laws to prevent job discrimination?
Equal Employment Opportunity Commission
Mary was promoted to supervisor and subsequently found out that Jack, who was also promoted to the same job title, was given $3,000 more in pay for the same job. Mary feels Jack received this pay because he is a male. If this is true, which act makes it illegal to pay Jack differently than Mary?
Equal Pay Act of 1963
Ultra vires acts are those that __________.
Exceed a corporation's powers
Trauma registry data is used for all of the following purposes except _____. following are: Performance improvement Public safety law Research
Except >Prosecution of drunk drivers
The HIPAA Privacy Rule states that required reporting is _____ from the HIPAA Privacy Rule.
Exempt
A plaintiff can establish a strict liability case related to product liability simply by proving which of the following?
Existence of a defective condition without having to establish that the condition was caused by a negligent act.
Federal E-SIGN legislation __________.
Facilitates electronic commerce, Gives e-signatures the same legality as handwritten signatures in interstate commerce, Provides guidance on how records may be stored and retained electronically
Who owns the health record of a patient treated in a healthcare facility?
Facility
Which of the following is most likely to result in a security breach?
Failing to deactivate user access at termination
The negligent tort of nonfeasance refers to which of the following statements?
Failure to do an act that a person is under a duty to do and that a person of ordinary prudence would have done under the same or similar circumstances
What law prescribes age limitations on the hiring of children?
Fair Labor Standards Act
A 1999 report by the Institute of Medicine concluded that very few preventable errors lead to patient deaths in hospitals.
False
A Corporate Integrity Agreement is a voluntary compliance program adopted by a healthcare organization.
False
A claim that is resubmitted based on a patient complaint is not a false claim because it was not initiated by the healthcare provider.
False
A corporate compliance officer position is ideally suited to a clerical staff person.
False
A hospital's strongest legal defense is the doctrine of charitable immunity.
False
A purpose of antitrust laws is to discourage marketplace competition.
False
All medical errors are sentinel events.
False
Although desirable, correct documentation in the health record is not necessary to support billing.
False
An incident report should be completed by an individual who investigated a situation and determined its cause.
False
Anonymous reporting of compliance violations should be prohibited because it inhibits open communication.
False
Healthcare abuse relates to a false representation of fact.
False
Incident reports are protected from discovery in all states.
False
Medicare deems all services to be medically necessary if they are ordered by a patient's attending physician.
False
National Patient Safety Goals are optional standards that an organization may choose to meet in order to receive a special designation from the Joint Commission.
False
Patient non-compliance with medical advice should not be documented in the health record because it might upset the patient.
False
Patient-centered care is one of 10 objectives recommended by the Institute of Medicine in 2001 as central to the U.S. healthcare system.
False
Sending a duplicate claim each month to a payer until it is paid is an acceptable billing practice.
False
The Deficit Reduction Act of 2005 made compliance programs voluntary rather than mandatory.
False
The False Claims Act targets anyone who knowingly submits false claims to a private insurance company
False
The Medicare Conditions of Participation encourage restraints in the interest of patient safety
False
Unbundling is a billing practice preferred by payers.
False
This act is used to combat Medicare fraud by penalizing those that submit incorrect information to the program.
False Claims Act
What is the federal government's primary litigation tool for combating healthcare fraud?
False Claims Act
This law establishes criminal penalties for paying to induce business for which payments from federal healthcare programs may be received.
Federal Anti-Kickback Statute
You have been asked to provide a synopsis of the Federal Sentencing Guidelines and provide an overview to the compliance committee. You have been asked to only provide primary sources of the information. The best source for you to explore would be_________.
Federal Register
Corporate compliance programs became common after adoption of which of the following:
Federal Sentencing Guidelines.
Report for a fetal death would be reported on which required form?
Fetal death certificate
Duty of loyalty is one component of __________.
Fiduciary duty
All but which one of the following must be included in a compliance program for HIM personnel?
Financial incentives for coders
Which of the following is not included as a patient responsibility? the following are: Provide full and honest information to providers Show respect for providers and other patients Make good-faith efforts to meet financial obligations
Follow treatment regimen as mandated by the provider
The Safe Medical Devices Act requires the reporting of medical device injuries to which agency?
Food and Drug Administration
If an HIM department act in deliberate ignorance or in disregard to official coding guideline, it may be committing...
Fraud
Define fraud and abuse and provide examples of each.
Fraud is a false representation of a fact, failing to disclose a fact, and/or damage to another party that reasonably relies on misrepresentation or failure to disclose. Ex. performing medically unnecessary services or accepting kickbacks for patient referrals Abuse specifically refers to provider, supplier, and practitioner practices that are inconsistent with accepted sound fiscal, business, or medical practices. Ex. unnecessary costs to a program or improper payment.
The Hill-Burton Act is significant because it did which of the following?
Funded hospital construction and modernization
In some states if an individual has filed a Workers Compensation claim, who may access the individual's health information without the individual's authorization? a. patient's employer b. employer's insurer c. employer's attorney d. employee's attorney e. a, b and c f. b and c g. all of the above
G
An underwriter at the Thompson Insurance Agency received health information on Mrs. Blake, who is applying for health and life insurance through the agency. Upon review of Mrs. Blake's health information, the underwriter finds documentation that indicates Mrs. Blake has the gene that is known to increase a woman's chances of developing breast cancer. Based on this finding, the underwriter denies Mrs. Blake's request for insurance. What federal law is this underwriter breaking as a result of his decision?
