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

The FCA imposes civil and criminal penalties for submitting false claims to federal healthcare programs like Medicare and Medicaid.

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

The Compliance Officer is responsible for developing, implementing, and overseeing the organization's compliance program to prevent and detect violations.

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

The OIG publishes an annual Work Plan identifying audit and enforcement priorities which healthcare organizations use to guide their compliance monitoring.

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

Upcoding is submitting a code representing a more intensive or expensive service than was actually documented or provided, constituting healthcare fraud.

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

The minimum necessary standard limits the amount of PHI disclosed or accessed to what is required for the specific purpose.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

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