CRCR CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations 2

Question 1

What does the False Claims Act prohibit in healthcare billing?

Accepted Answer

Knowingly submitting false or fraudulent claims for payment to the federal government

Answer

Submitting claims without a patient signature

Answer

Billing Medicare for services provided by a non-credentialed provider

Answer

Charging patients more than the Medicare allowable rate

Question 2

What is the role of a Compliance Officer in a healthcare organization?

Accepted Answer

To oversee the organization's compliance program including policy development, education, monitoring, and response to violations

Answer

To process Medicare billing submissions

Answer

To manage patient financial assistance applications

Answer

To conduct clinical audits of physician documentation

Question 3

Which federal agency publishes the OIG Work Plan that identifies compliance priorities for healthcare organizations?

Accepted Answer

The Office of Inspector General of the Department of Health and Human Services

Answer

CMS

Answer

The Joint Commission

Answer

The American Hospital Association

Question 4

What is upcoding and why is it illegal?

Accepted Answer

Assigning a higher-level code than the documentation supports to receive greater reimbursement which constitutes fraud

Answer

Using the wrong version of ICD codes

Answer

Billing for services on a date earlier than they were provided

Answer

Submitting a claim without a valid NPI

Question 5

What does HIPAA's minimum necessary standard require?

Accepted Answer

That covered entities use or disclose only the minimum amount of protected health information needed to accomplish the intended purpose

Answer

That only the minimum number of staff be involved in patient care

Answer

That the smallest possible copayment be charged to patients

Answer

That all PHI disclosures must have written authorization

Question 6

A hospital receives a subpoena requesting patient records. What is the appropriate response?

Accepted Answer

Contact legal counsel and follow established protocols for responding to legal requests which may include providing records under specific conditions

Answer

Refuse to provide any records to maintain patient confidentiality

Answer

Immediately fax all patient records to the requesting party

Answer

Notify the patient and wait for their verbal approval before responding