GINA
Mary Jones is being considered for a position as the coding coordinator for University Hospital. In checking her background, Susan in HR discovers that Mary carries the trait for cystic fibrosis and thus is concerned if she hires Mary that Mary's children would have the disease, it could result in the hospital's insurance rates to increase. What specific law is Susan violating if indeed she does not hire Mary because of this situation?
GINA
When Greg was released from Metro Hospital substance abuse inpatient facility, he authorized his records to be released to General Hospital, where he had his knee replaced. Greg's physical therapist has requested copies of his health record from the hospital. General Hospital releases Greg's information from Metro Hospital along with its own information to the physical therapy service. Select the statement that best addresses this situation.
General Hospital has violated redisclosure regulations by releasing the records from Metro Hospital to Physical Therapy Services.
When a physician or other healthcare professional renders care to another individual at a scene of an accident, the healthcare provider is usually not held liable for civil damages for acts or omissions of rendering care based on what form of state statue?
Good Samaritan Statute
Mary Jones stopped to help an individual who was in a car crash. The individual later brought a civil case against Ms. Jones alleging she contributed to injuries the person received at the site of the accident although Ms. Jones had nothing to do with the accident. What defense from liability may Ms. Jones rely on in this situation?
Good Samaritan immunity
What federal legislation enables Tom to request that his health information be restricted and not disclosed to a health plan for payment or operations purposes because he paid for the service completely out of his pocket?
HITECH
Bellville Community Hospital was required to provide a reasonable amount of uncompensated care under the Hill-Burton Act because it____
Had received federal money for construction and modernization
What term best describes an organization that has been formed to create an electronic framework that connects hospitals, physicians, pharmacies, and other healthcare entities for the purpose of sharing patient information?
Health information exchange
To which of the following does GINA apply?
Health insurers
Healthcare organizations should implement medical identity theft prevention programs because they are ______
Helpful to protect patient information
Mr. Thompson was working on his roof and fell off, sustaining a severe head injury that has left him in a coma. Before he fell from the ladder, he and his wife were in the process of getting a divorce. However, the divorce was not final. Which statement best describes the circumstance regarding who may authorize access to Mr. Thompson's records?
His wife may authorize access because she is next of kin and they are still married.
"Piercing the corporate veil" refers to __________.
Holding corporation owners liable for illegal acts
When competitors agree to fix prices to divide the market, they are committing __________.
Horizontal restraint of trade
What outcome stems from the Kadlec Medical Center v. Lakeview Anesthesia Associates case heard by the Louisiana Federal Court?
Hospitals have a duty to disclose information about their current or former medical staff members to other healthcare providers in order to protect future patients when a physician moves on.
IRS requirements for corporate articles of incorporation include all of the following except __________.
How much revenue the corporation expects to generate
With addressable standards, the covered entity may do all but which of the following?
Ignore the standard since it is addressable
Mr. Jones only asks individuals of Hispanic descent for employment verification. In doing so what law is Mr. Jones violating?
Immigration Reform and Control Act
The HIPAA Security Rule allows flexibility in implementation based on reasonableness and appropriateness. This means that covered entities can___________.
Implement based on organizational assessment
Which of the following is not a HIPAA individual right?
Import PHR content into the provider's health record
The significant difference between an organization's compliance program and a corporate integrity agreement is that a corporate integrity agreement is_________.
Imposed by the federal government and required for the organization
The negligent tort of misfeasance refers to which of the following statements?
Improper performance of an act that a person might lawfully do or active misconduct that causes injury to another
Courts apply the rule of reason analysis __________.
In the absence of per se antitrust violations
What is the data collection tool used by risk managers to gather facts about a potentially adverse event?
Incident report
What tool is used by a risk manager for capturing data about an adverse event?
Incident report
If parties to a contract agree to hold each other harmless for each other's actions or inactions, this is referred to as a(n) __________.
Indemnification
Challenges to tax-exempt corporations operating with a charitable purpose include all of the following except __________.
Inflated billing practices toward the insured
Several weeks after the discharge of a patient, the attending physician comes to the HIM director and requests access to enter a progress note in the record. The HIM director denies the request since the record is closed. She then reviews the record and notices documentation of the family expressing concerns about the care and interaction with the doctors and nursing staff. Which of the following should the HIM director do?
Inform the risk manager about the physician's request.
Which of the following is a public interest and benefit exception to the HIPAA authorization requirement?
Information on domestic violence
At Frank's recent medical appointment, his physician provided information to Frank, but Frank made his own treatment decisions. This situation describes what type of relationship?
Informative
One of the four general requirements a covered entity must adhere to for compliance with the HIPAA security rule is to ensure the confidentiality, ________, and availability of ePHI.
Integrity
Which of the term does the security rule use to define data or information that has not been altered or destroyed in an unauthorized manner?
Integrity
Which of the following is a potential consequence to the medical identity theft victim?
Intermingling of the victim's and perpetrator's medical information ______ Insurance denials Debt collection attempts
The patient-provider relationship that involves shared decision-making is_________.
Interpretive
Which of the following is a best practice to comply with the revised security provisions of the HITECH Act?
Inventory BAs to determine which Business Associates Agreements need amending.
The community benefit standard____
Is required for tax-exempt status
Assessing HIPAA training programs is important for which of the following reasons?
It is how the workforce knows what to do. It is highly visible to auditors.
Which of the following is true of health record destruction?
It is permitted pursuant to an approved retention schedule and destruction policy
Which of the following is a reason for not using e-mail to communicate sensitive patient information?
