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HW 4 docs Compatibility mode, Exams of Medicine

North-West College - Van NuysMedicine

A series of multiple-choice questions related to healthcare fraud and abuse, including topics such as Medicare and Medicaid programs, legal terms, and patient privacy. The questions cover areas such as identifying fraud, legal procedures, and regulations related to healthcare. likely intended for students or professionals studying healthcare administration or law.

Typology: Exams

2022/2023

Available from 09/27/2023

arnezieme9
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Microsoft Word - HW_4.docx
HW 4 docs Compatibility mode
Indicate the answer choice that best completes the statement or answers the
question.
1. Which program measures improper payments in the Medicaid program and
the State Children’s Health Insurance Program (SCHIP)?
a.CERT
b. FATHOM
c.HPMP
d. PERM
2. Which unique identifier is assigned to third-party payers and has 10 numeric
positions, including a check digit as the tenth position?
a.HPID
b. PAYERID
c.PlanID
d. UPIN
3. Which of the following is an example of fraud?
a.billing noncovered services as covered services
b. falsifying certificates of medical necessity plans of treatment
c.reporting duplicative charges on an insurance claim
d. submitting claims for services not medically necessary
4. Which is testimony under oath taken outside of court, such
as at the physician’s office? a. deposition
b. interrogatory
c. subpoena
d. subpoena duces tecum
5. Which program assesses and measures improper Medicare fee-for-service
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Partial preview of the text

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HW 4 docs Compatibility mode

Indicate the answer choice that best completes the statement or answers the question.

  1. Which program measures improper payments in the Medicaid program and the State Children’s Health Insurance Program (SCHIP)? a.CERT b. FATHOM c.HPMP d. PERM
  2. Which unique identifier is assigned to third-party payers and has 10 numeric positions, including a check digit as the tenth position? a. HPID b. PAYERID c.PlanID d. UPIN
  3. Which of the following is an example of fraud? a.billing noncovered services as covered services b. falsifying certificates of medical necessity plans of treatment c.reporting duplicative charges on an insurance claim d. submitting claims for services not medically necessary
  4. Which is testimony under oath taken outside of court, such as at the physician’s office? a. deposition b. interrogatory c. subpoena d. subpoena duces tecum
  5. Which program assesses and measures improper Medicare fee-for-service

payments (based on reviewing selected claims and associated medical record documentation)? a. CERT b. FATHOM c.HPMP d. PERM

  1. Which amended Title IX of the Public Health Service Act to encourage voluntary and confidential reporting of events that adversely affect patients, creating organizations that collect, aggregate, and analyze confidential information reported by health care providers? a.Deficit Reduction Act of 2005 b. Improper Payments Information Act of 2002 c.Patient Safety and Quality Improvement Act of 2005 d. Tax Relief and Health Care Act of 2006

b. Improper Payments Information Act of 2002 c.Patient Safety and Quality Improvement Act of 2005 d. Tax Relief and Health Care Act of 2006

  1. The Medicare Integrity Program includes medical review, which is defined by CMS as a review of claims to determine whether services provided are , as well as to followup on the effectiveness of previous corrective actions. a.affordable by patient populations b. covered by the Medicare program c.effective for treatment of conditions d. medically reasonable and necessary
  1. The Patient Protection and Affordable Care Act established a Medicare shared savings program to facilitate the to improve the quality of care for Medicare fee-for-service beneficiaries and to reduce unnecessary costs. a. coordination and cooperation among health care providers b. declining investment in infrastructure and redesigned care processes c. lack of coordinated care for services under Medicare fee-for-service d. reduction in accountability for the care of beneficiaries
  2. Which was established to require facilities to identify and reduce improper Medicare payments and the Medicare payment error rate and also established Clinical Data Abstracting Centers? a. COBRA b. PATH c.PEPP d. TEFRA
  3. Release of information (ROI) by a covered entity about protected health information (PHI) requires the patient (or representative) to sign an authorization to release information, which is reviewed for authenticity and processed within a HIPAA-mandated time limit. a. 10-day b. 30-day c.60-day d. 90-day
  4. Which requires Medicare administrative contractors to attempt the collection of overpayments received by a provider or beneficiary? a.False Claims Act b. Federal Claims Collection Act c.Privacy Act of 1974 d. Stark I
  5. Medicare administrative contractors are organizations that contract with the

b. example c.precedent d. statute

  1. Which is a legal document containing a list of questions that must be answered in writing? a. deposition b. interrogatory c.subpoena d. subpoena duces tecum
  2. Record retention is the of documentation for an established period of time, usually mandated by federal and/or state law. a. destruction b. privacy and security c. releas e d. storag e
  3. Drew Baker is referred to a health care provider by an employer for treatment of a fracture that occurred during a fall at work. The physician billed Medicare and did not indicate on the claim that the injury was work related. Medicare benefits were paid to the provider for services rendered. This resulted in Medicare contacting the provider, who is liable for the because of the provider’s failure to disclose that the injury was work-related. a. adjudication b. mediation c.overpayment d. unbundling
  4. The American Recovery and Reinvestment Act of 2009 (ARRA) protects

whistleblowers , who are individuals that covered by the Act. a.are prosecuted for disclosing protected information b. correct overpayments and other reimbursement issues c.make specified disclosures relating to funds d. receive remuneration for disclosing wrongdoings

