Healthcare Compliance and Ethics Flashcards
7 cards from real CDIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Healthcare Compliance and Ethics flashcards as text
Which type of physician query is considered NON-compliant because it suggests a specific diagnosis without clinical basis?
Answer: A leading query that implies the desired answer
A leading query is non-compliant because it guides the physician toward a specific, often higher-reimbursing diagnosis rather than seeking genuine clinical clarification.
Under the Corporate Integrity Agreement (CIA), a hospital is required to submit annual reports to the OIG. What is the primary purpose of a CIA?
Answer: To require ongoing compliance monitoring and reporting as a condition of continued Medicare participation after a fraud settlement
A CIA is a compliance oversight agreement imposed as part of a fraud settlement, requiring the organization to implement and report on compliance measures.
A CDI professional discovers that a colleague has been submitting queries after records are finalized and closed, then backdating them. What action is MOST appropriate?
Answer: Report the behavior to the compliance officer or through the organization's reporting mechanism
Backdating queries is a compliance violation that must be reported through proper channels such as the compliance officer or a confidential hotline.
Which of the following BEST describes the 'present on admission' (POA) indicator's role in compliance?
Answer: It distinguishes conditions that existed at admission from those acquired during hospitalization, affecting reimbursement and quality metrics
The POA indicator is critical for separating pre-existing conditions from hospital-acquired conditions, which affects both reimbursement and quality reporting.
What does 'compliance' mean in the context of a hospital's coding department?
Answer: Adhering to official coding guidelines, payer rules, and federal regulations when assigning diagnostic and procedure codes
Coding compliance means following all applicable official guidelines, payer policies, and regulations to ensure accurate and legally defensible code assignments.
Which scenario BEST illustrates a violation of patient data privacy under HIPAA's minimum necessary standard?
Answer: A billing employee accesses a patient's complete psychiatric history when only demographic information is needed for claim submission
The minimum necessary standard requires that access to PHI be limited to the information actually needed to perform the specific task.
In the context of the Revenue Integrity model, what is the primary goal of concurrent CDI review?
Answer: To capture accurate diagnoses and procedure documentation while the patient is still hospitalized, allowing for real-time clarification
Concurrent CDI review enables real-time documentation improvement while the patient is still in-house, improving accuracy and reducing post-discharge query burden.