It may be intercepted. The identity of the recipient may be unclear. It may consist of large amounts of data.
What is an effect of Christy's access to a patient health information portal?
It provides her with increased, timely access to her health information
Jack is a paramedic and recently assisted at a car accident where several individuals were hurt and had to be taken to the hospital for treatment. One victim had extensive injuries and there was a great deal of blood that Jack was exposed to as a result of assisting with this patient. As a result Jack has requested the results of an HIV blood test on the victim that he cared for. Which statement(s) below is (are) most likely correct in terms of Jack's request?
Jack may have the right to access the results based on state law permitting emergency personnel exposed to blood access to HIV test results of the person they assisted.
Johnny is 12 and his parents are divorced. He is living with his father, who has legal custody of Johnny. In order for Johnny to receive medical treatment, generally, __________.
Johnny's father as parent with legal custody would consent
Katie is 13 years old and lives with her mom who has custody of Katie since her parents are divorced. Katie has recently been in the hospital, and her mother is now seeking a copy of Katie's health record. Who must sign the authorization form that will enable Katie's mother to access Katie's record?
Katie's mother because she has custody of Katie
In order for an incident to be considered a false claim act violation, the healthcare provider must actually submit a false claim and meet the ________ standard.
Knowing
Which of the following is a defense doctrine used by HIT vendors?
Learned intermediary
Which of the following statements true regarding the doctrine of concept of charitable immunity?
Lost significance as a defense as a result of the Darling case
Which of the following types of activities is not one that should be audited and monitored in a compliance program?
Low risk
The following reporting exceptions to the doctrine of preemption are allowable except for which of the following?
Marketing
"Against medical advice" discharges_________.
May result, if prohibited by the provider, in a battery claim against the provider
A healthcare decision to provide services that a physician deems clinically appropriate based on generally accepted standards of medical practice is known as_________.
Medically necessary
Services that are statutorily non-covered by Medicare can be located on the:
Medicare Notice of Exclusions From Medicare Benefits.
When a state requirement exists that compels a healthcare facility to report patient information and there is an absence of specific data elements required for reporting, what should be disclosed?
Minimum necessary information
Marty Jones has been out of work for three months and has recently applied for a position at a local factory. As part of the employment process, the employer has asked Mr. Jones to complete a pre-employment physical that includes genetic testing for any diseases that might interfere with Mr. Jones' ability to run an expensive piece of factory equipment. Of the options below what is the best option?
Mr. Jones informs the employer that GINA regulations prohibit employers from requiring genetic information as part of the employment process.
As the director of a health information management department, Mrs. Smith is considered part of the hospital management structure, thus is not entitled to overtime pay. Under the Fair Labor Standards Act, how would you classify Mrs. Smith in terms of her employee status and pay?
Mrs. Smith is classified as an exempt employee.
What major accommodation must a healthcare organization make for a patient who is identified as a LEP person?
Must provide an interpreter
Physicians __________.
Must treat only individuals with whom they have a physician-patient relationship
Which of the following pieces of information is not typically mandated by state law child abuse reporting requirements?
Name of siblings
What initiative was developed to promote correct coding of healthcare services in an effort to prevent Medicare payment for improperly coded services?
National Correct Coding Initiative (CCI)
What independent agency at the federal level safeguards employee rights to engage in union activity?
National Labor Relations Board
Teresa is a billing advocate. NetHealth is an insurance company. StarServe is a provider. Bob is a patient. Which of the following roles will Teresa serve?
Negotiating with StarServe to lower Bob's medical bills
Which of the following statements is not part of the EMTALA regulations? the following are: Every patient arriving at the emergency department must receive an appropriate medical screening exam If an emergency medical condition exists, the hospital must treat and stabilize the emergency condition or transfer the patient Transfers of non-stabilized patients must only occur under certain specific conditions
Non-Medicare, indigent patients must be transferred to the nearest Level 1 trauma center
The EMTALA regulations include all but which of the following?
Non-Medicare, indigent patients must be transferred to the nearest Level 1 trauma center.
Mrs. Bolton is an angry patient who resents her physicians "bossing her around," refuses to take a portion of the medications that the nurses bring to her pursuant to physician orders, and is verbally abusive to the patient care assistants. Of the following options, the most appropriate way to document Mrs. Bolton's behavior in the patient medical record is __________.
Non-compliant and hostile toward staff
Common data reported to the medical examiner in cases of reportable deaths typically includes all but which data element?
Number of children
Which of the following personnel should be authorized, per hospital policy, to take a physician's verbal order for the administration of medication?
Nurse working on the unit where the patient is located
The newly remodeled HIM department has unprotected wires from two desktop computers running across the aisle in the front of the department. What law is the director of the department adhering to when he works to have the wires placed below the floor?
OSHA
Which of the following would constitute a violation of the Federal Trade Commission Act?
Offering misleading prices
Which government office has the responsibility for enforcing the confidentiality provisions of the Patient Safety Rule as it relates to PSO?
Office of Civil Rights
A competent adult female has a diagnosis of ovarian cancer and while on the operating table suffers a stroke and is in a coma. Her son would like to access her health records from a clinic she recently visited for pain in her right arm. The patient is recently divorced and lives with her two grown children. According to the Uniform Health-Care Decision Act (UHCDA), who is the logical person to request and sign an authorization to access the woman's health records from the clinic?
Oldest adult child
Which of the following facilities must report information about implantable cardiac defibrillators?
Only hospitals seeking reimbursement
The American Hospital Association's Patient Care Partnership was originally called the:
Patient Bill of Rights.
