RHIT Healthcare Compliance and Regulations 3

Question 1

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?

Accepted Answer

Effective lines of communication including a hotline

Answer

Written policies and procedures

Answer

Regular auditing and monitoring

Answer

Appropriate disciplinary action

Question 2

A coding professional unbundles a surgical procedure to maximize reimbursement. Under the National Correct Coding Initiative (NCCI), this practice is:

Accepted Answer

Prohibited because component codes are already included in the comprehensive code

Answer

Acceptable when a modifier is appended

Answer

Permitted for outpatient claims only

Answer

Required when procedures are performed in separate sessions

Question 3

Which federal agency is primarily responsible for investigating healthcare fraud and abuse under the Medicare and Medicaid programs?

Accepted Answer

Office of Inspector General (OIG) of HHS

Answer

The Joint Commission

Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

Department of Justice Civil Division only

Question 4

A patient's psychotherapy notes are requested by their primary care physician. Under HIPAA, these notes:

Accepted Answer

Require a specific authorization separate from a general medical records authorization

Answer

Can be released under the Treatment exception without authorization

Answer

Are subject to the same rules as other medical records

Answer

Must be released within 30 days of any clinical request

Question 5

In the context of the Stark Law (Physician Self-Referral Law), which of the following is TRUE?

Accepted Answer

It prohibits physician referrals for designated health services to entities in which the physician has a financial relationship, with limited exceptions

Answer

It applies only to criminal referral arrangements

Answer

It only applies to Medicaid referrals

Answer

It requires intent to defraud to establish a violation

Question 6

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:

Accepted Answer

The date the overpayment is identified

Answer

The date the overpayment occurred

Answer

The end of the fiscal year

Answer

The date the OIG issues a subpoena

Question 7

Which accreditation organization's standards are most commonly used by hospitals seeking deemed status to meet CMS Conditions of Participation?

Accepted Answer

The Joint Commission (TJC)

Answer

National Committee for Quality Assurance (NCQA)

Answer

URAC

Answer

Healthcare Facilities Accreditation Program (HFAP)