CRCR CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations 4

Question 1

Under HIPAA, which of the following is NOT considered a covered entity?

Accepted Answer

A self-insured employer that administers its own health plan internally without using a third-party administrator

Answer

A self-insured employer acting solely in its capacity as an employer is not a covered entity; however, if it uses a TPA to administer the plan, the TPA (not the employer) is the covered entity.

Question 2

The OIG's Work Plan is significant for revenue cycle compliance because it:

Accepted Answer

Identifies audit areas and billing vulnerabilities OIG plans to review in the coming year

Answer

The OIG Work Plan outlines specific topics and billing areas OIG will audit, helping compliance teams proactively self-audit those same areas.

Question 3

A patient requests access to their Protected Health Information (PHI) under HIPAA. In most cases, the covered entity must provide access within:

Accepted Answer

30 days, with one 30-day extension if needed

Answer

HIPAA requires covered entities to act on an individual's request for access to PHI within 30 days, with one 30-day extension allowed if the individual is notified in writing.

Question 4

Which of the following best describes 'upcoding' in the context of healthcare billing compliance?

Accepted Answer

Billing a higher-level or more complex code than the service actually provided

Answer

Upcoding is billing a code that reflects a higher level of service or a more expensive procedure than was actually performed, which is a form of healthcare fraud.

Question 5

Under the Conditions of Participation (CoPs) for Medicare, hospitals must maintain a compliance program that includes which of the following?

Accepted Answer

Written standards, training, a compliance officer, and a reporting mechanism

Answer

CMS Conditions of Participation require hospitals to have a compliance program including written policies, training, a compliance officer, and a confidential reporting system.

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 4