The American Hospital Association's Patient Bill of Rights became the____
Patient Care Partnership
What legislation encouraged clinicians and hospitals to voluntarily report their confidential quality and patient safety data on events that adversely affect patients?
Patient Safety and Quality Improvement Act
EMTALA was passed in response to the problem of_________.
Patient dumping
An advance directive is used to direct an individual's healthcare wishes in the event of __________.
Patient incapacitation
Which of the following is an example of an adverse patient outcome?
Patient receives wrong medications in IV.
Security awareness training programs require the implementation of awareness and training of all workforce members and should include___
Periodic security reminders
In general, reviews for compliance with various aspects of the security rule should be conducted___________.
Periodically
Which of the following information is not included about a physician in the National Practitioner Data Bank?
Personal bankruptcy
A wife who is legally authorized to make healthcare decisions and act on behalf of her husband, who is a patient, is acting in what capacity?
Personal representative
Which of the following is not a purpose of a risk management program?
Prediction of an unfavorable deviation from expectations
The legal term used to describe when a patient has the right to maintain control over certain personal information is referred to as: A) access B) confidentiality C) privacy D) Security
Privacy
When developing security procedures for remote workforce, the HIM director should reference which of the following?
Privacy and security rules, state statutes and other federal statutes
What protects confidential communication from disclosure between a doctor and patient related to diagnosis and treatment during civil and some criminal misdemeanor litigation?
Privilege statutes
Mary Smith has gone to her doctor to discuss her current medical condition, what is the legal term that best describes the type of communication that has occurred between Mary and her physician? A) closed communication B) open communication C) private communication D) privileged communicated
Privileged Communication
If a healthcare provider is accused of breaching the privacy and confidentiality of a patient what resource may a patient rely on to substantiate the provider's responsibility for keeping health information private? A) professional code of ethics B) federal code of fair practice C) federal code of silence D) state code of fair practice
Professional Code of Ethics
Which of the following was a precursor to quality improvement organizations?
Professional Standards Review Organization (PSRO) and Peer Review Organization
The Sherman Act __________.
Prohibits concerted activities with the goal of restraining trade
In general, the three federal antitrust statutes seek to __________.
Protect the public against monopolies that control a market
The HIPAA Security Rule requires which of the following to achieve compliance?
Protecting ePHI
Middleburg Hospital recently purchased new protective safety needles for use with routine intramuscular injections. However, the number of needle sticks has increased 20 percent since the purchase of the needles. What should the risk manager do?
Provide re-training on the use of the needles.
All of the following are goals of the ZPICs except for _________.
Provide training and education
Who owns the health record? A) patient B) provider who generated the information C) insurance company who paid for the care recorded D) no one
Provider who generated the information
What term describes when an employee suspects that proper billing practices are not being followed and then reports this to the appropriate individuals?
Qui tam
AHIMA recommends that documents of health record destruction include all of the following except __________.
Reason for destruction
The release of information manager at Hope Hospital has received a request to obtain copies of an individual's recent hospitalization for spousal abuse. Upon reviewing the request, the manager notices that the signature on the request does not look like the patient's signature on the informed consent in the patient's medical record. What would be the best course of action?
Refer the request to the hospital's medical identity theft committee to ascertain if this is indeed the patient requesting the information.
Which of the following is not a designated health service under the Stark Law?
Referrals to specialty care providers
Five years ago, 75 percent of cardiac patients in Hart County sought services at Regency Health because of the national reputation of the skill of its medical staff. Now, five years later, 80 percent of cardiac patients in Hart County seek services at Regency Health because of its continued national reputation and the completion of a new cardiac outpatient center. Which of the following statements is true?
Regency Health's actions may not be antitrust violations because of the superior skill of its medical staff.
Which of the following health information handlers are required to provide authorization for access and disclosure of PHI.
Release of information Contractor
Telephone callback procedures are used primarily for __________.
Remote employees
Quality Improvement Organizations (QIOs) are responsible for all of the following except_______.
Requiring every facility to use the same software for data collection
The burden of proof falls upon the defendant, contrary to the usual burden of proof requirement, except in cases that apply this principle __________.
Res ipsa loquitur
What is the term used to denote the liability of an employer for the acts of its employees?
Respondeat superior
Medicare requirements pertaining to seclusion and restraint___
Restrict their use
Which of the following entity authentication processes would be the most difficult to breach?
Retinal scan
What statement best describes the responsibility of a healthcare provider who receives an overpayment from a health plan?
Return the payment to the health plan
The lead coder in the HIM department is an acknowledged coding expert and is the go-to person in the organization for coding guidance. As the HIM director, you learn that she is not following proper coding guidelines and her coding practices are not compliant. The best steps to take would be which of the following?
Review the coding errors and counsel the employee.
In a risk management process, what technique is aimed at preventing or reducing the chances and effects of a loss occurrence?
Risk control
What term refers to the systematic means of determining potential losses in a risk management process?
Risk identification
The role of the risk manager is best described by which of the following statements?
Risk managers try to identify exposure before occurrences
Uniform access to patient information for all nursing staff best describes ___.
Role-based access
The most common place to find intrusion detection software would be on the network ___
Routers
For which of the following conditions would a minor most likely be able to consent to treatment on his own behalf?
STD
Which of the following is not an example of a private or governmental group focused on quality?
Safe Practices for All
Crossing the Quality Chasm: A new Health System for the 21st Century identified the need for healthcare to be______.
