Compliance, Ethics, HIPPA, Adminstration Flashcards
If a practitioner receives an order for a HALO and they are not Certified, Licensed or qualified they should
a. notify the doctor to seek a qualified practitioner
b. fit the device
c. call the manufacturer for detailed instructions
d. ignore the order.
a. notify the doctor to seek a qualified practitioner
CTO’s require the practitioner to have proper certification and proof of competency.
TRUE
FALSE
TRUE
CTO - Cervical Thoracic Orthosis
Which of the following are benefits of a Compliance Program?
a. More efficient operation
b. Increased likelihood of fraud prevention and unethical conduct
c. Decrease in liability for civil damages
d. All of the above
d. All of the above
Some additional benefits:
- formulation of better internal control procedures
- concrete demonstration that business has a strong commitment to honest and responsible corporate conduct
- improved internal communications
early detection and reporting, minimizing loss
All verbal orders must be promptly verified written form.
True
False
True
OIG stands for
a. Office of Insurance grants
b. Official information Gatherers
c. Office Inspectors, Government
d. Office of Inspector General
d. Office of Inspector General
The OIG was established by Congress in 1976 to identify and eliminate fraud, waste, and abuse in Health and Human Services programs
If you have a question about HCPCS codes you can call
a. JCAHO
b. The OIG
c. CMS
d. PDAC
d. PDAC
Pricing, Data Analysis and Coding (PDAC) contractor maintains the Durable Medical Equipment Coding System (DMECS). DMECS is an official source for Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) product code verification and assignment.
Which of the following is the federal agency that enforces Medicare program compliance?
a. HCFA
b. CMS
c. OIG
d. DMEPOS
c. OIG
Office of Inspector General was established by Congress in 1976 to identify and eliminate fraud, waste, and abuse in Health and Human Services programs
It is accepted practice to send out refill supplies to Medicare customers without their permission each month as long as you have a current order or prescription
True
False
False
Which of the following should be included in an effective Compliance Program?
a. Implementing written policies
b. Designating a compliance officer
c. Conducting effective training and education
d. Developing effective lines of communication
e. Enforcing standards through well publicized disciplinary guidances
f. Responding promptly to detected offenses and developing a corrective action
g. All of the above
g. All of the above
A compliance program’s purpose is to
a. Prevent fraud
b. Decrease waste
c. Improve your company’s profitability
d. All of the above
a. Prevent fraud
You are a company with 1 employee-yourself
a. Since you know your policies and procedures, you do not need a written compliance program
b. You do not need to do an OIG exclusion list check on yourself
c. You do not need a separate job description for a compliance officer
d. None of the above
e. All of the above
d. None of the above
Abuse is
a. Practices that are inconsistent with sound business, financial or medical practices that cause unnecessary costs to the healthcare system
b. Over-use of services and resources
c. Planned deception for unjust gain
d. Submission of claims for services not rendered that resulted in you being paid
a. Practices that are inconsistent with sound business, financial or medical practices that cause unnecessary costs to the healthcare system
Fraud is
a. Practices that are inconsistent with sound business, financial or medical practices that cause unnecessary costs to the healthcare system
b. Over-use of services and resources
c. Planned deception for unjust gain
d. Submission of claims for services not rendered that resulted in you being paid
c. Planned deception for unjust gain
A false statement
Waste is
a. Practices that are inconsistent with sound business, financial or medical practices that cause unnecessary costs to the healthcare system
b. Over-use of services and resources
c. Planned deception for unjust gain
d. Submission of claims for services not rendered that resulted in you being paid
b. Over-use of services and resources
Compliance training is required every year, regardless of how well you know the information.
True
False
True
and upon hiring
If you knowingly submit false information to the government in order to receive payment for a fraudulent claim, you are in violation of (the)
a. False Claims Act
b. health insurance portability and accountability act (HIPAA)
c. Anti-kickback statute
d. Freedom of Information Act
a. False Claims Act
It is in your best interest to report suspected fraud, waste or abuse you have witnessed because
a. Fraud waste and abuse increase the cost of health care and all related costs
b. You could be implicated in the deception if you are aware of it and fail to report it
c. As an employee it is your responsibility to report it
d. All of the above
d. All of the above
CMS stands for
Centers for Medicare and Medicaid Services
The “contractor” responsible form monitoring FWA (Fraud, Waste and Abuse) in MPD (Medicare Prescription Drug) benefits program
Investigations Medicare Drug Integrity Contractor (I-MEDIC)
In regards to HIPPA regulations, confidential health information applies only to written records and lab results:
a. true
b. false
b. false
All communication and documentation apply so only written records and lab results would be false. The info could be spoken, pictures etc
When obtaining the certifying physician statement for therapeutic shoes, the Medicare therapeutic shoe bill states: the statement can be signed by:
a. a chiropractor
b. a doctor of osteopathic medicine
c. a nurse practitioner
d. all of the above
b. a doctor of osteopathic medicine
According to documentation guidelines specified by Medicare, a doctor of medicine or a doctor of osteopathy who is treating the beneficiary’s systemic diabetic condition under a comprehensive plan of care must certify the need for therapeutic footwear.
A Statement of Certifying Physician for Therapeutic Shoes ◦ This document certifies your need for therapeutic shoes. ◦ This must be completed and signed by the physician who is treating your diabetes. This physician must be an MD or DO.
