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
Under the False Claims Act, what is the term for a private individual who files a lawsuit on behalf of the government alleging healthcare fraud?
Answer: Relator
A relator (also called a whistleblower) files a qui tam lawsuit under the False Claims Act on behalf of the government.
Which federal statute prohibits healthcare providers from referring patients to entities in which they have a financial relationship, unless an exception applies?
Answer: Stark Law
The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare/Medicaid patients to entities where they or an immediate family member have a financial interest.
A CDI specialist notices a physician consistently documents 'pneumonia' without specifying the type. What is the MOST appropriate first step?
Answer: Submit a physician query requesting clarification of the pneumonia type
A compliant physician query requesting clarification of the pneumonia type is the appropriate first step to improve documentation specificity.
Which element is REQUIRED for a physician query to be considered compliant according to AHIMA guidelines?
Answer: The query must be clear, concise, and not leading
AHIMA guidelines require physician queries to be clear, concise, and non-leading to avoid influencing documentation inappropriately.
What does the term 'upcoding' refer to in the context of healthcare billing compliance?
Answer: Billing for a more complex or higher-reimbursement service than was actually provided
Upcoding is a fraudulent practice of billing for a higher-level or more expensive service than was actually rendered.
A hospital's compliance program identifies a pattern of incomplete surgical documentation. Under OIG guidelines, what is the recommended corrective action?
Answer: Conduct physician education, implement monitoring, and document corrective steps taken
OIG guidelines recommend education, monitoring, and documented corrective action as the appropriate response to identified compliance issues.
Which principle of healthcare ethics requires clinicians and coders to act in the best interest of the patient?
Answer: Beneficence
Beneficence is the ethical principle of acting in the patient's best interest and providing positive benefit.