Safe, patient-centered, efficient, effective, equitable, timely
Dr. Watson is known to chronically not remember his password and ask other physicians and nurses to use their passwords. This is reported by various staff, but the security officer ignores the complaints since Dr. Watson is the chief of staff. The hospital most likely has not complied with which of the following?
Sanction policy
Which of the following applies to the joint actions of two parties conspiring to restrain trade?
Section 1 of Sherman Act
What is the legal term used to describe the physical and electronic protection of health information? A) access B) confidentiality C) privacy D) security
Security
The Medicare Conditions of Participation __________.
Set forth health record content requirements
Which statement best describes the right of a mother about the reporting of her child's birth?
She may request an account of the disclosure about the birth.
When a hospital denies hospital privileges, to an otherwise qualified physician, for the purposes of limiting the competition for that physician's services what law is the hospital violating?
Sherman Antitrust act
Dr. Jones and Dr. Smith own a medical practice that has existed as a general partnership. They wish to incorporate. Advantages of incorporating include __________.
Shielding Dr. Jones and Dr. Smith from personal liability and Allowing the practice to continue to exist even if Dr. Jones or Dr. Smith dies
A countersignature __________.
Signifies review of a first provider's actions and documentation
The Uniform Health-Care Decisions Act ranks the next-of-kin in the following order for medical decision-making purposes:
Spouse, adult child, parent, adult sibling
The federal physician self-referral statute is also known as the
Stark Law.
Healthcare facilities are required to report vital statistics to which of the following authority?
State department of health
Responsibility for completing a fetal death certificate is determined by _____.
State law
When determining which immunizations must be reported, which of the following would you refer to first?
State reporting requirements
Which of the following is not an example of a high-risk area for fraudulent billing practices that HIM professionals are responsible for?
Submitting duplicate claims for the same encounter
Examples of reportable deaths include which of the following?
Sudden, unexpected, violent, suspicious
The Uniform Photographic Copies of Business and Public Records as Evidence Act (UPA) __________.
Supports the admissibility of reproductions into evidence with stipulations
What is the term used when public health departments engage in the systematic gathering and analysis of health data which may include PHI to detect a bioterrorism threat or an outbreak of Ebola?
Syndromic surveillance
Which federal law mandated the creation of recovery audit contractor services?
Tax Relief and Health Care Act.
What is the not-for-profit, nongovernmental entity that offers voluntary accreditation programs for all types of health care organizations?
The Joint Commission
When comparing the HIPAA-defined designated record set with the legal health record, which of the following is correct?
The designated record set is wider in scope than the legal health record.
Ownership of a secondary data source such as a hospital trauma registry belongs to _____.
The entity that created it
When ownership of a physician practice changes, __________.
The health records of the practice may be transferred as assets
What is the role of the health record in risk management programs?
The information in health records is relied upon to determine things such as whether standards of care were followed, the extent of a patient's injuries, and what caused those injuries.
The medical staff at Regency Health is nationally renowned for its skill in performing cardiac procedures. The nursing staff in the cardiac unit has noticed a significant lack of informed consents prior to the performance of certain procedures. Administration at the facility should reinforce that __________.
The physician responsible for the procedure obtain informed consent
Mrs. Davis is preparing to undergo hernia repair surgery at Deaconess Hospital. Who is responsible for obtaining Mrs. Davis's consent for this procedure?
The surgeon should obtain Mrs. Davis' informed consent.
Risk management and quality improvement programs are related because of which of the following reasons?
They share similar underlying processes.
A claims management program should include the retention of all insurance policies.
True
A corporate code of conduct expresses an organization's commitment to ethical behavior.
True
A qui tam action involves whistleblowers who file a complaint alleging fraud against the government.
True
A review of patient complaints can assist in the risk identification process.
True
A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.
True
Billing for services never rendered is one of the most common types of healthcare fraud.
True
CPT codes that should not be billed together are listed in Medicare's Correct Coding Initiative.
True
Darling vs. Charleston Community Memorial Hospital is a landmark case that extended negligence liability to hospitals.
True
EMTALA was passed by Congress to combat transfer and discharge of patients, and refusal to treat, based on inability to pay.
True
Establishing the frequency or severity of a particular loss occurring is part of the risk treatment process.
True
Federal Sentencing Guidelines encourage organizations to have fraud prevention and detection programs in place.
True
Fraudulent billings practices are a major compliance risk area for healthcare organizations.
True
In addition to recognizing patient rights, many hospitals have adopted codes of patient responsibility.
True
In its definition of "referral," the Stark Law excludes a request by a radiologist for diagnostic radiology services.
True
Joint Commission accredited organizations are expected to complete a root cause analysis following a sentinel event.
True
Pay for performance provides incentives to healthcare providers to deliver high-quality care.
True
Quality Improvement Organizations provide consultation and quality improvement resources to a wide range of providers.
True
Quality and risk management programs have evolved concurrently.
True
Risk management focuses on an organization's financial liability.
True
State healthcare fraud and abuse laws apply to all payers.
True
The American Hospital Association's Patient Bill of Rights is now the Patient Care Partnership, which focuses on patient expectations, rights, and responsibilities.
True
The False Claims Act utilizes a knowing standard, which includes acting in deliberate ignorance.
True
The Federal Anti-Kickback Statute targets those who pay, solicit or receive payment in exchange for business that will be reimbursed by a federal healthcare program.
True
The Hill-Burton Act is federal legislation, passed in 1946, that provided hospitals money for construction and modernization.