A Certified Fitter may receive a prescription from a nurse practitioner and still file to Medicare:
a. true
b. false
a. true
A NP can sign a prescription for DMEPOS.
You will need 3 documents for theraputic shoes
* A Statement of Certifying Physician for Therapeutic Shoes This document certifies your need for therapeutic shoes. This must be completed and signed by the physician who is treating your diabetes. This physician must be an MD or DO.
* A Standard Written Order - This document specifies the item(s) that the ordering provider is requesting be provided to you. ◦ The ordering provider can be your doctor, podiatrist, nurse practitioner, physician assistant or clinical nurse specialist.
* Clinical Evaluation/Notes (Acquire directly from your doctor)
Orthotic fitters must include clinical documentation, prescription and POD in file.
a. true
b. false
a. true
All should be part of the clinical chart documentation
If the prescription and diagnosis do not correlate you should:
a. Call the physician
b. call the physical therapist
c. fit the brace for the Dx
a. Call the physician
Call the physician for the physicians dx and your dx should match.
c. correct the patient and document that you have corrected the patient
It should be noted in the chart that the patient was corrected.
To provide an orthotic without a prescription, all of these must be true except:
a. It is for a close friend
b. No professional skills are expended in custom fitting the orthosis
c. It is billed in accordance with 3rd party payer regulations
d. The patient is billed directly
a. It is for a close friend
Discussing financial matters for services and devices with the patient should be done:
a. At delivery
b. After delivery
c. At patient intake
d. At final fitting
c. At patient intake
Which of these falls under the scope of practice of a Certified Orthotic Fitter?
a. Cervical Collars for Unstable Fractures
b. Breast prostheses
c. Cervical Collars for Stable Spine Conditions
d. Halos
c. Cervical Collars for Stable Spine Conditions
This person/agency determines the medical appropriateness of the prescription:
a. Certified Fitter
b. Physician
c. Patient
d. Medicare
b. Physician
The certified fitter may refer repairs or adjustments to an orthosis to an orthotist or pedorthist without notifying the prescribing healthcare provider as long as repairs or adjustments conform to the original prescription.
a. False
b. True
b. True
It is unethical for the certified fitter to accept any prescription when the certified fitter knows, or has good cause to believe, that the orthosis and/or shoes cannot be furnished:
a. Next day
b. In the exact color that the patient wants
c. Without additional cost
d. Within a reasonable period of time
d. Within a reasonable period of time
All certified fitters shall report to the Certifying Organization any conduct that appears to be:
a. Illegal
b. Unethical
c. Incompetent
d. All of these
d. All of these
Which of these are in the scope of practice of an Orthotic Fitter?
a. Breast forms
b. Prefabricated TLSO
c. Halos
d. Scoliosis Braces
b. Prefabricated TLSO
Which of these would NOT be in the scope of practice of an Orthotic Fitter?
a. Semi-Rigid TLSO
b. Functional Electrical Stimulation Orthotic
c. Corsets
d. Semi-Rigid LSO
b. Functional Electrical Stimulation Orthotic
Orthotic Fitters are allowed to formulate Treatment Plans?
a. False
b. True
b. True
Which of these practitioners would be allowed to treat unstable spinal conditions and long bone fractures?
a. Certified Orthotist
b. Certified Pedorthist
c. Certified Prosthetist
d. Certified Orthotic Fitter
a. Certified Orthotist
According to the facts in the presentation, how many disabling workplace injuries occur each year?
Select one:
a. Nearly 3 million
b. Nearly 4 million
c. Nearly 1 million
d. Nearly 2 million
b. Nearly 4 million
Patient Education includes all of these EXCEPT:
Select one:
a. Donning and Doffing
b. Trimming and Customization
c. Warranty and Return
d. Care and Maintenance
b. Trimming and Customization
For every business, a ______ is the vital first step
Select one:
a. Business Plan
b. Marketing Plan
c. Mission Statement
d. Profit and Loss Sheet
a. Business Plan
The orthotic fitter must use the applicable ____ codes
Select one:
a. HIPAA
b. HCPCS
c. HIPPIE
d. HIPPA
b. HCPCS
Communicating patient information to the referring physician may include all of these EXCEPT:
Select one:
a. New Brace Pricing Structures
b. Acknowledging Referrals
c. Clarifying Prescriptions
d. Reporting Patient Progress
a. New Brace Pricing Structures
Clarifying Prescriptions or orders with the physician or their staff is usually done:
Select one:
a. via mail
b. in person
c. automatically by computer
d. via telephone
d. via telephone
Poor quality materials and devices may result in all of these EXCEPT:
Select one:
a. increased referrals
b. poor patient care
c. loss of referrals
d. litigation
a. increased referrals
Acknowledging referrals is a way to thank the healthcare provider for their continued referrals. It can be done with all of these EXCEPT:
Select one:
a. in person
b. money
c. card
d. letter
b. money
You go to your referral source’s office to obtain some records. While there, you see a plaque on the wall. It says “To serve our community with dignity, integrity, and compassion”. What did you just read?
Select one:
a. Marketing Plan
b. Mission Statement
c. Balance Sheet
d. Business Plan
b. Mission Statement
You are submitting a Medicare claim for a Semi-Rigid TLSO for your 67 year old patient who was injured falling off a ladder. He does not have a secondary insurance. Your company has decided to accept assignment. What percentage of the bill is this patient responsible to pay?
Select one:
a. None
b. 30%
c. 10%
d. 20%
d. 20%
