practice test

Question 1

Under the HIPPA Act of 1996, Public Law 104-191, what is the name of the national program designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse?

Answer 1

Health Care Fraud and Abuse Control Program (HCFAC)

Question 2

According to the Federal Sentencing Guidelines, “To have an effective compliance and ethics program…, and organization shall exercise due diligence to prevent and detect criminal conduct.” The FSGs also state organization shall:

Answer 2

Promote an organizational culture that encourages ethical conduct and a commitment to compliance with the law

Question 3

If a physician practice uses another entity’s standards of conduct, the practice must:

Answer 3

Tailor those materials to the physician practice where they will be applied.

Question 4

As the compliance contract for your physician practice, you are charged with developing the policies and procedures related to coding and billing. When developing these policies and procedures:

Answer 4

For any service billed, documentation must be present in the patients medical record to support the services.

Question 5

City Orthopedics, a large physician group practice employs several physician assistants and nurse practitioners. There have been several questions by the physicians on how incident to services should should be billed. The compliance officer has called the Medicare Administrative Contractor for the practice and was given some information on how incident to services should be billed. Because the practice will be relying on the information received from the Medicare Administrative Contractor, what steps should the compliance officer take at the conclusion of the call according to the OIG Compliance Guidance for Individual and Small Group Physician Practices?

Answer 5

Document the conversation and retain the records

Question 6

Developing effective compliance policies and procedures is an important part of any compliance program. To help your practice mitigate compliance risk, policies and procedures should:

Answer 6

Be sure any timeframes or requirements listed can be accomplished given the practice’s resources

Question 7

Centennial Medical Associates is committed to following Federal, State, and Local laws, rules, guidelines, and regulations. To promote this effort, Centennial Medical Associates will perform claims audits at least on an annual basis to ___________.

Answer 7

Verify accuracy of coding and reimbursement for the services performed

Question 8

You have just been identified as the compliance officer at your practice. The OIG Compliance Guidance for Individual and Small Group Physician Practices suggest six specific duties that may be assigned to you. What is one of those duties?

Answer 8

Reviewing reports to see that new employees and vendors have been checked against the OIG’s list of excluded individuals and entities.

Question 9

For larger physician practices, how frequently does the OIG recommend reporting compliance activities to the Board of Directors and CEO?

Answer 9

Regularly

Question 10

When conducting compliance training within a physician practice, what is one of the goals that the practice should strive for in this training?

Answer 10

All employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations.

Question 11

What is the goal of ongoing auditing and monitoring in a physician’s practice?

Answer 11

Ongoing auditing and monitoring will evaluate whether the physician practice’s standards and procedures are current and accurate and whether the compliance program is working.

Question 12

A compliance program’s plan for communication should include a provision for non-retaliation for reporting fraudulent conduct. Which method below helps ensure that an employee would be free from retribution?

Answer 12

Well-publicized disciplinary actions for retaliation

Question 13

What does the HHS OIG suggest as possible warning signs that non-compliance may exist?

Answer 13

Significant change in the number or type of claim rejections.

Question 14

Having the ability to respond to issues enables a practice to develop effective action plans to correct problems and prevent future problems from occurring. What is one step that can be taken to establish compliance effectiveness for responding to and/or preventing compliance issues?

Answer 14

Create a response team, consisting of representatives from compliance, audit, and any other relevant functional department.

Question 15

A physician office laboratory is authorized to perform urinalysis testing, including the microscopic analysis under their Provider-Performed Microscopy Procedures (PPMP) certification. It has been the physician’s experience that many of his patients that have urinalysis testing done also requires the microscopic exam. Because of this and to be able to provide better treatment, he has established an office policy that for all urinalysis testing performed in his office, the lab should also perform the microscopic test. Is this a compliance risk?

Answer 15

Yes. Performing the microscopic test on all patients when the results of the urinalysis are negative could be considered medically unnecessary.

Question 16

Billing companies should have written policies and procedures that reflect and reinforce Federal and State statutes. These policies must create a mechanism for the billing or reimbursement staff to communicate effectively and accurately with the health care provider. Which of the following policies and procedures should a billing office have in place to meet these needs?

Answer 16

Establish and maintain a process for pre- and post-submission review of claims to ensure claims submitted for reimbursement accurately represent services provided, are supported by sufficient documentation and are in conformity with any applicable coverage criteria for reimbursement.

Question 17

According to the OIG, medically unnecessary services should only be billed to Medicare in what circumstances?

Answer 17

To receive a denial so that the claim can be submitted to a secondary payer.

Question 18

As part of a practice’s compliance program, record retention policies and procedures should be developed. This policy and procedure should address the timeframes associated with the retention of various records. When developing a policy, which of the following statements should be present?

Answer 18

Specific records must be retained based upon the most stringent requirement identified in federal or state law, or internal policies and procedures.

Question 19

A patient being seen by a physician has unpaid medical bills in excess of $5,000 after insurance payments. The patient has now lost his job and has limited financial resources. The office manager has reviewed the patient’s financial situation to asses the patient’s ability to pay and has agreed to reduce the fees owed to $2,500. Would this act violate the OIG gift allowance for beneficiaries?

Answer 19

No, this would be an exception to the OIG gift allowance because it is based on the patient’s ability to pay.

Question 20

Services furnished in teaching settings are paid under the Medicare Physician Fee Schedule (MPFS) if the services are:

Answer 20

Personally furnished by a physician who is not a resident.

Question 21

Which of the following settings is the incident-to rule not applicable?

Answer 21

Hospital

Question 22

True or False:
Physicians or suppliers who have chosen to accept assignment may as a result collect from the enrollee or anyone else any amount which, when added to the benefit, may exceed the Medicare allowed amount.

Answer 22

False