True
The Leapfrog Group consists of organizations that are responsible for purchasing healthcare coverage for employees.
True
The National Practitioner Data Bank collects malpractice and disciplinary action information on physicians.
True
The Stark Law prohibits physicians from ordering certain health services for Medicare patients from entities in which the physician or immediate family member has a financial relationship.
True
The mission of the Office of the Inspector General for the U.S. Department of Health and Human Services (HHS) is to protect the integrity of HHS programs, and the health and welfare of those programs' beneficiaries.
True
Under the CMP law, a hospital may be excluded from the Medicare program if it's wrongdoing caused harm to an HHS program.
True
What term is used to describe billing practices in which providers use multiple procedure codes instead of a comprehensive code in an attempt to maximize reimbursement?
Unbundling
Which of the following is a good policy for faxing PHI?
Use a cover sheet with a confidentiality statement
Based on the "Red Flags Rule," entities are considered creditors if they ___
Use consumer reports in connection with credit transactions Furnish information to consumer reporting agencies Extend credit
Which of the following is the public or known portion of most user log-ins?
User ID
During the flu season, a nursing home reports the cases of known flu in the nursing home population. The local health department calls and wants more information on the recent hospitalizations of these flu patients. How should the request be handled?
Verify the authenticity of the request and provide information.
The most widely-used feature provided by patient health information portals is_________.
Viewing test results
Under which of the following conditions is Mr. Smith's authorization required for the use and disclosure of his health information? Correct!
When Mr. Smith's attorney is requesting the information
Disabling the USB drive on a computer is an example of what type of security?
Workstation
Which computer virus stores and replicates itself?
Worm
Over a 24hour time period a large number of individuals have arrived in the emergency department of a local hospital complaining of severe abdominal pain, vomiting, and diarrhea that they have all seemed to pick up at a local restaurant in town. The hospital has provided the public health department with the PHI of all patients treated for the illness. Did the hospital have the right to disclose this information?
Yes, the hospital may disclose PHI to a public health department if state law does not specifically require it if the disclosure is for controlling the spread of disease.
Zach is 14 years old and consented to completing a three-month drug rehabilitation program. When he completes the program, who has the right to authorize the release of his health information to another party?
Zach
Except as provided by law, who controls access to a patient's health information by third parties such as insurance companies? answers are : Patient Patient's legal representative .
a and b only
An example of a documentation indicator in a health record, signaling a problem, is:
a correction in a record is obliterated so that only the newly added and correct information appears
If an HIM department receives gifts from vendors in exchange for purchasing a specific encoder software, this is:
a kickback.
Mia is a 16 year old pregnant female who plans on having an abortion. Mia has the right to choose who her health information may be released to. What other healthcare situations exist that give Mia the right to authorize release of her healthcare information?
a, b, and c Mental health Substance abuse Veneral diseases
All of the following statements are true in regard to Patient Safety Organizations except _______ .Collect, analyze and aggregate patient safety data Serve local, regional and national adverse event data collection needs Created and monitored by AHRQ
a, b, c and d
Under federal drug and alcohol abuse regulations, what situation enables the disclosure of patient information without patient written authorization?
a, c, and d Audits ,Program evaluation , and Scientific research
Alison, who is a competent adult, has consulted her physician for chronic right upper quadrant pain. Her physician recommends an elective cholecystectomy. In this case, who must consent to the operative procedure?
alison
Which of the following sources should be checked to verify the credentials of an individual seeking staff privileges at a hospital? medical school transcripts National Practitioner Data Bank Office of the Inspector General
all of the above
submission of incorrect medicare calims is due to
all of the above
the OIG has issued specific compliance guidance for the following entities
all of the above
Why would an enterprise risk management approach be important to an integrated hospital system?
all of the options are correct
Regarding life-sustaining treatment and a patient's right of self-determination, courts have generally held that __________.
an incompetent adult has a right to withdrawal of medical treatment if while competent, had expressed his/her wishes and the state now determines that the evidence of those wishes is sufficient and An emancipated minor has the right to refuse medical treatment
The Americans with Disabilities Act:
applies to impairments that substantially limit major life activities.
What medical staff membership classification grants all responsibilities of medical staff membership and all privileges but does not allow the member to serve as medical staff officers or chair medical staff committees?
associate
A security procedure that causes a computer session to end after a predetermined period of inactivity is a(n)
automatic log-off
which of the following is not an example of a false claim
billing for covered services
Which if the following is not an example of a false claim?
billing for covered services.
Jason is considered a nonexempt employee in his role as a release of information clerk. What requirement must the healthcare organization add in regard to this nonexempt status? Must be paid at least minimum wage up to 40 hours a week Must maintain accurate time records
c and d
Which of the following statements are true? Some risks may have a low probability of occurrence but a catastrophic impact. Data from quality improvement activity may help in reducing and preventing risk.
c and d
The following legal doctrine was widely recognized by the courts until the landmark ruling of Darling v. Charleston Community Memorial Hospital was issued.
charitable immunity
In the Cruzan case, the court held that a person cannot assume end-of-life decisions on behalf of an incompetent person without _________ evidence that the person would refuse the continuation of life-sustaining treatment.
clear and convincing
Emergencies are an exception to the consent requirement for __________.
competent adults, married minors, incapicapted adults
Community Hospital and Mercy Hospital created a new corporation, Community-Mercy Hospital, Inc. Community Hospital and Mercy Hospital each ceased to exist as individual organizations. The process that has taken place is __________.
