ACMPE ACMPE Quality Improvement and Compliance 2 — Questions and Answers
Question 1: Which federal law governs the submission of false claims to Medicare and Medicaid and exposes violators to significant civil penalties?
- False Claims Act (Correct answer)
- Anti-Kickback Statute
- Stark Law
- HIPAA
Correct answer: False Claims Act
The False Claims Act imposes civil liability on individuals and organizations that knowingly submit fraudulent claims to federal healthcare programs.
Question 2: In a medical practice, a root cause analysis (RCA) is primarily used to investigate which type of event?
- Sentinel events or serious adverse outcomes (Correct answer)
- Routine billing errors
- Staff attendance issues
- Minor patient complaints
Correct answer: Sentinel events or serious adverse outcomes
RCA is a structured process used to identify the underlying system failures that contribute to sentinel events and serious adverse patient outcomes.
Question 3: Which quality indicator measures the proportion of patients who receive a recommended preventive service or treatment per established clinical guidelines?
- Process measure (Correct answer)
- Outcome measure
- Structure measure
- Balancing measure
Correct answer: Process measure
Process measures assess whether recommended clinical actions (e.g., screenings, vaccinations) are delivered to eligible patients.
Question 4: Under OSHA's Bloodborne Pathogens Standard, medical practices must offer which vaccine to employees with occupational exposure risk at no cost?
- Hepatitis B vaccine (Correct answer)
- Influenza vaccine
- COVID-19 vaccine
- Tetanus vaccine
Correct answer: Hepatitis B vaccine
OSHA requires employers to offer the hepatitis B vaccine series at no cost to employees with occupational exposure to bloodborne pathogens.
Question 5: Which CMS quality payment program rewards eligible clinicians based on performance in quality, cost, improvement activities, and promoting interoperability?
- Merit-Based Incentive Payment System (MIPS) (Correct answer)
- Alternative Payment Model (APM)
- Physician Quality Reporting System (PQRS)
- Value-Based Purchasing (VBP)
Correct answer: Merit-Based Incentive Payment System (MIPS)
MIPS consolidates prior CMS quality reporting programs and adjusts Medicare payments based on composite performance scores.
Question 6: A medical practice's compliance officer discovers a pattern of upcoding on claims. Which is the most appropriate immediate action?
- Conduct an internal audit, quantify the overpayments, and voluntarily disclose to CMS (Correct answer)
- Immediately terminate the responsible staff
- Ignore it if the amounts are small
- Wait for a government audit before acting
Correct answer: Conduct an internal audit, quantify the overpayments, and voluntarily disclose to CMS
Voluntary disclosure through the OIG's Self-Disclosure Protocol allows practices to report and resolve overpayments, typically at reduced penalties.
ACMPE ACMPE Quality Improvement and Compliance 2
Which federal law governs the submission of false claims to Medicare and Medicaid and exposes violators to significant civil penalties?