Deck 5: Code and Standards Infractions

Question 1

Down-coding can be considered:

A) a violation of the Stark laws.
B) a violation of the Medical Practice Acts.
C) fraud.
D) noncompliance.

Answer 1

C
Many providers down-code their services to avoid any fraud, but indeed this too is considered to be fraud, although, unlike Falsely billing or coding to increase reimbursement, there are no cases of known prosecution for down-coding.

Question 2

If a coder consistently put the wrong code on a claim, this is considered:

A) a fraudulent claim.
B) an infraction.
C) acceptable.
D) a simple mistake.

Answer 2

B
This mistake is not deliberate fraud, but it is of course an infraction-a breaking of the principles and requirements of the insurance carrier for billing and coding.

Question 3

What are workplace standards?

A) Standards that are expected of employees dependent upon their position
B) Rules of the workplace, no matter your position
C) Laws set forth by local governments
D) Standards set by society

Answer 3

A
Every medical or healthcare employer, whether a hospital, agency, or group practice, should have a set of standards of what is expected of their employees based on their position and expertise. As new employees sign-off on the workplace, they acknowledge the specified consequences that will result from working outside of the parameters of that job description or violating the code of ethics.

Question 4

Protected health information is:

A) information about any individual that is protected by law.
B) the patient's name.
C) the patient's address.
D) any information a patient does not want you to know.

Question 5

A compliance plan is used to:

A) let the employee know the rules of his or her employer.
B) inform the employee of potential measures to be taken when company policies are violated.
C) inform the employee of the results of not reporting one of their coworkers for any wrongdoing.
D) explain to the employee why he or she should not share a patient's personal information.

Question 6

If due diligence is shown in a billing error on behalf of the provider, and any refunds are paid to the insurance company, generally:

A) the provider is issued a fine, but not prosecuted.
B) the provider is fined and prosecuted.
C) the provider is prosecuted, but not fined.
D) no further action is taken.

Question 7

Consequence that is levied against a legal or ethical violation is called:

A) compliance.
B) due process.
C) sanction.
D) disciplinary action.

Question 8

If it is not documented:

A) it did not happen.
B) it can be documented later.
C) it may have happened.
D) it can be billed out.

Question 9

Due process is:

A) giving the employee the chance to explain himself.
B) interviewing others who saw the offense.
C) following policies and procedures through every step before termination, and documenting that such steps were taken.
D) firing an employee after speaking to him or her for the third time, but not documenting it.

Question 10

Disciplinary action varies from all of the following except:

A) state to state.
B) facility to facility.
C) one area of expertise to another.
D) state and federal regulations.

Question 11

What organization regulates HIPAA rules?

A) AMA
B) OIG
C) OCR
D) AHIMA

Question 12

If an individual does something illegal, whose responsibility is it to enforce sanctions?

A) The person who caught them
B) The person who did the illegal action
C) The employer of the governing entity
D) Their coworkers

Question 13

What is an example of a disciplinary action for a serious infraction?

A) Permanent loss of license
B) Small fine
C) Suspension
D) Large fine

Question 14

A patient's right to confidentiality is covered under:

A) AMA.
B) AHIMA.
C) OCR.
D) HIPAA.

Question 15

Workplace sanctions depend on ____ to instill.

A) laws
B) whistleblowers
C) professional codes of conduct
D) policies and procedures

Question 16

The Office of the Inspector General investigates:

A) the American Medical Association.
B) the Occupational Safety and Health Administration.
C) the Department of Labor.
D) the Department of Health and Human Services.

Question 17

A physician bills an insurance company for services not rendered. This is considered:

A) noncompliance.
B) a violation of the Stark laws.
C) a violation of the Medical Practice Acts.
D) fraud.

Question 18

What is necessary for an employee to be terminated for violating a policy that is clearly described in the company's policies and procedures as "immediate dismissal"?

A) A verbal warning before termination
B) A corrective action plan
C) A written warning before termination
D) Documentation of the offense in the employee's file

Question 19

If a company treats two employees differently for the same infraction, this is considered:

A) noncompliance.
B) discrimination.
C) harassment.
D) illegal.

Question 20

What is an example of disciplinary action for a minor infraction?

A) Termination
B) Suspension
C) Large fine
D) Corrective action plan

Question 21

Physicians are governed not only by state laws but also by:

A) the American Medical Association.
B) the Association of American Physicians.
C) the American Medical Group Association.
D) all of the above.

Question 22

If a healthcare professional oversteps his or her scope of practice, which can occur?

A) Loss of license
B) License suspension
C) Censure
D) All of the above.

Question 23

The Medical Practice Act that governs healthcare professionals is regulated:

A) locally.
B) state by state.
C) federally.
D) by all of the above.

Question 24

If an insurance carrier finds an error, they look for:

A) the intent of the error.
B) reasons to sue the physician.
C) who is responsible for the error within the physician's office.
D) all of the above.

Question 25

If a physician receives rewards from a drug manufacturer to prescribe their drugs, this is considered:

A) abuse of privilege.
B) kickbacks.
C) a violation of the Stark laws.
D) all of the above.