CHAP Compliance & Regulatory Requirements 5

Question 1

The 'safe harbor' provisions under the Anti-Kickback Statute protect certain arrangements by:

Accepted Answer

Defining specific payment and business practices that will not be treated as violations

Answer

Safe harbors under the AKS specify types of financial arrangements that meet strict criteria and are therefore shielded from prosecution, even though they might otherwise appear to violate the statute.

Question 2

Under the Genetic Information Nondiscrimination Act (GINA), health insurers are prohibited from:

Accepted Answer

Using genetic information to make eligibility, coverage, underwriting, or premium-setting decisions

Answer

GINA Title I prohibits health insurers from using genetic information for underwriting purposes, including setting premiums, eligibility determinations, or coverage decisions.

Question 3

A healthcare administrative professional discovers that a billing coder submitted claims with upcoded procedure codes. The appropriate first action is to:

Accepted Answer

Report the finding through the organization's compliance reporting mechanism

Answer

Suspected fraudulent billing should first be reported internally through the compliance program's reporting process, which will then trigger an investigation.

Question 4

The '72-hour rule' under Medicare requires that outpatient services provided within 72 hours of an inpatient admission be:

Accepted Answer

Bundled into the inpatient prospective payment system (IPPS) payment

Answer

Medicare's 72-hour rule requires that outpatient diagnostic and related therapeutic services rendered within 72 hours before an inpatient admission be bundled into the inpatient DRG payment.

Question 5

Which element is required in every valid HIPAA-compliant authorization for use or disclosure of PHI?

Accepted Answer

A description of the information to be used or disclosed and the purpose

Answer

A valid HIPAA authorization must include a description of the PHI to be disclosed and the purpose of the use or disclosure, along with other required core elements.

(CHAP) Certified Healthcare Administrative Professional Practice Test

(CHAP) Certified Healthcare Administrative Professional Practice Test

CHAP Compliance & Regulatory Requirements 5