  1. Which of the following is an example of abuse? a.billing noncovered services/procedures as covered services/procedures b. falsifying health care certificates of medical necessity plans of treatment c.misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment d. submitting claims for services and procedures knowingly not provided
  2. Which consists of audits implemented by DHHS that examines the billing practices of physicians at teaching hospitals with the focus on compliance with the Medicare rule affecting payment for physician services provided by residents and whether the level of the physician service was coded and billed properly? a. NCCI b. PATH

areas to compare their performance with that of other hospitals? a. CERT b. FATHOM c.PEPPER d. PERM

  1. Which restricts patient information access to those with proper authorization and maintains the security of patient information? a.authorization b. confidentiality c.privacy d. security
  1. Which is the format of the EIN? a. 000000000 b. 00- c. 000-00- d. 000-000-
  2. Which is a legal newspaper published every business day by the National Archives and Records Administration (NARA), and is available in paper form, on microfiche, and online? a.Coding Clinic b. Code of Federal Regulations c.Federal Register d. Medicare Bulletin
  3. Which is a hospital payment monitoring program data analysis tool that provides administrative hospital and statespecific data for specific CMS target areas? a.CERT b. FATHOM c.PEPPER d. PERM
  4. Breach of confidentiality involves the unauthorized release of patient information to a third party, such as health care employees who. a.access patient health care information with an appropriate job-related reason b. communicate patient information to family members with the patient’s consent c.discuss patient information outside an exam room where other patients are present d. ensure that patient information is not available on a computer screen display
  5. The HIPAA Privacy Rule creates national standards to protect individuals’ medical records and other personal health information, and it also provides

c.NSF d. UB-

  1. HIPAA defines abuse as involving actions that are with accepted, sound medical, business, or fiscal practices, which directly or indirectly result in unnecessary costs to the program through improper payments. a. compatible b. inconsistent c.recurrent d. unvarying
  2. Which regulates fraud associated with military contractors selling supplies and equipment to the Union Army? a. False Claims Act b. Federal Claims Collection Act c. Privacy Act of 1974 d. Stark I
  3. An electronic signature will result in a unique bit string (or computer code) called a(n) , which is encrypted and appended to the electronic document. a. electronic transaction b. message digest c.transmitted version d. unique identifier
  4. The Patient Protection and Affordable Care Act (PPACA) of 2010 includes a health care reform measure that requires implementation of the hospital program to promote better clinical outcomes and patient experiences of care. a. inpatient quality reporting b. physician quality reporting c.recovery audit contractor d. value-based purchasing
  1. The proposed standard for an electronic signature is , which applies a mathematical function to the electronic document. a. decrypted b. digital c.manual d. standard
  2. HIPAA requires payers to implement rules called electronic , which result in a uniform language for electronic data interchange. a. data interchanges b. health records c.medical records d. transaction standards

b. case c.civil d. public

  1. Which established the Hospital IQR, RAC, and ZPIC programs? a.Deficit Reduction Act of 2005 b. Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 c.Patient Safety and Quality Improvement Act of 2005 d. Tax Relief and Health Care Act of 2006
  2. Which requires documents, such as a patient record, to be produced in court? a. deposition b. interrogatory c.subpoena d. subpoena duces tecum
  1. Which unique identifier is assigned to health care providers as a 10-digit numeric identifier, including a check digit in the last position? a. EIN b. HPID c.NPI d. UPIN
  2. Which documents patient information sent to authorized requestors and can be kept in manual or software formats? a. decryption and encryption b. electronic data interchange c.release of information log d. transmittals and manuals
  3. Which specifically requires an individual’s authorization prior to disclosure and for which HIPAA has established specific requirements for an authorization form? a. covered entity data and information b. designated record set c.protected health information d. treatment, payment, and operations
  4. Which program provides consumers with quality of care information so they can make more informed decisions about health care options? a.Hospital Inpatient Quality Reporting (Hospital IQR) b. Medicaid Integrity Program (MIP) c.Recovery Audit Contractor (RAC) d. Zone Program Integrity Contractor (ZPIC)
  5. Which was created by the Centers for Medicare and Medicaid Services for the purpose of assigning unique identifiers to health care providers and health plans? a.CMS
  1. Which is an order of the court that requires a witness to appear at a particular time and place to testify? a. deposition b. interrogatory c.subpoena d. subpoena duces tecum
  2. Which are assigned to the MAC jurisdictions (replacing Program Safeguard Contractors) to review billing trends and patterns, focusing on providers whose billings for Medicare services are higher than the majority of providers in the community? a.hospital value-based purchasers b. Recovery Audit Contractors c.whistleblowers d. Zone Program Integrity Contractors
  3. Because the diagnosis and procedure codes reported affect the DRG selected (and resultant payment), some hospitals engage in a practice called , which is the assignment of an ICD-10-CM diagnosis code that does not match patient record documentation, for the purpose of illegally increasing reimbursement. a. downcoding b. jamming c.unbundling d. upcoding
  4. Federal and state are laws passed by legislative bodies, such as federal Congress and state legislatures. a. policies b. procedures c.regulations d. statutes
  5. Which established the CERT, FATHOM, HPMP, PEPPER, and PERM programs?

a.Deficit Reduction Act of 2005 b. Improper Payments Information Act of 2002 c.Patient Safety and Quality Improvement Act of 2005 d. Tax Relief and Health Care Act of 2006

  1. Which created the Physician Quality Reporting System that established a financial incentive for eligible professionals who participate in a voluntary quality reporting program? a. Deficit Reduction Act of 2005 b. Improper Payments Information Act of 2002 c.Patient Safety and Quality Improvement Act of 2005 d. Tax Relief and Health Care Act of 2006
  2. Which is maintained by the Food and Drug Administration (FDA) and identifies prescription drugs and some overthe-counter products? a. CDT