Ch 14-15 Legals

Fraud
If an HIM acts in deliberate ignorance or in disregard to official coding guidelines, it may be committing
kickback
if an HIM department receives gifts from vendors in exchange for purchasing a specific encoder software, this is:
safe harbors
exceptions to the federal anti-kickback statute that allow legitimate business arrangements and are not subject to prosecution are
Stark Law
The federal physician self-referral statute is also known as the
Pharmacies
the OIG has specific compliance guidance for all of the following entities except
Returned overpayments
examples of high risk billing practices create compliance risks for healthcare organizations include all but which of the following
Federal Anti-Kickback Statute
This law establishes criminal penalties for paying to induce business for which payments from federal health care programs may be received
failure to document medical necessity
the OIG states that insufficient or missing documentation and which one of the following are responsible for 70% of bad claims submitted to medicare
Referrals
Which of the following types of activities is not one that should be audited and monitored in a compliance program?
The Deficit Reduction Act of 2006
Made compliance programs mandatory
Unnecessary costs to a program
Healthcare fraud is all but which of the following
False Claims Act
This act is used to combat medicare fraud by penalizing those that submit incorrect information to the program
Federal sentencing guidelines
corporate compliance programs became common after adoption of which of the following
medically unnecessary services
healthcare abuse relates to practices that may result in
Medicare Notice of Exclusions From Medicare Benefits
Services that are statutorily non-covered by Medicare can be located on the
Provider
responsibility for the filing of accurate claims ultimately belongs to the
Qui Tam
Healthcare fraud and abuse laws provide a whistleblower provision also known as
Provider’s documentation
Coding and billing documentation must be based on the
failure to use a comprehensive code to inappropriately maximize reimbursement
unbundling refers to
all of the above
submission of incorrect medicare claims is due to
tax relief and health care act
which federal law mandated the creation of recovery audit contractor services
all of the above
the OIG has issued specific compliance guidance for the following
the government’s investigative powers
the fraud enforcement and recovery act expands
the stark law
prohibits physicians from ordering from enitites that they have a financial relationship
billing for covered services
which of the following is not an example of a false claim.
they share similar underlying processes
risk management and quality improvement programs are related because of which of the following
risk identification
the systematic means of determining potential losses defines the process of
significant and should be investigated every time it occurs
a sentinel event in a joint commission accredited facility is
wrong leg amputated during surgery
which of the following gives information to be classified as a reviewable sentinel event, according to the JC
Understand the causes of a sentinel event
the purpose of root cause analysis (RCA) is to
safety, timelessness, efficiency, effectiveness, equitable, patient-centered care (STEEEP)
the IoM obectives for improvement include
Non-medicare, indigent patients must be transferred to the nearest level 1 trauma center
the EMTALA regulations include all but which of the following
Safe practices for all
which of the following is not an example of a private or governmental group focuses on quality?
a correction in a record is obliterated so that the only newly added and correct information appears
an example of a documentation indicator in a health record, signaling a problem, is:
eliminating the doctrine of charitable immunity
Darling v. Charleston Community Memorial Hospital is most often credited for
requiring that personal health records are used by every facilities
Quality improvement organizations (QIOs) are responsible for all of the following except
Quality Thresholds
Risk analysis involves the consideration of
the health record should be secured
After an adverse patient event, which of the following should occur with regard to the health record?
All of the above
The Joint Commission’s safety goals include
Hypertension
The Joint Commission’s quality improvement activities for health record documentation include all but which of the following core performance measures for hospitals
Patient Bill of Rights
The American Hospital Association’s Patient Care Partnership was originally called the:
Hill-Burton Act
provided hospitals with money for construction and modernization
Credentialing
The National Practitioner Data Bank is associated most closely with which hospital function?
Applies to impairments that substantially limit major life activities.
The Americans with Disabilities Act:
Restrict their use
With regard to seclusion and restraint, federal laws:
Professional Standards Review Organization (PSRO)
Which of the following was a precursor to quality improvement organizations?
Peer Review Organization
Which of the following was a precursor to quality improvement organizations?
All of the above
Which of the following has/have initiatives in place to reduce medical errors and improve patient safety?
Will encourage better health outcomes
Pay for performance
State Law
Risk management programs are more commonly governed by:

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