consolidation
Jerry Jones was a patient who presented with a very unusual set of symptoms that only one physician in the community was capable of treating, Dr. Drake. Dr. Smith, Jerry's doctor, contacted Dr, Drake who did not have admitting privileges at the hospital and requested Dr. Drake's input in treating Jerry. What medical staff classification category would enable Dr. Drake to assist with Jerry's care?
consulting
What medical staff membership classification allows for limited number of hospital admissions without the responsibilities of membership?
courtesy
The National Practitioner Data Bank is associated most closely with which hospital function?
credentialing
Which of the following terms denotes the form of monetary compensation a court may award to an individual in a civil action who has been injured by another party?
damages
A tortfeasor refers to which individual in a legal court case?
defendent
To ensure compliance with the HIPAA security rule training requirement, the HIIM Director should do which of the following?
determine special needs of HIM staff and provide training
If a physician coerces a patient into undergoing experimental treatments, the contract between them may be void based on which defense for nonperformance?
duress
What term best describes the situation when a physician is denied medical staff privileges because his specialty is not a big money maker for the healthcare organization?
economic credentialing b. monetary credentialing
Darling v. Charleston Community Memorial Hospital is most often credited for:
eliminating the doctrine of charitable immunity.
The workforce security administrative safeguard requires policies and procedures that
ensure appropriate ePHI access by workforce members prevent access to ePHI by workforce members who should not have access
A young child is killed by a hit-and-run driver. The case is reported to the medical examiner for all of the following reasons except _____. following are: Suspicious death Unexpected death Violence that caused death
except )Age of the child
The OIG states that insufficient or missing documentation and which one of the following are responsible for 70% of bad claims submitted to Medicare.
failure to document medical necessity
unbundling refers to
failure to use a comprehensive code to inapproprately maximize reimbursement
Unbundling refers to:
failure to use a comprehensive code to inappropriately maximize reimbursement.
this act is used to combat medicare fraud by penalizizing those tha tsubmit incorrect information to the program
false claims act
Which of the following are factors that influence health record retention periods?
federal and state laws, Costs of retention, Statutes of limitations
the law esablishes criminal penalties for paying to induce business for which payment from federal healthcare programs may be received
federal anti-kickback statute
corporate compliance programs became common after adoption of which of the following
federal sentencing guidlines
What is the term used to describe a time-limited period during which an organization evaluates and determines a practitioner's professional performance of privileges?
focused professional practice evaluation
If an HIM department acts in deliberate ignorance or in disregard to official coding guideline, it may be committing:
fraud.
Consent forms that allow for the performance of routine services by healthcare providers are __________.
general consents
Who is ultimately responsible for ensuring medical staff members how are not physicians are qualified to practice in facility?
governing board
When a competent adult refuses treatment, a court may be required to balance the individual's privacy interests against __________.
governments interest in protecting human life
Authentication methods include __________.
handwritten signature, Rubber signature stamp, electronic signature
The OIG has issued specific compliance guidance for the following:
hospitals. clinical laboratories. home health agencies. (all of the above)
The Joint Commission's quality improvement activities for health record documentation include all but which of the following core performance measures for hospitals:
hypertension.
Janice arrives at her physician's office for her 10:30 scheduled appointment and pays her office visit copayment. Her physician examines her. Based on these facts, Janice's consent is __________.
implied
Which of the following information would you not expect to find on an application for medical staff privileges?
income tax paid in last year
A statute of limitations may begin to run when _________.
injury was discovered, injury occurs, injured party reaches the age of majority
If an HIM deparment recieves gifts vendors in exchange for purchasing a specific encoder software, this is...
kickbacks
Submission of incorrect Medicare claims is due to:
lack of physician understanding of Medicare coding, documentation and billing guidelines. failure of healthcare facilities to invest time and resources in education related to coding, documentation and billing. complexity and changing nature of Medicare rules. (all of the above)
What is the legal term that refers to the legal obligation or responsibility of Dr. Smith to owe his patient money as a result of a lawsuit the patient has won against Dr. Smith for negligence?
liability
What type of defamation of character occurs when a false communication is made in writing about an individual?
libel
Which of the following communicable diseases is typically not required to be reported? following are: ebola syphilis yellow fever
lice
the deficit reduction act of 2006
made compliance programs mandatory
The Deficit Reduction Act of 2006:
made compliance programs mandatory.
Healthcare abuse relates to practices that may result in:
medically unnecessary services
healthcare abuse relates to practicces that may result in
medically unnecessary services
services that are statutorily non covered by medicare can be located in the
medicare notice of exvlusions from medicare benefits
General Hospital is a 250-bed facility. Mercy Hospital is a 250-bed facility. They join to form one corporation, which is named General Hospital. The restructuring that has most likely occurred is a(n) __________.
merger
Dr. Harvey has changed a piece of data in a patient record. The information that tracks this change and enables a jury to see this change in a medical malpractice action is called __________.
metadata
Which of the following best describes the role that the HIIM professional should play in HIPAA security compliance?
moderate involvement since the rule is very operational
Tax-exempt organizations must be __________.
not for profit
If a healthcare facility sustains physical damage caused by a tornado, the disaster recovery mechanism which provides the greatest protection of the data is ____
off-site data storage
Which of the following is/are required for a legal contract to be formed?
offer, Legally competent parties, consideration
The OIG staes that isufficient or missing documentation and which one of the following are responsible for 70 percent of bad claims submitted to medicare?
overcoding
Any data, reports, records or written or oral material developed by a provider or a PSO for patient safety purposes is protected from discovery if it is identified as a _______.
patient safety work product
In its record retention schedule, AHIMA recommends that the master patient index be retained __________.
permanently
the OIG has specific compliance guidance for all of the following entities except
pharmacies
The OIG has specific compliance guidance for all of the following entities except:
pharmacies.
