HIM 478 RHIA REVIEW QUESTIONS CHAPTER 10

Question 1

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 1

False Claims Act

Question 2

Examples of high-risk billing practices which create compliance risks for healthcare organizations include all but which of the following?

a. Altered claim forms
b. Returned overpayments
c. Duplicate billings
d. Unbundled procedures

Answer 2

Returned overpayments

Question 3

Healthcare fraud and abuse laws provide a whistleblower provision also known as_________.

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

Answer 3

Qui tam

Question 4

The Deficit Reduction Act of 2006_________.

a. Encouraged voluntary compliance programs
b. Made compliance programs mandatory
c. Affects entities that make or receive at least $9 million in Medicaid payments
d. Did not address healthcare fraud and abuse

Answer 4

Made compliance programs mandatory

Question 5

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 5

Failure to use a comprehensive code to inappropriately maximize reimbursement

Question 6

Coding and billing documentation must be based on the_________

a. Provider’s documentation
b. Highest available reimbursement amount
c. Most efficient utilization of resources
d. Wishes of the patient

Answer 6

Provider’s documentation

Question 7

The Fraud Enforcement and Recovery Act expands_________

a. The role of HIPAA in compliance
b. The office of the RACs
c. The government’s investigative powers
d. The office of the OIG

Answer 7

The government’s investigative powers

Question 8

The Fair and Accurate Credit Transactions Act works to reduce ____________.

a. privacy breaches.
b. security breaches.
c. the number of invalid authorizations.
d. identity theft.

Answer 8

identity theft.

Question 9

The federal physician self-referral statute is also known as the _________.

a. Stark Law
b. Deficit Reduction Act
c. False Claims Act
d. Sherman Anti-Trust Act

Answer 9

Stark Law

Question 10

Exceptions to the Federal Anti-Kickback Statute that allow legitimate business arrangements and are not subject to prosecution are_________.

a. Safe harbors
b. Qui tam practices
c. Exclusions
d. Safe practices

Answer 10

Safe harbors