Chapter 18 Quiz Flashcards
If an HIM department acts in deliberate ignorance or in disregard to official coding guideline, it may be committing_________.
a. Fraud
b. Malpractice
c. Kickbacks
d. Abuse
Fraud
If an HIM department receives gifts from vendors in exchange for purchasing a specific encoder software, this is_________.
a. Malpractice
b. Negligence
c. Kickbacks
d. Abuse
Kickbacks
Exceptions to the Federal Anti-Kickback Statute that allow legitimate business arrangements and are not subject to prosecution are _________.
a. Qui tam practices
b. Exclusions
c. Safe harbors
d. Safe practices
Safe harbors
The federal physician self-referral statute is also known as the _________.
a. False Claims Act
b. Sherman Anti-Trust Act
c. Deficit Reduction Act
d. Stark Law
Stark Law
Examples of high risk billing practices which create compliance risks for healthcare organizations include all but which of the following?
a. Returned overpayments
b. Unbundled procedures
c. Duplicate billings
d. Altered clam forms
Returned overpayments
This law establishes criminal penalties for paying to induce business for which payments from federal healthcare programs may be received_________.
a. Federal Physician Self-referral Act
b. Federal Anti-Kickback Statute
c. Sherman Anti-Trust Act
d. False Claims Act
Federal Anti-Kickback Statute
The Deficit Reduction Act of 2006_________.
a. Made compliance programs mandatory
b. Did not address healthcare fraud and abuse
c. Affects entities that make or receive at least $9 million in Medicaiid payments
d. Encouraged voluntary compliance programs
Made compliance programs mandatory
This act is used to combat Medicare fraud by penalizing those that submit incorrect information to the program:
a. Medicare Act
b. Qui Tam Act
c. False Claims Act
d. Fraud Prevention Act
False Claims Act
Healthcare fraud and abuse laws provide a whistleblower provisions also known as _________.
a. False claim
b. Qui Tam
c. Res judicata
d. Knowing standards
Qui Tam
Unbundling refers to_________.
a. Failure to use a comprehensive code to inappropriately maximize reimbursement.
b. Failure to use multiple procedure codes to inappropriately maximize reimbursement
c. Combined billing for pre and post-surgery physician services
d. None of the above
Failure to use a comprehensive code to inappropriately maximize reimbursement.
The OIG states that insufficient or missing documentation and which one of the following are responsible for 70 percent of bad claims submitted to Medicare.
Failure to document medical necessity
Which of the following types of activities is not one that should be audited and monitored in a compliance program?
Referrals
Healthcare fraud is all but which of the following_________.
Unnecessary costs to a program
Corporate compliance programs became common after adoption of which of the following?
Federal Sentencing Guidelines
Healthcare abuse relates to practices that may result in_________.
Medically unnecessary services.
Services that are statutorily non-covered by Medicare can be located on the_________.
Medicare Notice of Exclusions From Medicare Benefits.
Responsibility for the filing of accurate claims ultimately belongs to the_________.
Provider
Coding and billing documentation must be based on the_________.
Provider’s documentation
Submission of incorrect Medicare claims is due to_________.
a. Lack of physician understanding of Medicare coding, documentation and billing guidelines.
b. Failure of healthcare facilities to invest time and resources in education related to coding, documentation and billing.
c. Complexity and changing nature of Medicare rules.
d. All of the above
All of the above
Which federal law mandated the creation of recovery audit contractor services?
Tax Relief and Health Care Act
The OIG has issued specific compliance guidance for the following entities:
a. Hospitals
b. Clinical laboratories
c. Home health agencies
d. All of the above
All of the above
The Fraud Enforcement and Recovery Act expands_________.
The government’s investigative powers
The Stark Law_________.
Prohibits physicians from ordering from entities that they have financial relationship
Which of the following is not an example of a false claim?
Billing for covered services
The OIG has specific compliance guidance for all of the following entities except _________.
pharmacies
