Essential of Healthcare Compliance Practice Test

These questions are part of the practice quiz. Start practicing

• What is an essential step in an audit process?
• What should the notice of due diligence to Filene include?
• Before writing policies and procedures, what must be done with the laws?
• Which entity is NOT a source for updates to the compliance plan?
• What is essential for a policy document to include related to non-compliance?
• What is the primary purpose of external audits?
• Under HIPAA, what must covered entities obtain from patients regarding the notice of privacy practices?
• What assurance should be given to anyone reporting non-compliance?
• What was the purpose of creating the National Practitioner Data Bank?
• What does a Do Not Resuscitate (DNR) order signify when signed by a patient?
• How should compliance procedures be integrated into an organization’s workflow?
• What does restitution require a person to do?
• Which organization primarily oversees the enforcement of HIPAA regulations?
• Which component is included in the Seven Steps of Due Diligence?
• The audit report indicating coding for coverage on claims for friends suggests what type of violation?
• Which conditions are classified as superconfidential information?
• What legal mechanism allows individuals to report false claims against the government?
• When do external audits performed by agencies like OIG typically occur?
• Who should be listed on the claim form for the National Provider Identifier (NPI)?
• Why might a healthcare facility require a thorough background check for employees?
• Compliance risk assessments are typically conducted to identify:
• Facilities should ensure that staff members have access to what type of document regarding policies?
• A finding that a large percentage of claims were undercoded indicates what type of problems?
• What role does documentation play in disciplinary actions?
• What is the primary focus of the False Claims Act?
• What types of healthcare facilities can be subject to external audits?
• What type of nature should policies maintain?
• When assessing a complaint, what is the expected first step?
• When might balanced billing be illegal?
• Qui Tam is also known as?
• What kind of act is known as the Whistleblower Protection Act?
• What does the acronym PRA represent?
• What is a consequence of having irrelevant training sessions for staff?
• Which act allows patients to receive information on their health care decisions?
• Integrity is best defined as a personal characteristic of someone who has:
• What must clinicians ensure about patient documentation?
• Which organization is responsible for investigating fraud?
• What must policies clearly explain regarding non-compliance?
• What does 'balance billing' involve?
• Statistics pulled from patients' records may be utilized to:
• 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?
• Civil monetary penalties (CMP) can be assessed when which of the following occurs?
• What is NOT included in proper planning for large projects?
• What does the acronym PHI stand for in healthcare?
• What information should an informed consent form include?
• How may the results of an audit affect processes?
• Which type of condition must be reported by law?
• DRG creep in hospitals is similar to which fraudulent activity?
• Why is compliance training important for healthcare staff?
• Investigations into fraud and abuse are also known as:
• Which principle is essential in ensuring healthcare compliance among staff?
• What can violation of HIPAA result in?
• What is a Certificate of Medical Necessity primarily used for?
• What term describes having a high level of skill in performing a task?
• Which factor should contribute to the severity of disciplinary action in a healthcare setting?
• Who can be designated as a health care surrogate?
• Claims created in Madison Hospital for services performed this month are sent to an auditor before being forwarded to the third party payer. This is a(n) _____ audit.
• The role of a compliance officer primarily focuses on ensuring adherence to:
• What essential information must a physician document when admitting a patient to the hospital?
• Which information is NOT included in the CMS' Quarterly Provider Update?
• What identifies a guilty party under the False Claims Act?
• What do audits performed by the OIG primarily review?
• What is the primary question most staff members need to know first?
• What act ensures patients receive written notice of their right to refuse medical treatment?
• Which is NOT a good practice when dealing with patient complaints?
• When mixing education with work, what is often the best practice?
• Which of the following is a primary component of an effective compliance program?
• What authority should a compliance officer have?
• What characteristic should reporting systems possess?
• Updates to the compliance plan may originate from:
• What effect might providing staff with advanced notification of an audit have?
• What does an effective policy aim to direct?
• The Stark Law primarily addresses which aspect of healthcare?
• The term "whistleblower" generally refers to:
• What type of suspicion must health care professionals report in many states?
• How often should compliance plans be updated once written?
• Which of the following activities is crucial for maintaining compliance in an organization?
• Which aspect is critical for all staff to comply with facility policies?
• What is included in the primary responsibilities of an HIM compliance officer?
• Which of the following is a common consequence of failing to comply with healthcare regulations?
• During an initial patient meeting, what should the healthcare provider prioritize?
• What is the main reason for including details in patient records?
• Why is staff training important in healthcare compliance?
• What does the education of staff entail?
• What can result from refusing to follow a subpoena?
• Health information professionals must prioritize which of the following?
• When are exit interviews most productive?
• Who can be responsible for writing policies in a compliance program?
• What action should be taken when a complaint is received from a patient?
• In the context of healthcare, what is implied consent?
