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HCCA Compliance 101 > Ch 3 & 4 > Flashcards

Ch 3 & 4 Flashcards

Ch 3 & 4

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1
Q

Who is the focal point of the compliance program?

a. Employees
b. Board of Trustees
c. Federal Government
d. Compliance Officer

A

d. Compliance Officer

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2
Q

What should be considered when developing an audit agenda?

a. The OIG workplan
b. OCR investigation
c. OIG fraud alerts
d. A and C
e. A and B

A

d. A and C

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3
Q

The entity’s level of commitment to compliance is directly related to the resources (human and financial.

a. True
b. False

A

b. False

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4
Q

The compliance plan should be reviewed:

a. When the OIG issues new guidelines
b. When a new regulation is passed
c. At least annually
d. All of the above

A

d. All of the above

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5
Q

The most important communication device for a compliance program is:

a. Code of Conduct
b. Education
c. Open door policy
d. All of the above

A

c. Open door policy

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6
Q

The code of conduct should address the organization’s:

a. Culture
b. Beliefs
c. Ethical position
d. All of the above

A

d. All of the above

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7
Q

Which of the following strategies is not recommended when communicating about compliance to physicians?

a. Emphasize clinical and fiscal improvements
b. Minimize time of physician involvement by working to resolve compliance issues prior to communication
c. Build trust through involvement
d. Give physicians lots of data

A

b. Minimize time of physician involvement by working to resolve compliance issues prior to communication

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8
Q

Once signed by employees, code of conduct attestations must be maintained by the compliance department.

a. True
b. False

A

b. False

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9
Q

Which of the following is one objective of a baseline audit?

a. Evaluate compliance program operations
b. Investigate an alleged violation
c. Offer recommendations regarding necessary remediation
d. Create a mission statement for the compliance department that is consistent with the mission statement of the organization

A

c. Offer recommendations regarding necessary remediation

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10
Q

The Board of Directors involvement with compliance includes all except:

a. Written endorsement
b. Allocating sufficient budgetary resources
c. Active role in the daily compliance operations
d. Establishing compensation structures that reward compliance

A

c. Active role in the daily compliance operations

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11
Q

When developing an effective code of conduct, an organization should consider:

a. Soliciting another organization’s code and tweaking it to fit
b. Methods for reporting issues
c. Zero tolerance for fraud and abuse
d. B and C

A

d. B and C

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12
Q

A primary source of information for the team conducting an audit would be:

a. OIG work Plan
b. Organization’s existing documents
c. CPT and ICD9 books
d. HCCA
e. Investigation Procedures
f. Promise of non-retaliation
g. Chain of command

A

b. Organization’s existing documents

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13
Q

You are the new compliance officer for a hospital and see that it is currently under an OIG CIA. What would be the first course of action in your new position?

a. Review the current OIG Work Plan and update the audit schedule for the hospital.
b. Review the Code of Conduct and Policies and Procedures and update them as appropriate.
c. Meet with the Compliance Board and discuss your vision of how compliance will be run in the future.
d. Review the audit schedule and pick up where the previous compliance officer left off.

A

b. Review the Code of Conduct and Policies and Procedures and update them as appropriate.

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14
Q

It was brought to your attention that a nurse on the OIG Exclusion List have been seeing and treating patients. What would your first course of action?

a. Disallow the nurse to treat patients with government payers. Allow her to continue to see and treat patients with non-government payers only.
b. Investigate further with HR concerning the OIG Exclusion list and determine possible reimbursement to Medicare/Medicaid.
c. Assign nurse to administrative duties with no patient interaction.
d. Terminate the individual for falsifying her employment application.

A

a. Disallow the nurse to treat patients with government payers. Allow her to continue to see and treat patients with non-government payers only.

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15
Q

In the course of an audit, you find that a provider and a secretary have been repeatedly violating the privacy of an individual. The provider was given a verbal warning and the secretary was written up and suspended for 3 days. What would your first course of action be?

a. Do nothing, as each division/clinic manager has powers to do as they like.
b. Get HR involved and recommend that discipline should be fair, equitable, and consistent.
c. Immediately report the incident to OCR.
d. Get local and federal labor department involved for unfair discipline.

A

b. Get HR involved and recommend that discipline should be fair, equitable, and consistent.

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16
Q

One of the most important foundations of your compliance program is:

a. The Compliance Policy Manual
b. The Organization Code of Conduct
c. The non-retaliation policy
d. Adequate staffing and information systems

A

b. The Organization Code of Conduct

17
Q

One of the first steps in launching an effective compliance program is:

a. A retrospective audit
b. A concurrent audit
c. A baseline audit
d. A CPT code review

A

c. A baseline audit

18
Q

When evaluating your compliance program, annually review:

a. Is what you have in place for policy really occurring
b. Are policies being monitored and reviewed annually
c. How has the compliance message been communicated to the organization
d. All of the above

A

d. All of the above

19
Q

Staying on top of compliance issues is a day to day obligation of?

a. Board of Directors
b. Compliance Officer
c. Managers
d. Employees

A

c. Managers

20
Q

The best way to correct an error is to prevent an error by?

a. Monitoring
b. Fair and consistent discipline
c. Education and training
d. Conduct Internal Assessment

A

c. Education and training

21
Q

A key element of an effective compliance program, includes a code of conduct

a. Plain and concise language
b. CEO endorsement
c. Description of Compliance Program with names of all compliance committee members
d. Provides guidance for appropriate conduct.

