Deck 5: Healthcare Standards and Compliance

Question 1

Disciplinary action varies except for the following

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

Answer 1

state and federal regulations.

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

an infraction.

Question 3

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.

Answer 3

no further action is taken.

Question 4

Which is true about CLIA?

A) It is a governmental agency.
B) It is a professional organization.
C) It is a group of laws.
D) It is a proposed law.

Question 5

Upcoding can be considered

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

Question 6

A compliance plan is used to

A) let the employee know the rules of his or her employer.
B) provide guidelines for employees and inform them of what measures will be taken when a policy is 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 7

A physician bills an insurance company for services never rendered. This is considered

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

Question 8

Which of the following agencies may impose sanctions on a healthcare professional?

A) OSHA
B) An employer
C) CMS
D) All of the options

Question 9

Which of the following laws protects a patient needing critical care when arriving at any hospital emergency room?

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

Question 10

Which law can be waived under certain circumstances?

A) Patient's Bill of Rights
B) EMTLA
C) OSHA
D) CLIA

Question 11

Consequence that is imposed against a legal or ethical violation is called

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

Question 12

If a hospital performs clinical testing and does not comply with CLIA, what policies might it be violating?

A) Conditions of Participation for Hospitals for Laboratory Services
B) Clinical Laboratory Improvement Act
C) Occupational Safety and Health Act
D) All of the options

Question 13

Which of the following healthcare professional should follow the Patient's Bill of Rights?

A) The nurse providing patient care
B) The physician and his or her staff
C) The ancillary personnel in the hospital
D) All healthcare personnel

Question 14

Workplace sanctions are determined by

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

Question 15

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 options

Question 16

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 17

Which of the following regulate laboratory testing and require clinical laboratories to be certificated?

A) Patient's Bill of Rights
B) EMTLA
C) Compliance plan
D) CLIA

Question 18

The Office of the Inspector General functions under which agency?

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 19

If a physician is placed on the OIG's exclusion list, which of the following may occur?

A) Receive a fine
B) Not be able to receive Medicare payments
C) Be employed by a hospital and participate in federal healthcare programs
D) All of the options

Question 20

Which of the following agency oversees CLIA?

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

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 options

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 options

Question 23

If a physician receives financial incentives from a drug manufacturer to prescribe a particular drug, this is considered

A) abuse of privilege.
B) kickbacks.
C) a violation of the Stark law.
D) All of the options

Question 24

The medical practice act that governs healthcare professionals is regulated

A) locally.
B) state by state.
C) AMA.
D) by an employer.

Question 25

If a physician sends a patient to a cardiologist, who happens to also be her husband, this may violate the

A) anti-kickback law.
B) Stark law.
C) CLIA.
D) False Claims Act.