CEHRS Regulatory Compliance and Quality Assurance 3

Question 1

Which regulation requires clinical laboratories to maintain quality control records and participate in proficiency testing?

Accepted Answer

Clinical Laboratory Improvement Amendments (CLIA)

Answer

HIPAA Privacy Rule

Answer

Joint Commission standards

Answer

CMS Conditions of Participation

Question 2

When conducting an internal audit of EHR documentation, which metric best measures the completeness of medical records?

Accepted Answer

Deficiency rate per record

Answer

Average length of stay

Answer

Coder productivity per hour

Answer

Claims denial rate

Question 3

A patient requests an amendment to their medical record because they believe information is incorrect. Under HIPAA, the covered entity may deny the request if:

Accepted Answer

The record was not created by that covered entity

Answer

The patient lacks medical knowledge to judge accuracy

Answer

More than 30 days have passed since treatment

Answer

The amendment would extend the record

Question 4

Which standard defines the electronic format for submitting HIPAA-covered healthcare claims from providers to payers?

Accepted Answer

ASC X12 837

Answer

HL7 FHIR R4

Answer

NCPDP SCRIPT

Answer

ASC X12 835

Question 5

In quality management, a fishbone (Ishikawa) diagram is used to:

Accepted Answer

Identify root causes of a quality problem

Answer

Track patient satisfaction scores over time

Answer

Map the flow of patients through a department

Answer

Monitor key performance indicators

Question 6

The Stark Law (Physician Self-Referral Law) primarily prohibits physicians from:

Accepted Answer

Referring Medicare patients to entities in which they have a financial relationship

Answer

Accepting speaking fees from pharmaceutical companies

Answer

Billing for services not personally performed

Answer

Owning more than one practice location

Question 7

Which element is required in a valid authorization for release of protected health information under HIPAA?

Accepted Answer

Expiration date or event

Answer

Witness signature

Answer

Treating physician approval

Answer

Insurance company verification