A

c. Description of Compliance Program with names of all compliance committee members

22
Q

As a resource for all staff and affiliates, the code of conduct should include a detailed outline of procedures for handling questions about compliance or ethical issues, beginning with a description of what?

a. Reporting methods
b. Chain of command
c. Official Board of Trustees
d. Non-retaliation

A

b. Chain of command

23
Q

Describe the Quality Management Technique P-D-C-A that is used for ongoing evaluation of a compliance program that is up and running

A

Plan-Do-Check-Act

24
Q

List the 3 Cs of Communication

A

Clear-Concise-Creative

25
Q

Which is not considered part of the 3 C’s of Communication?

a. Creative
b. Confident
c. Clear
d. Concise

A

b. Confident

26
Q

When developing the compliance budget and establishing financial support, which one of the following statements is false?

a) The Board of Directors must be willing to make a financial commitment to compliance
b) When considering funding costs, focus on a handful of departments in the organization
c) Poor infrastructure, especially communications and data processing, will require additional resources
d) Specialized training is needed for physicians plus coding and billing departments

A

b) When considering funding costs, focus on a handful of departments in the organization

27
Q

While education and experience are important to the compliance officer position, trust and respect within the organization are most important.

a. True
b. False

A

a. True

28
Q

Which of the following applies to a baseline internal audit:

a) The scope should include all areas of concern
b) Should not be performed by an outside or contracted expert
c) Has three main objectives: outlines current operations; identifies weaknesses; offers remedial action
d) All the above

A

c) Has three main objectives: outlines current operations; identifies weaknesses; offers remedial action

29
Q

What is the most important element to be included in every organization’s Code of Conduct?

a. Board letter or resolution approving and announcing the compliance program
b. Organization’s mission or vision and values
c. Outline of procedures for handling questions about compliance or ethical issues, beginning with a description of chain of command with a clearly stated promise of non-retaliation
d. An emphasis on zero tolerance for fraud or abuse, commitment to timely billing and compliance with all laws and regulations

A

d. An emphasis on zero tolerance for fraud or abuse, commitment to timely billing and compliance with all laws and regulations

30
Q

What is the best reporting mechanism for employees to voice concerns?

a. An open door
b. An anonymous compliance hotline or helpline
c. A trusted Compliance Officer
d. An Employee Relations liaison in Human Resources

A

a. An open door

31
Q

Which is NOT one of the three main objectives of a baseline compliance audit (according to the OIG’s goal “to facilitate identification of problem areas and elimination of potential areas of abusive or fraudulent conduct”)?

a. Outline current operational standards and the extent to which legal requirements are met
b. Identify real and potential weaknesses for procedures to measure and enforce compliance
c. Assess compliance with the Generally Accepted Accounting Principles for healthcare organizations
d. Offer recommendations regarding remedial actions and weaknesses

A

c. Assess compliance with the Generally Accepted Accounting Principles for healthcare organizations

32
Q

What are the 3 main objectives of a baseline audit?

A

Outline the current operational standards,
identifies real and potential weaknesses,
offers recommendations.

33
Q

What data base sanction list of providers and physicians can be found?

A. LEIE
B. GSA
C. OIG
D. HHS

A

A. LEIE

34
Q

A medical private practice have a high volume of seeing patients, there seems to a billing issue that have occurred and the claims are tainted and submitted to Medicare for payment. What should the private practice do?

A. Should the practice remain open and continue to see the patients as scheduled and still send out the bill to Medicare for payment.
B. Should the practice shutdown the facility and not see any patient until the billing issue have been resolve
C. Should the practice remain open and see patients as schedule and suspend all claims billing to Medicare for payment, until the billing issue have been resolved. Once the billing have been resolved and correct, resumed billing to Medicare for proper payment.

A

C. Should the practice remain open and see patients as schedule and suspend all claims billing to Medicare for payment, until the billing issue have been resolved. Once the billing have been resolved and correct, resumed billing to Medicare for proper payment.

35
Q

The first and best line of defense in compliance is:

a. Having to hotline to report compliance violations anonymously
b. Education and training
c. Sufficient budget for the Compliance Department
d. Written policies and procedures

A

b. Education and training

36
Q
  1. Which of the following is not an objective of a baseline audit:

a. outlines the current operational standards
b. identifies real and potential weaknesses
c. offers recommendations regarding necessary remedial action, areas of potential weaknesses to monitor closely, and targeted areas of need
d. identifies staff for disciplinary action

A

d. identifies staff for disciplinary action

HCCA Compliance 101 (8 decks)

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