HW 4;EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS BEST RATED SOLUTION, Exams of Nursing

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HW 4;EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2023

GUARANTEED SUCCESS BEST RATED SOLUTIONS

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
6. 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
• c. Patient Safety and Quality Improvement Act of
• d. Tax Relief and Health Care Act of

7. Which program was implemented to find and correct improper Medicare payments paid to health care providers participating in fee-for-service Medicare? a. Hospital Inpatient Quality Reporting (Hospital IQR) b. Medicaid Integrity Program (MIP) c. Recovery Audit Contractor (RAC) d. Zone Program Integrity Contractor (ZPIC)
8. Which is the official document that contains new and changed Medicare policies and/or procedures that are to be incorporated into a specific CMS program manual? a. bulletins b. companion guides c. face sheets d. transmittals
9. Which program measures, monitors, and reduces the incidence of Medicare fee-for-service payment errors for shortterm, acute care, inpatient PPS hospitals? a. CERT b. FATHOM c. HPMP d. PERM
10. HIPAA defines fraud as an deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment. a. accidental b. intentional
11. Which increased resources available to CMS to combat abuse, fraud, and waste in the Medicaid program, creating the Medicare Improvement Program (MIP)? 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
12. 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

13. 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
14. 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
15. 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
16. 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
17. Medicare administrative contractors are organizations that contract with the Centers for Medicare and Medicaid Services to process fee-for-service health care claims and perform for both Medicare Part A and Part B. a. assignment of codes b. electronic data interchange c. legal mediation d. program integrity tasks
18. Civil law deals with all areas of the law that are not classified as law. a. administrative b. case c. criminal d. standard
19. Court decisions establish standard use legal decisions that serve as authoritative rules or patterns in future similar cases. The legal term for standard is.

a. decision

b. example c. precedent d. statute

20. 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
21. 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. release d. storage
22. 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
23. 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
24. 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
25. 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

c. SCHIP d. ZPIC

26. Which is the right of individuals to keep their information from being disclosed to others? a. authorization b. confidentiality c. privacy d. security
27. Which flat file is a series of fixed-length records that is currently used to bill institutional services, such as services performed in hospitals? a. ANSI ASC X12N 837 b. CMS- c. NSF d. UB-
28. Which was implemented to assist with CMS audit, oversight, anti-fraud, and anti-abuse efforts related to the Medicare Part D benefit? a. Hospital Inpatient Quality Reporting program b. Medicare Integrity Program c. Medicare Drug Integrity Contractors Program d. Zone Program Integrity Contractor program
29. The HIPAA Security Rule adopts standards and safeguards to protect health information that is collected, maintained, used, or transmitted. a. electronically b. manually c. personally d. physically
30. Which is a hospital payment monitoring program that contains hospital-specific administrative claims data for a number of CMS-identified problem areas to compare their performance with that of other hospitals? a. CERT b. FATHOM c. PEPPER d. PERM
31. 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

32. Which is the format of the EIN? a. 000000000 b. 00- c. 000-00- d. 000-000-
33. 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
34. 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
35. 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
36. The HIPAA Privacy Rule creates national standards to protect individuals’ medical records and other personal health information, and it also provides patients with. a. conveniences, like not signing an authorization b. greater access to their own medical records c. less control over how their PHI is used d. the ability to collect monetary penalties
37. Court decisions that establish a standard create law. a. administrative b. admiralty c. case d. criminal
38. Which flat file is used to bill physician and noninstitutional services, such as services reported by a general practitioner, on the CMS-1500? a. CDT

b. EDI

c. NSF d. UB-

39. 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
40. 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
41. 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
42. 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
43. 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
44. 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

45. Which prohibits physicians from referring Medicare patients to clinical laboratory services in which the physicians or their family members have a financial ownership/investment interest and/or compensation arrangement? a. False Claims Act b. Federal Claims Collection Act c. Privacy Act of 1974 d. Stark I
46. Which was implemented to protect the privacy of individuals identified in information systems maintained by federal government hospitals and to give individuals access to records concerning themselves? a. False Claims Act b. Federal Claims Collection Act c. Privacy Act of 1974 d. Stark I
47. Any information communicated by the is considered privileged communication, and HIPAA provisions address the privacy and security of protected health information. a. patient to a health care provider b. patient to a third-party payer c. provider to a third-party payer d. third-party payer to a provider
48. Laws that are implemented as guidelines written by administrative agencies, such as CMS, are called. a. policies b. procedures c. regulations d. statutes
49. Criminal law is law (statute or ordinance) that defines crimes and their prosecution. a. administrative b. case c. civil d. public
50. 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
51. Which requires documents, such as a patient record, to be produced in court? a. deposition b. interrogatory c. subpoena

d. subpoena duces tecum

52. 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
53. 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
54. 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
55. 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)
56. 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 b. DEEDS c. EDI d. NPPES
57. Which involves the safekeeping of patient information by controlling access to records, protecting patient information from alteration/destruction/tampering/loss, and providing employee training in HIPAA requirements, which includes the consequences of improper disclosure of patient information? a. authorization b. confidentiality c. privacy d. security

58. 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
59. 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
60. 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
61. Federal and state are laws passed by legislative bodies, such as federal Congress and state legislatures. a. policies b. procedures c. regulations d. statutes
62. 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
63. 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
64. Which is maintained by the Food and Drug Administration (FDA) and identifies prescription drugs and some overthe-counter products?

a. CDT

b. ICD c. NDC d. NSF

65. Which is an abbreviation for the Latin phrase qui tam pro domino rege quam pro sic ipso in hoc parte sequitur, meaning “who as well for the king as for himself sues in this matter”? a. qui tam b. res gestae c. respondeat superior d. subpoena duces tecum

66. Encoding or a computer file makes it safe for electronic transmission so that unauthorized parties cannot read it. a. decrypting b. digesting c. encrypting d. interchanging
67. Which is the physician self-referral law that protects patients and federal health care programs from fraud and abuse by curtailing the corrupting influence of money on health care decisions? a. Federal Anti-Kickback Law b. Federal Claims Collection Act c. Occupational Safety and Health Act d. Social Security Act
68. Which authorizes CMS to enter into contracts with entities to perform cost report auditing, medical review, anti- fraud activities, and the Medicare Secondary Payer (MSP) program? a. COBRA b. MIP c. PEPP d. TEFRA
69. Which is a variable-length file format used to bill institutional, professional, dental, and drug claims? a. ANSI ASC X12N 837 b. CMS- c. NSF d. UB-
70. Which code set is copyrighted by the American Dental Association? a. CDT b. CPT c. ICD-10-CM d. ICD-O-