What is the process followed when a medical staff credentialing coordinator obtains an official certified transcript directly from the medical school in which an applicant has graduated?
primary source verification
Which of the following has/have initiatives in place to reduce medical errors and improve patient safety?
private organizations state government federal government (all of the above)
the stark law
prohibits physicians from ordering from entities that they have financial relationship with
The Stark law:
prohibits physicians from ordering from entities that they have financial relationship.
Fred resigned from his position at University Hospital. According to the HIPAA security rule, his access to the electronic health record system should be terminated
promptly upon resignation
The Hill-Burton Act:
provided hospitals with money for construction and modernization.
responsibility for the fillinf of accurate claims ultimately belongs to the
provider
Coding and billing documentation must be based on the:
provider's documentation.
Responsibility for the filing of accurate claims ultimately belongs to the:
provider.
coding and billing documentation must be based on the
providers documentation
Risk analysis involves the consideration of:
quality thresholds.
Healthcare fraud and abuse laws provide a whistleblower provision also known as:
qui tam
healthcare fraud and abuse laws provide a whistleblower provision also know as
qui tam
Which of the following types of activities is not one that should be audited and monitored in a compliance program?
referrals
which of the following types of activities is not one that should audited and monitored in a ocmpliance program
referrals
The role of the National Practitioner Data Bank in quality improvement can best be described as which of the following?
reporting providers with adverse actions
Quality improvement organizations (QIOs) are responsible for all of the following except:
requiring that personal health records are used by every facilities.
With regard to seclusion and restraint, federal laws:
restrict their use.
Examples of high risk billing practices which create compliance risks for healthcare organizations include all but which of the following?
returned overpayments
examples of high risk billing practices which create compliance risks for healthcare organizations include all but which of the following
returned overpayments
In a risk management program, what process involves identifying which risks should be proactively addressed, and which risks are low priority?
risk analysis
The systematic means of determining potential losses defines the process of:
risk identification.
Mary is contemplating triple bypass surgery. Informed consent by her surgeon would typically contain which of the following elements?
risks associated with the behavior, Purpose of proposed procedure, non invasive treatment options
Exceptions to the federal anti-kickback statute that allow legitimate business arrangments and are not subject to prosecution are
safe habors
Exceptions to the Federal Anti-Kickback Statute that allow legitimate business arrangements and are not subject to prosecution are:
safe harbors.
The Institute of Medicine objectives for improvement include:
safety, timeliness, efficiency, effectiveness, equitable, patient-centered care (STEEEP).
Active physicians on a hospital medical staff have an obligation to perform all of the following duties except
select (hire) the chief executive officer (CEO)
Which of the following is not a purpose of the health record?
serve as a legal document, Provide proof of services for reimbursement, Serve as a communication tool among providers
A sentinel event in a Joint Commission accredited facility is _______.
signals the need for immediate investigation and response by the organization.
A sentinel event in a Joint Commission accredited facility is:
significant and should be investigated and evaluated every time it occurs.
What type of defamation of character occurs when a false oral communication is made about an individual?
slander
What legal concept maybe applied when Dr. Smith failed to prescribe the appropriate treatment for a patient that would have been prescribed by any other physician in a similar situation treating a patient with a similar condition?
standard of care
the federal physician self referral stature is also known as the
stark law
Risk management programs are more commonly governed by:
state law.
The legal health record must meet standards as defined by the following:
state laws, federal regulations, Accreditation body standards
When external reviewers request access to electronic patient records, the IT professionals at Charity Clinic determine that giving the reviewers a user name and password to access all records in the database is the quickest and easiest approach. As the HIIM Director, your response to this would be to
suggest records necessary for audit be placed in a queue
which federal law mandated the creation of recovery audit contractor services
tax relief and health care act
The Fraud Enforcement and Recovery Act expands:
the government's investigative powers.
the fraud enforcement and recovery act expands
the governments investigative powers
After an adverse patient event, which of the following should occur with regard to the health record?
the health record should be secured
The Joint Commission's safety goals include:
time-outs prior to procedures. use of at least two patient identifiers. read-back of verbal orders. (all of the above)
Which of the following terms denotes a civil wrongdoing for which the law will provide a remedy in the form of a law suit to recover damages?
tort
A subcontractor of a business associate may
transmit ePHI on the business associate's behalf if it provides satisfactory assurances that the information will be appropriately safeguarded
The purpose of root cause analysis (RCA) is to:
understand the causes of a sentinel event.
healthcare fraud is all but which of the following
unnecccessary costs to a program
Healthcare fraud is all but which of the following:
unnecessary costs to a program.
Which of the following is a statement made by one party to induce another party to enter into a contract?
warrenty
Pay for performance:
will encourage better health outcomes.
Express contracts are __________.
written or spoken
Which of the following gives information to be classified as a reviewable sentinel event, according to The Joint Commission?
wrong leg amputated during surgery
What are the essential areas that should be included in a compliance program for an HIM department?
• Code of Conduct • Designation of a Compliance Officer or Contact • Policies and Procedures • Education and Training • Open Lines of Communication • Auditing and Monitoring • Offense Detection and Corrective Action Initiatives • Enforcing Disciplinary Standards through Well-Publicized Guidelines
