Deck 3: The Legal and Ethical Side of Medical Insurance

Question 1

Certain precise steps should be followed when a physician terminates the patient/doctor contract to avoid a lawsuit for:

A) cessation.
B) termination.
C) abandonment.
D) altercation.

Answer 1

abandonment.

Question 2

In compliance with HIPAA,when patients visit their healthcare providers for treatment,they are given a/an:

A) privacy statement.
B) waiver of accountability.
C) availability statement.
D) both a and b

Answer 2

privacy statement.

Question 3

When a society tends to be hasty in bringing lawsuits,it is said to be:

A) illegal.
B) litigious.
C) diligent.
D) formidable.

Answer 3

litigious.

Question 4

The Office of Inspector General (OIG)recommends all medical facilities review their existing standards and procedures to determine if they:

A) have an adequate patient protection policy.
B) have a soundproof examination room.
C) have access to a third-party review panel.
D) are in compliance with HIPAA laws and regulations.

Question 5

Members of a medical team who are not physicians are called _____ members.

A) cohort
B) third-party
C) ancillary
D) emancipated

Question 6

Medicare records must be kept a minimum of _____ years.

A) 2
B) 3
C) 5
D) 10

Question 7

The federal act that states that Medicare is the secondary payer in the case of automobile or liability coverage is the:

A) Federal Privacy Act of 1974.
B) Federal Omnibus Budget Reconciliation Act of 1980.
C) Tax Equity and Fiscal Responsibility Act of 1982.
D) Consolidated Omnibus Budget Reconciliation Act of 1986.

Question 8

The type of contract that exists between a healthcare provider and a patient is a/an _____ contract.

A) implied
B) verbal
C) written
D) all of the above

Question 9

A health insurance company is referred to as the _____ party.

A) first
B) second
C) third
D) fourth

Question 10

Under HIPAA rules,if medical personnel call a patient by name in the reception area,that kind of exposure is called:

A) breach of confidentiality.
B) infringement of etiquette.
C) incidental disclosure.
D) violation of compliance.

Question 11

Following the rules and conventions governing correct or polite behavior in society is called:

A) ethics.
B) etiquette.
C) socialization.
D) protocol.

Question 12

The act that addresses the prevention of healthcare fraud and abuse of patients eligible for Medicare and Medicaid benefits is the:

A) Fraud and Abuse Act.
B) Federal Privacy Act of 1974.
C) Federal Omnibus Budget Reconciliation Act of 1980.
D) Tax Equity and Fiscal Responsibility Act of 1982.

Question 13

The act that made Medicare benefits secondary to employer group health plans for employees (or spouses)older than 65 is the:

A) Federal Privacy Act of 1974.
B) Federal Omnibus Budget Reconciliation Act of 1980.
C) Tax Equity and Fiscal Responsibility Act of 1982.
D) Consolidated Omnibus Budget Reconciliation Act of 1986.

Question 14

The Latin term for "let the master answer" is:

A) litigious.
B) ancillary.
C) negligent.
D) respondeat superior.

Question 15

In contract law,the "thing of value" that each party gives to the other is the:

A) offer.
B) acceptance.
C) consideration.
D) binding element.

Question 16

The HIPAA legislation was signed into law in:

A) 1988.
B) 1996.
C) 2000.
D) 2005.

Question 17

Elements of a legal contract include all of the following,except:

A) an attorney.
B) consideration.
C) competent parties.
D) offer and acceptance.

Question 18

A proposition to create a contract is the:

A) offer.
B) acceptance.
C) consideration.
D) binding element.

Question 19

Standards of human conduct (sometimes called morals)are:

A) ethics.
B) etiquette.
C) socialization.
D) protocol.

Question 20

A contract can be terminated when:

A) a full year has passed.
B) both parties agree to terminate it.
C) either party defaults on the provisions.
D) both b and c

Question 21

Direct and indirect patient contact involves __________ and __________ responsibilities.

Question 22

A legal document that requires an individual to appear in court with a piece of evidence that can be examined by the court is called a:

A) respondeat superior.
B) subpoena duces tecum.
C) certificate of evidence.
D) notarized sanction.

Question 23

An authorization to release information should contain all of the following,except the:

A) patient's name.
B) primary diagnosis.
C) patient's signature.
D) description of the information to be released.

Question 24

When an individual has the legal ability to handle another person's affairs,he or she is said to have ____________________.

