Chapter 18 Quiz

Question 1

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

Answer 1

Fraud

Question 2

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

Answer 2

Kickbacks

Question 3

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

Answer 3

Safe harbors

Question 4

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

Answer 4

Stark Law

Question 5

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

Answer 5

Returned overpayments

Question 6

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

Answer 6

Federal Anti-Kickback Statute

Question 7

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

Answer 7

Made compliance programs mandatory

Question 8

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

Answer 8

False Claims Act

Question 9

Healthcare fraud and abuse laws provide a whistleblower provisions also known as _________.

a. False claim
b. Qui Tam
c. Res judicata
d. Knowing standards

Answer 9

Qui Tam

Question 10

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

Answer 10

Failure to use a comprehensive code to inappropriately maximize reimbursement.

Question 11

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.

Answer 11

Failure to document medical necessity

Question 12

Which of the following types of activities is not one that should be audited and monitored in a compliance program?

Answer 12

Referrals

Question 13

Healthcare fraud is all but which of the following_________.

Answer 13

Unnecessary costs to a program

Question 14

Corporate compliance programs became common after adoption of which of the following?

Answer 14

Federal Sentencing Guidelines

Question 15

Healthcare abuse relates to practices that may result in_________.

Answer 15

Medically unnecessary services.

Question 16

Services that are statutorily non-covered by Medicare can be located on the_________.

Answer 16

Medicare Notice of Exclusions From Medicare Benefits.

Question 17

Responsibility for the filing of accurate claims ultimately belongs to the_________.

Answer 17

Provider

Question 18

Coding and billing documentation must be based on the_________.

Answer 18

Provider’s documentation

Question 19

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

Answer 19

All of the above

Question 20

Which federal law mandated the creation of recovery audit contractor services?

Answer 20

Tax Relief and Health Care Act

Question 21

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

Answer 21

All of the above

Question 22

The Fraud Enforcement and Recovery Act expands_________.

Answer 22

The government’s investigative powers

Question 23

The Stark Law_________.

Answer 23

Prohibits physicians from ordering from entities that they have financial relationship

Question 24

Which of the following is not an example of a false claim?

Answer 24

Billing for covered services

Question 25

The OIG has specific compliance guidance for all of the following entities except _________.

Answer 25

pharmacies