CCCP Healthcare Compliance & HIPAA 5

Question 1

The '60-day rule' in healthcare compliance, established by the Affordable Care Act, requires providers to:

Accepted Answer

Report and return identified Medicare/Medicaid overpayments within 60 days of identification

Answer

The ACA requires providers to report and return identified Medicare/Medicaid overpayments within 60 days of identification to avoid False Claims Act liability.

Question 2

Under HIPAA's Privacy Rule, which of the following constitutes a 'use' of PHI (as distinct from a 'disclosure')?

Accepted Answer

A billing clerk within the hospital views a patient's diagnosis to process a claim

Answer

A 'use' occurs when PHI is shared, examined, or applied within the covered entity itself, whereas 'disclosure' involves releasing PHI outside the entity.

Question 3

A healthcare compliance risk assessment should be conducted:

Accepted Answer

Periodically and whenever significant operational or regulatory changes occur

Answer

Effective compliance programs require periodic risk assessments that are also triggered by material changes in operations, laws, or enforcement priorities.

Question 4

Which HIPAA provision allows a covered entity to disclose PHI to a public health authority without patient authorization for the purpose of preventing or controlling disease?

Accepted Answer

The public health activities exception under 45 CFR § 164.512(b)

Answer

45 CFR § 164.512(b) permits disclosure of PHI to public health authorities authorized to collect data for preventing or controlling disease without patient authorization.

Question 5

A compliance officer at a hospital system wants to assess whether clinical documentation supports the billing codes submitted. The most appropriate internal audit methodology would be:

Accepted Answer

Random sampling of claims followed by medical record review against billing data

Answer

Random sampling of claims with corresponding medical record review is the standard methodology for assessing coding accuracy and documentation compliance.

(CCCP) Certified Corporate Compliance Professional Practice Test

(CCCP) Certified Corporate Compliance Professional Practice Test

CCCP Healthcare Compliance & HIPAA 5