• Which types of facilities are excluded from needing to create a policy manual?
• What is an example of upcoding?
• Which of the following should be taken into consideration when determining the appropriate action for a compliance infraction?
• Which of the following is considered an example of an advance directive?
• What should an employee who has violated a policy more than once be considered for?
• When can abbreviations be used in patient records?
• Which of the following documents is critical for processing insurance claims?
• What type of audit was conducted by auditors reviewing claims over a specific timeframe?
• If an office manager instructs a coder to engage in fraudulent activity, who is at the greatest risk for being charged?
• What does the Federal Register list?
• Documentation requested by an external investigator must be submitted by when?
• If found guilty of fraud, what may an individual be ordered to do?
• An allowance in compliance terms refers to what?
• Which of the following best describes compliance monitoring?
• Which category of compliance includes ensuring that billing practices are accurate and lawful?
• Appealing a Notification of Error from CMS is best described as?
• Claims can be fraudulent when they are?
• Which organization enforces compliance with laboratory tests standards?
• Informal disciplinary actions should include:
• Blue Cross Blue Shield's Participation Programs and Responsibilities is an example of?
• What is the appropriate disciplinary action when there is a series of violations?
• Should a health care facility receive an overpayment from a third-party payer, they must?
• Which code set is used for reporting diagnoses and procedures?
• What does billing "incident to" imply?
• In healthcare compliance, what does HIPAA stand for?
• Which of the following factors is essential for maintaining healthcare compliance?
• What is a key responsibility of the project coordinator regarding policies?
• Where can employees obtain their education?
• Which of the following best describes a compliance officer's primary function?
• Whenever physician's notes are ______, HIM must query the physician?
• When a government agency creates rules, what are these also referred to as?
• What is typically required for a healthcare professional to avoid charges of battery?
• Which concept emphasizes continuous improvement in healthcare services?
• What right does the Fourteenth Amendment of the U.S. Constitution uphold regarding medical treatment?
• What is an essential requirement for all compliance officers?
• What is considered a key component of enforcement for non-compliance?
• Which agency can investigate physician's offices?
• What is a key responsibility of an HIM compliance officer?
• What can project management software help track?
• Which of these is a credible source for employee education?
• Who instigates an internal audit?
• Which group is tasked with investigating providers of Medicaid services?
• Charging for the release of information is:
• What happens when bias occurs during an audit?
• What does it mean if an informed consent form lacks the patient's diagnosis?
• Potential penalties for non-compliance may include which of the following?
• Which of the following should be excluded from training program content?
• What type of documentation is crucial for compliance audits?
• After implementing a policy, what should a facility conduct?
• Which agency oversees HIPAA and investigates violations?
• Why is consistent enforcement of penalties crucial in a compliance program?
• What is the role of the compliance director in a healthcare facility?
• Health documentation serves what primary purpose?
• According to compliance best practices, how often should training and updates on regulations be reviewed?
• What role should the HIM compliance officer fulfill within the organization?
• What does the term 'Kickback' refer to in healthcare compliance?
• An official policy should include which of the following?
• Which code is used for reporting PQRI?
• What aspect of compliance focuses on understanding and applying laws and regulations?
• All policies should have known consequences for non-compliance that are:
• What is the most effective manner of presenting training information to staff?
• HIPAA stands for:
• What type of compensation is required for programs held during off-hours?
• Which is an objective of creating official policies in a health care facility?
• Which requirement pertains to patient rights in the hospital setting?
• Fraud can occur in many ways, including all except which of the following?
• What is a potential benefit of a formal compliance program?
• The federal False Claims Act applies to services provided in which settings?
• Laws that are created and enacted by the legislature are called?
• What type of education is required annually to keep professionals current?
• Policies are designed to guide which aspect of a facility?
• HIPAA is an example of a?
• Information on the Joint Commission website is applicable to which of the following?
• What is typically included in a living will?
• What is a common challenge faced by compliance officers?
• What does express consent mean?
• If a false claim is filed, who may be held culpable under the federal False Claims Act?
• The National Procurement Fraud Task Force primarily prosecutes violations relating to:
• Which of the following is a reliable source for compliance update information?
• Which law prohibits the exchange of money or benefits for health care referrals?
• What type of audit was performed when a professional was hired to review claims at Dr. Oppenheim's office?
• What is a good source for compliance update information?
• Why are organizational skills important in healthcare compliance?
• What does a subpoena ad testificandum require from the individual receiving it?
• Individuals who falsify health care information may face which consequence?
• What is a warning classified as in the disciplinary process?
• What is the first step in creating a compliance program?
• Which of the following is NOT a type of audit?
• What is one responsibility that compliance officers do not have?
• What is required to keep Electronic Health Records (EHR) secure?
• How should internal reporting be treated in healthcare compliance?
