Healthcare Compliance and Regulations Flashcards
7 cards from real RHIT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Healthcare Compliance and Regulations flashcards as text
The OIG Compliance Program Guidance recommends seven elements of an effective compliance program. Which element involves establishing clear lines of communication for reporting suspected violations?
Answer: Effective lines of communication including a hotline
Effective lines of communication, such as a confidential hotline, are one of the OIG's seven core compliance program elements.
A coding professional unbundles a surgical procedure to maximize reimbursement. Under the National Correct Coding Initiative (NCCI), this practice is:
Answer: Prohibited because component codes are already included in the comprehensive code
NCCI edits prohibit unbundling because component procedures are considered included in the comprehensive procedure code.
Which federal agency is primarily responsible for investigating healthcare fraud and abuse under the Medicare and Medicaid programs?
Answer: Office of Inspector General (OIG) of HHS
The OIG of HHS has primary authority to investigate fraud and abuse in Medicare and Medicaid and can impose exclusions and civil monetary penalties.
A patient's psychotherapy notes are requested by their primary care physician. Under HIPAA, these notes:
Answer: Require a specific authorization separate from a general medical records authorization
Psychotherapy notes receive heightened protection under HIPAA and require a specific patient authorization, separate from a general authorization.
In the context of the Stark Law (Physician Self-Referral Law), which of the following is TRUE?
Answer: It prohibits physician referrals for designated health services to entities in which the physician has a financial relationship, with limited exceptions
The Stark Law is a strict-liability civil statute prohibiting referrals for designated health services to financially related entities, with no intent requirement.
A hospital's coding department finds a pattern of overcoding that resulted in overpayments from Medicare. Under the 60-Day Rule, the hospital must report and return the overpayment within 60 days of:
Answer: The date the overpayment is identified
Under the 60-Day Rule (ACA Section 6402), overpayments must be reported and returned within 60 days of identification to avoid False Claims Act liability.
Which accreditation organization's standards are most commonly used by hospitals seeking deemed status to meet CMS Conditions of Participation?
Answer: The Joint Commission (TJC)
The Joint Commission is the most widely recognized accrediting body, and its deemed status is accepted by CMS as meeting the Conditions of Participation.