Question 25

A clinical,scientific,administrative,and legal document of facts containing statements relating to a patient is a definition of a:

A) compliance plan.
B) HIPAA standard.
C) medical record.
D) retention statute.

Question 26

The primary objectives of HIPAA include all of the following,except to:

A) ensure health insurance portability.
B) reduce healthcare fraud/abuse.
C) enforce standards for health information.
D) lower healthcare costs.

Question 27

List HIPAA's four primary objectives.

Question 28

Exceptions to confidentiality include all of the following,except:

A) child abuse.
B) emergency treatment.
C) communicable diseases.
D) injuries caused by firearms.

Question 29

Improper methods of doing business that are contradictory to accepted business practices are a definition of:

A) fraud.
B) abuse.
C) criminal intent.
D) a breach of etiquette.

Question 30

Upcoding and unbundling of charges are examples of:

A) healthcare fraud.
B) confidentiality breaches.
C) HIPAA deregulations.
D) exceptions to privacy.

Question 31

When a health insurance professional intentionally and knowingly misrepresents facts to increase the payment of a claim,it is commonly known as:

A) fraud.
B) abuse.
C) criminal intent.
D) a breach of etiquette.

Question 32

List four purposes of a medical record.

Question 33

Identify which of the following is not a valid way to prevent fraud and abuse in the medical office.

A) Use the most current coding manuals, and code to the greatest specificity.
B) Notify a superior immediately when fraud or abuse is suspected.
C) Discuss potential problems with law enforcement professionals.
D) Take advantage of ways to improve coding skills.

Question 34

List six ethical areas in healthcare.

Question 35

_________________ concerns the communication of private and personal information from one person to another.

Question 36

Before medical information can be divulged to a third party,the patient should sign a/an:

A) written consent form.
B) assignment of benefits form.
C) release of medical information form.
D) either a or c

Question 37

Failure to exercise a reasonable degree of care is a definition of:

A) fraud.
B) abuse.
C) a crime.
D) negligence.

Question 38

To be in conformance with HIPAA rules and for best defense against possible problems,medical practices should develop a written _______________.

Question 39

Legal form is only applicable in __________ contracts.

Question 40

List the five elements of a legal contract.

Question 41

The primary goal of the health insurance professional is to accurately complete and submit insurance claims in a timely manner.

Question 42

A medical record serves only one purpose-to chronologically document a patient's healthcare treatment.

Question 43

HIPAA affects various categories of people/businesses involved with healthcare.

Question 44

Businesses have the same obligation to protect employees' medical records as medical practices.

Question 45

HIPAA's regulations affect only healthcare issues.

Question 46

A medical record is not a legal document.

Question 47

A contract must be legal before it can be enforced.

Question 48

A patient can terminate the doctor/patient contract simply by paying the bill and not returning to the practice.

Question 49

Several factors may affect time requirements for retaining medical records.List at least four of these factors.

Question 50

Direct and indirect contact with patients presents continuous ethical and legal responsibilities for the health insurance professional.

Question 51

There is a subtle distinction between "privacy" and "confidentiality."

Question 52

It is generally an accepted fact that medical records are the property of the healthcare facility.

Question 53

In today's healthcare environment,patients are frequently referred to as customers.

Question 54

All 50 states have a mandatory 5-year retention of records law.

Question 55

Medical law and liability is the same in all 50 states.

Question 56

Because insurance is not governed by universal laws,health insurance professionals do not need to worry about legal issues.

Question 57

A three-way contract exists among the physician,patient,and insurance carrier.

Question 58

Some states allow disclosure of certain types of mental health information without patient consent.List four of these types of information.

Question 59

Under no circumstances can a minor enter into a legally binding contract.

Question 60

A patient who is being treated for an injury as a result of an accident on the job is not required to sign a release of information.

Question 61

Timely,complete,and accurate documentation is an important factor in quality patient care.

Question 62

Under no circumstance may information in a patient's record be released without the express written authorization by the patient or his or her parent/guardian.

Question 63

The Federal False Claim Amendments Act (of 1986)expands the government's ability to control fraud and abuse in healthcare.

Question 64

It is illegal for the health insurance professional to make any documentation entries in a patient's health record.

Question 65

The terms fraud and abuse are interchangeable.

Question 66

Child abuse,but not the abuse of an adult,is an exception to confidentiality.

Question 67

Generally,COBRA affects employers with more than 20 employees.