• Most HIM compliance officers need which of the following?
• Informed consent is a principle that has been taken from?
• What is a potential benefit of training staff on compliance?
• Good communication skills are necessary to avoid writing policies that are:
• Punitive action might be described as:
• What is necessary for health information management departments regarding compliance?
• The individual responsible for compliance of a certain policy has what primary responsibility?
• What should not be included when ensuring the accuracy of patient documentation?
• Which element is NOT required to be included in all policy documents?
• What is meant by 'due diligence' in the context of healthcare compliance?
• What can be the result of inadequate compliance training in a healthcare setting?
• Which of the following is a type of patient consent?
• What is one potential outcome when an employee engages in a legal violation?
• What motivates governmental investigations in healthcare compliance?
• Regular audits in healthcare are conducted to ensure compliance with what?
• If an investigation is necessary to determine employee guilt or innocence, what is the recommended action?
• What does the term 'upcoding' refer to?
• Which of the following is an example of unbundling?
• How should penalties for non-compliance be structured?
• What is the term for reporting several codes instead of one combination code?
• The review of claims filed by an office over a specific past period is an indication of what type of audit?
• Why would a health care facility need to create official policies?
• Every project assignment should include what essential component?
• What should results of audits be used for?
• Under HIPAA's Privacy Rule, complying with mandatory report laws is:
• Rodman Clinic has a 43 percent denial rate for their claims. This is an _______ indicator of problems.
• Who is responsible for clarifying the meaning of medical terminologies to patients?
• Good compliance plans are designed to:
• Which of the following actions best reflects adherence to compliance documentation standards?
• What does the acronym ABN stand for?
• Which of the following is an example of a health care regulation?
• Which of the following might NOT occur when using an incorrect place of service code?
• Which of the following is a result of an effective compliance plan?
• Who is responsible for the accuracy of the information in a healthcare compliance context?
• Which statement is true regarding healthcare facilities and fraud investigations?
• What defines a law in the context of compliance?
• Who collaborates with state auditors within the Partnership Plan?
• What does a subpoena duces tecum require?
• What is one key element that should be established in a compliance program?
• A crucial aspect of compliance training is to:
• Referring a patient to a specific imaging center might be a violation of?
• Is the creation of a compliance program for individual physicians' offices mandatory or voluntary?
• Which of the following statements is true regarding superconfidential patient information?
• According to the professional code of ethics, compliance professionals should:
• What does retribution mean in the context of compliance?
• How should disciplinary actions be administered among staff?
• Before a procedure, what vital information should a patient be informed about?
• The purpose of compliance programs in healthcare is primarily to?
• Who must comply with the policies established at a facility?
• Which of the following is NOT included in a preliminary compliance program?
• Repercussions for non-compliance should be:
• Which of the following is a standard practice regarding policy implementation?
• Corrective action strategies can be developed from which source?
• Which of the following is NOT a component of a compliance program?
• What type of form is typically required to disclose Protected Health Information (PHI)?
• What must the OIG or RAC do to request documentation for an audit?
• What does the acronym PFSH stand for in encounter notes?
• What is the role of the health care surrogate?
• Who is responsible for compliance in a healthcare organization?
• What is a suit filed by private citizens on behalf of the government called?
• A finding of negligence indicates the auditor believes errors were due to?
• What should be avoided in the structure of a healthcare compliance policy?
• How do appeals processes differ among insurers?
• Which phrase is commonly found in legal language concerning knowledge and responsibility?
• The review of 100 patient records and claim forms out of 2000 indicates what type of audit?
• When delegating tasks, work should be assigned based on team members' what?
• What type of documentation is critical evidence in the evaluation of Filene's violation?
• Creating a written compliance program is considered what in the context of compliance?
• What is the best source for correct information on HIPAA compliance?
• Which entity is responsible for processing claims for Medicare in a state?
• Who is primarily responsible for investigating health care fraud?
• What does the FSG Manual contain?
• A Qui Tam lawsuit is commonly known as what?
• Which learning style prefers lecture-based presentations?
• What does CLIA certify?
• In healthcare compliance, which of the following actions is necessary after confirming a complaint from a patient?
• Lab tests performed in a health care facility are most likely required to have certification under which regulation?
• When should internal audits be conducted?
• How should management respond to non-compliance discovered during audits?
• What may auditors do when a sampling audit discovers an overpayment?
• What is the purpose of corrective action plans in compliance?
• What is the best location for conducting a training program?
• Which facility does The Joint Commission not accredit?
• A contingency behavior refers to actions that are taken under which circumstance?
• What should employees who are terminated for wrongdoing have access to?
• Compliance programs are primarily intended to reduce what?
• Why should deadlines be set in a project?
• According to HIPAA's Privacy Rule, the release of information upon receiving a subpoena is: