HIM 105 final exam questions with detailed correct answers.

What protects confidential communication from disclose between a patient & doctor related to diagnosis and treatment during civil and some criminal misdemeanor litigation? - correct answers Privilige status Health Insurance Portability & Accountability Act HIPAA of 1996 - correct answers Established a criminal federal offense of "healthcare fraud" In regard to protecting the concept of priviliged communication, a healthcare provider who wrongfully releases a pt record may be accused of - correct answers Breach of fiduciary duty This type of law consists of rules and regulations issued by agencies that implement statutory law. - correct answers Administrative law what statement best describes the ethical principle of nonmaleficnce? - correct answers Doing no harm The confidentiality applies to which of the following? - correct answers All of the above The legal term used to describe when a patient has the right to maintain control over certain personal info is referred to as - correct answers privacy Population health is also known as - correct answers public health Which was the precursor to today's HIO? - correct answers RHIO HIO's are managed by - correct answers Public-private partnerships Which HIE model does not have a centralized database of pt info, is more common, and works much like the internet? - correct answers Federated What is the process that ensures that the person is who they say they are, have the authority to do what they need to, and that their actions are tracked? - correct answers identity management Negligence is generally not inferred or presumed from an injury and the burden of proof falls upon the plaintiff, except in cases that apply this principle - correct answers Res Ipsa Loquitor Which of the following terms denotes a civil wrongdoing for which the law will provide a remedy in the form of a lawsuit to recover damages? - correct answers Tort What is the term used to denote the liability of an employer for the acts of its employees - correct answers Respondeat Superior If a hospital is in its own right for the harm or negligence that may have been caused to a patient, the legal theory being applied is - correct answers Corporate negligence A patient in the emergency room for server laceration of the foot. The patient is given written instruction by the physician to have the sutures removed in 3 day, which the patient fails to do. A severe infection ensues resulting in permanent damage to the patient's foot. The patient sues the surgeon for negligence and the surgeon uses the EHR record to prove - correct answers Contributory negligence What legal concept may be applied when Dr. Smith failed to prescribe the appropriate treatment for a pt. that would have been prescribed by any other physician in a similar situation treating a pt with a similar condition? - correct answers Standard of care The negligent tort of nonfeasance refers to - correct answers Failure to do an act that a person is under a duty to do & that a person of ordinary prudence would have done under the same or similar circumstances A statute of limitations may begin to run when - correct answers all of the above Although a cause of action for false imprisonment may result if a hospital retains a patient against the patient's will, a hospital may be protected from liability if the patient - correct answers is a danger to himself or others What is the goal of the Joint Comnission policy on sentinel events - correct answers all of the above Risk management and quality improvement programs are related because of which of the following reasons? - correct answers They share similar underlying processes Which of the following is not a purpose of a risk management program - correct answers Prediction of an unfavorable program Quality improvement organizations (QIO's) are responsible for all of the following except - correct answers Requiring every facility to use the same software for data collection What is the not-for-profit, non governmental entity that offers voluntary accreditation programs for all types of healthcare organizations? - correct answers The Joint Commission The role of National Practitioner Data Bank in quality improvement can best be described as which of the following? - correct answers Reporting providers with adverse actions A sentinel event in a Joint Commission accredited facility - correct answers Signals the need for immediate investigation and response by the organization What tool is used by a risk manager for capturing data about an adverse event? - correct answers incident report Which of the following statements is true? - correct answers Some risks may have...catastrophic event... C & D When a state requirement exists that compels a healthcare facility to report patient information and there is an absence of specific data elements required for reporting, what should be disclosed - correct answers minimum necessary information During the flu season, a nursing home reports the cases of known flu in the nursing home population. The local health department calls and wants more info on the recent hospitalizations of these flu patients. How should the request be handled? - correct answers Verify the authenticity of the request and provide information Healthcare facilities are required to report vital statistics to which of the following authority? - correct answers State Department of Health Trauma registry data is used for all the folowing purposes except - correct answers prosecution of drunk drivers the safe medical devices act requires the reporting of medical device injuries to which agency? - correct answers Food and Drug Administration Responsibility for completing fetal death certificate - correct answers State law A competent adult female has a diagnosis of ovarian cancer and while on the operating table suffers a stroke and is in a coma. Her son would like to access her health records from a clinic she recently visited for pain in her right arm. The patient is married and lives with her husband and two grown children. According to the Uniform Health-Care Decision Act (UHCDA) who is the logical person to request and sign an authorization to access the woman's health records from the clinic? - correct answers Oldest adult child An underwriter at the Thompson Insurance Agency received health information Mrs Blake who is applying for health and life insurance through the agency. What federal law is this underwriter breaking as a result of his decision? - correct answers GINA Most state laws deem adoption records to be confidential and allow their release only under what circumstance? - correct answers Court Order When Greg was released from Metro Hospital substance abuse inpation facility, he authorized his records to be released to General Hospital, where he had his knee replaced. Greg's physical therapist has requested copies of his health record from the hospital. General Hospital releases Greg's information from Metro Hospital with its own information to Physical Therapy Service. Select the statement that best addresses the situation - correct answers General Hospital has violated re-disclosures regulations by releasing the records from Metro Hospital to Physical Therapy Services Zach is 14 and consented to completing a 3 month drug rehab program. When he completes the program, who has the right to authorize the release of his health info to another party? - correct answers Zach A mental health professional cannot be compelled to testify or disclose protected health information without patient authorization in a judicial situation except in what situation? - correct answers all of these Under which of the following conditions is Mr. Smith's authorization required for the use and disclosure of his health information - correct answers When Mr. Smith's attorney is requesting the information Who owns the record of a patient treated in a healthcare facility - correct answers The facility A wife who is legally authorized to make healthcare decisions and act on behalf of her husband, who is a patient is acting in what capacity - correct answers personal representative What term best describes an organization that has been formed to create an electronic framework that connects hospitals, physicians, pharmacies and other healthcare entities for the purpose for sharing patient information? - correct answers Health Information Exchange Katie is 13 years old and lives with her mon who has custody. katie has recently been in the hospital, and her mom is seeking a copy of Katie's health record. Who must sign authorization form that will enable Katie's mom to access Katie's record? - correct answers Katie's mother because she has custody Except as provided by law, who controls access to a patient's health information by third parties such as insurance companies? - correct answers A & B only Which of the following should occur when a patient leaves a hospital against medical advice? - correct answers All of these At its most basic level, patient rights addresses - correct answers conduct between a healthcare provider and a patient Patients diagnosed with a mental illness and involuntarily committed - correct answers are not necessarily deemed incompetent by virtue of the mental illness What is the term used to describe the interconnected organizations that have the capability of sending and receiving confidential patient information anywhere in the country? - correct answers ehealth exchange Board of Directors - correct answers -ultimate responsibility for the quality of care and financial well-being of the healthcare organization -Controlling authority for healthcare authority Responsible for providing adquate staff Medical Staff By-Laws - correct answers outline the obligation of the staff define organizationl structure of the divisions withing the medical staff, define standards, disciplinary status, etc Medical staff bylaws - correct answers Standards governing the practice of medical staff members; typically voted upon by the organized medical staff and the medical staff executive committee and approved by the facility's board; governs the business conduct, rights, and responsibilities of the medical staff; medical staff members must abide by these bylaws in order to continue practice in the healthcare facility Medical staff executive committee - correct answers A body composed of those elected representative members of the medical staff who are authorized to act on behalf of the medical staff credentials, bylaws, HIM clinical oversight, Professional officers, etc. credentialing process - correct answers The process of reviewing and validating the qualifications (degrees, licenses, and other credentials) of physicians and other licensed independent practitioners, for granting medical staff membership to provide patient care services Due Process - correct answers 2 elements - Substantive - guarantees laws are fair, reasonable, and not arbitrary. Procedural - government shall not take a person's life, liberty or property without due process of law When a provider is excluded from Federal healthcare programs, services he orders for a beneficiary of one of these proghrams will be paid as long as the service is furnished by a non-executed provider - correct answers false If an overpayment is not returned to medicare within 30 days, it becomes a violation of the False Claims Act - correct answers False Primary difference between fraud and abuse is intention - correct answers true Billing for services never rendered is one of the most common types of healthcare fraud - correct answers true Paying physicians for referrals is a practice encouraged by medicare - correct answers false Paying physicians for referrals is a practice encouraged by Medicare - correct answers False Some electronic health record features include fraud and abuse risks - correct answers True For a provider to be liable under the False Claims Act there must be proof of a specific intent to defraud - correct answers False To fit within the Anti-kickback Statute safe harbor for EHR items and services, the software must be interoperable - correct answers true The Stark Law is another name for the Anti-Kickback Statute - correct answers False The Stark Law is the government's primary litigation tool for combatting fraud - correct answers False Risk sharing arrangements are a Stark law exception to the referral prohibition - correct answers True What is the 4th stage in the following sequence of events: data, information, knowledge, and - correct answers wisdom The medical staff has the ultimate responsibility for the quality and financial well-being of the health organization. - correct answers false medical staff by-laws are considered a contract and are legally binding in most states - correct answers true The executive committee of the medical staff does not have to follow the medical staff by-laws - correct answers false if a practitioner is assigned a medical staff category of "associate", he or she can chair the medical staff executive committee - correct answers False The classification of medical staff membership impacts a provider's ability to admit patient's to a healthcare facility - correct answers True Categories of medical staff - correct answers Active, associate, courtesy, consulting, honorary, affiliate, Corporate Compliance - correct answers 1. A facility-wide program that comprises a system of policies, procedures, and guidelines that are used to ensure ethical business practices, identify potential fraudulence, and improve overall organizational performance 2. A program that became common after the Federal Sentencing Guidelines reduced fines and penalties to organizations found guilty of fraud if the organization has a prevention and detection program in place Compliance Plan - correct answers Compliance plan should not only adhere to medicare, medicaid, but private sector too fraud - correct answers Intentional deception Corporate Compliance - correct answers Adherence to laws and regulations passed by official regulating bodies, as well as general principles of ethical judgement Corporate Compliance In Healthcare - correct answers means meeting the statutory and regulatory requriements set out for particular activities in the provision of healthcare Improper Payment - correct answers Payment that should not have been made, made in incorrect amount (overpayments and underpayments) Federal Anti-Kickback Law - correct answers Prohibits knowingly and willfully receiving or paying anything of value to influence the referral of federal health care program business. Stark Law - correct answers Prohibits physicians or their family members who own health care facilities from referring patients to those entities if the federal government, under Medicare or Medicaid, will pay for treatment. Upcoding - correct answers billing for a service at a higher level than was actually provided Unbundling - correct answers submitting multiple CPT codes when one code should be submitted False Claims Act (FCA) - correct answers A federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. The governments primary litigation tool for combatting fraud Whistleblowers Quit Tam Relators - correct answers Private individuals that can bring civil legal actions under FCA and may receive percentage of recovery when the legal action is successful The Knowing Standard - correct answers The fact that the provider must have knowingly submitted the false claim. Fraud Enforcement and Recovery Act of 2009 (FERA) - correct answers Expands both the potential for liability under the False Claims Act (FCA) and the government's investigative powers, and it eliminates the requirement that a person has to present a false claim to a US government officer or employee, or a member of the US armed services, in order to be liable under the FCA renumeration - correct answers payment for work done Safe Harbors - correct answers Exceptions to the Federal Anti Kickback Statute that allow legitimate business arrangements and are not subject to prosecution are Civil Monetary Penalties Law - correct answers A law passed by the Federal Government to prosecute cases of Medicaid fraud. Referral - correct answers Means, for Medicare Part B services "the request by a physician for the item or service and for all other medicare and medicaid services Sherman Antitrust Act - correct answers collectively make it illegal to restrain trade through contracts trade through contracts or conspiracies and they prohibit price fixing, and mergers that lessen competition medical staff - correct answers The staff members of a healthcare organization who are governed by medical staff bylaws; may or may not be employed by the healthcare organization Guidelines offer seven steps for an effective compliance program - correct answers minimum guidelines , must have compliance officer Role of the Office of the Inspector General (OIG) - correct answers Responsibility to report program and mangement problems to both the HHS secretary and congress, along with recommendations to correct them Roel of the Department of Justice DOJ - correct answers root out fraud and safeguard tax payers from illegal conduct, works in collaboration with a number of other federal agencies to investigate and prosecute fraudulent activities Healthcare Fraud and Abuse Control (HSFAC) Program - correct answers Goal to coordinate state and federal local fraud and abuse activities, healthcare fraud prevention partnership (HFPP) goal is to be proactive in identifying fraud, Healthcare fraud prevention and enforcement Action Team Patient Protection and Affordable Care Act - correct answers health care reform law passed in 2010 that includes incentives and penalties for employers providing health insurance as a benefit Stark Law (The Physician Self-Referral Law - correct answers otherwise known as the Stark Law, builds on the Anti-Kickback Statute and prohibits a physician from referring patients to a business in which he or she or a member of the physician's immediate family has financial interests. For example, if the physician owns a dialysis center, he or she cannot refer a patient for dialysis at that location. If he or she does refer a patient to the facility, then the physician cannot receive Medicare or Medicaid funding (CMS 2014c). ) Safe Harbor for Electronic Health Records - correct answers Intended to protect beneficial arrangements that would eliminate perceived barriers to the adoption of EHRs without creating undue risk that the arrangements might be used to induce or reword the generation of federal healthcare program business Federal Anti-Kickback Law - correct answers Prohibits knowingly and willfully receiving or paying anything of value to influence the referral of federal health care program business. Unbundling codes - correct answers refers to separating the components of a procedure and reporting them as billable codes with charges to increase reimbursement rates Upcoding - correct answers A fraudulent practice in which provider services are billed for higher procedural codes than were actually performed, resulting in a higher payment. Waivers of the Stark Law, False Claims act, and civil monetories penalties law provision relating to beneficiary inducements apply to certain ACO arrangements - correct answers False The patient protection and affordable care act added penalties for failing to report or return a known repayment - correct answers true The Deficit Reduction Act extended the application and scope of the current civil monetary and exclusion authoritories beyond programs funded by HHS to all federal health care programs - correct answers False Mergers of the healthcare organizations are subject to the Sherman Anti-Trust Act - correct answers True All billing errors that result in overpayments by a federal healthcare program should be reported to the government through the Provider Self-Disclosure Act protocol - correct answers False The Government Accountability Office recommended that increased use of prepayments edits would help prevent improper Medicare Payments - correct answers True The Medicare Fee-For_Service improper payment rate calculated through the Comprehensive Error Rate Testing (CERT) program is widely regarded to be an accurate reflection of the true size of fraud, waste and abuse problem - correct answers False The Health Care Fraud prevention and Enforcement Action Team (HEAT) uses real-time data analysis to investigate health care fraud cases - correct answers True The federal governments primary approach to combatting healthcare fraud is "pay and chase" - correct answers False Detection of compliance violations is an important part of an effective compliance program - correct answers true Oversight of the compliance program is primarily the responsibility of the organizations general counsel - correct answers false The 7 fundamentals of an effective compliance program recommended by the OIG are based on HHS regulatory standards - correct answers False An effective compliance program is a mitigating factor in reducing a provider's liability under fraud and abuse laws - correct answers True A corporate compliance program is an internal set of policies, processes, and procedures that an organization implement to help it act ethically and lawfully - correct answers true Which of the following types of interoperability refers to how the data should be formatted and structured so that seamless exchange can take place - correct answers Syntactic What federal agency is responsible for the coordination and implementation of EHR technology for the exchange of ePHI - correct answers ONC In order to implement a meaningful consent process at an HCO, consumers would need to be informed of the available possibilities and decisions, its importance in continued treatment, the process of releasing their health information and to whom, and what it means for them. This falls under which of the 3 components of a meaningful consent program? - correct answers Patient education and agreement The patient's right to the confidentially of his or her health information is reinforced through - correct answers all of these Medicare requirements pertaining to seclusion and restraint - correct answers restrict their use Which of the following statements is not part of the EMTALA regulations - correct answers non-medicare indigent patients must be transferred to the nearest Level Trauma Center Disabling the USB drive on a computer is an example of what type of security - correct answers workstation Security awareness training programs required the use of awareness and training of all workforce members and should include - correct answers provide security reminders Which of the following are required components of a HIPAA-compliant disaster plan - correct answers Data backup data recovery, emergency mode of operations, and user IDs Which of the following is a reason for NOT using email communicate sensitive patient information - correct answers All of these Which of the following is potential consequences to the medical identity theft victim - correct answers all of these If a healthcare facility sustains physical damage caused by a tornado, the disaster recovery mechanism which provides the greatest protection of the data is - correct answers off-site data storage Uniform access to patient information for all nursing staff best describes: - correct answers role based access Based on the red flags rule - correct answers all of these When external reviewers request access to electronic patient records, the IT professionals at Charity Clinics determine that giving the reviewers a user name and password to access all records in the database is the quickest and easiest approach. As the HIIM Director, your response to this would be to: - correct answers A) agree with IT and grant access to the records. B) disagree with IT and deny access to the records. C) suggest records necessary for audit be placed in a queue. D) contact a clinic attorney to get a legal opinion about access to the records. a subcontractor of a business associate may - correct answers transmit ePHI on the business associate's behalf if it provides satisfactory assurances that the information will be appropriately safeguarded Which of the following is best practice to comply with the revised security provisions surrounding business associates of the HITECH act - correct answers Inventory BA's to determine which Business Associates Agreements need amending Dr Watson is know to chronically his password and asks other physicians and nurses to use their passwords. This is reported by various staff, but the security officer ignores the complaints since Dr. watson is chief of staff. The hospital has not complied with - correct answers Sanction Policy Which term does the security rule use to define information has not been altered or destroyed in an unauthorized manner - correct answers Integrity The HIPAA Security Rule allows flexibility in implementation based on reasonableness and appropriateness. This means that covered entities can - correct answers implement based on organizational assessment Which of the following is true about restriction request - correct answers It can be terminated by either the covered entity or the individual Under HIPAA, a covered entity may deny a patient's amendment request for which of the following reasons - correct answers all of these Breach notification requirements apply to - correct answers All of these The privacy rule permits charging patients for labor and supply costs associated with copying health records. Mercy Hospital is located in a state where state law allows charging patients a $100 search fee associated with locating records that have been requested. - correct answers The Privacy Rule will preempt state law in this situation Jack Mitchell, a patient in Ross Hospital, is being treated for gallstones. He has not opted out of the facility directory. Callers who request information about him may be given - correct answers general condition and acknowledgement of admission The state department of behavioral health SDBH funds services by private providers throughout the state. It also issues regulations pertaining to the administration of behavioral healthcare throughout the state. It operates five outpatient sites and 3 inpatient sites around the sate. SDBH is - correct answers Hybrid Entity Which of the following is not an element that makes "PHI" under the HIPAA privacy rule - correct answers contained within a personnel file Which of the following statements does the privacy rule NOT require the notice of privacy practices to contain - correct answers A statement that all disclosures will be prohibited from future re-disclosures The designated record staff - correct answers includes medical and billing records medical info loses the phi status and is no longer protected by the hipaa privacy rule when it - correct answers Is de-identified The Privacy rule resides in - correct answers Title II of HIPAA Central City Clinic has requested that Ghent Hospital send its hospital records from Susan Hall's most recent admission to the clinic for her follow-up appointment. Which of the following statements is true? - correct answers The Privacy Rules minimum necessary requirement does not apply Which of the following should be included in the definition of the legal health record - correct answers history and physical Which of the following is true of health record destruction - correct answers It is permitted pursuant to an approved retention schedule and destruction policy Authenticity pertains to the - correct answers genuineness of a record If two healthcare workers disagree about the course of treatment for a patient how should this be documented in the health record - correct answers Both professionals should record their opinions in the record independently of each other The Uniform Photographic copies of Business and Public Records as Evidence Act UPA - correct answers supports the admissability of reproduction into evidence with stipulations When comparing the HIPAA defined-designated record set with the legal health record, which of the following is correct? - correct answers the designated record set is wider in scope than the legal health record Dr. Harvey has changed a piece of data in a patient record. The information that tracks this change and enables a jury to see this change in a medical malpractice action is called - correct answers Metadata Printing EHRs is seen as a - correct answers negative because it raises questions as to the source of the truth Mary Jackson is 95 years old. While an inpatient at General Hospital, she agrees that she does not want to be resuscitated if she would have a cardiopulmonary arrest. She signs a form and the physician documents it in the record. This best describes a(an) __________. - correct answers A DNR order For which of the following conditions would a minor most likely be able to consent to treatment on his own behalf - correct answers STD If an individual who has been identified as non-compos mentis, then - correct answers a,b, and c The medical staff at Regency Health is nationally renowned for its skill in performing cardiac procedures. The nursing staff in the cardiac unit has noticed a significant lack of informed consents prior to the performance procedures, administration at the facility should reinforce - correct answers The physician responsible for the procedure obtain informed consent Emergencies are an exception to the consent requirement for: - correct answers All options correct Johnny is 12 and parents divorced. he is living with his father, who has legal custody. In order for Johnny to receive medical treatment, generally - correct answers Johnny's father as parent with legal custody would consent Mary is contemplating triple bypass surgery. Informed consent by her surgeon would typically contain which of the following elements: - correct answers All options correct Janice arrives at her physician's office for her 10:30 scheduled appointment and pays her office visit co-payment. Her physician examines her. Based on these facts, Janice's consent is - correct answers implied Regarding life-sustaining treatment and a patient's right of self-determination, courts have generally held that: - correct answers a & c A patient self-determination act requires healthcare providers to - correct answers all options are correct The best evidence rule allows for - correct answers copies of records to be allowed as evidence In regard to protecting the concept of privileged communication, a healthcare provider who wrongfully releases a patient's record may be accused of __________. - correct answers Breach of fiduciary duty The affidavit of the custodian of records allow the health record to be - correct answers admitted into evidence When Dr. Smith realized he was being sued over a malpractice issue, he intentionally destroyed certain records and other evidence relevant to the legal proceedings. What legal concept is indicative of this situation? - correct answers Spoilation From a business record standpoint, authorization of a record refers to - correct answers establishment of its baseline trustworthiness Information about EHR, such as the date and time of data creation is - correct answers metadata When a legal hold is issued by the court, what action must an organization take? - correct answers Suspend the processing or destruction of the records in question Which of following types of records may be protected from discovery by privilige - correct answers incident reports Forms of evidence include - correct answers all options are correct Patient-provider privilege is defined by - correct answers state laws The affidavit of the custodian of records the health record to be - correct answers admitted into evidence Information about an electronic health record, such as the date and time of data creation is - correct answers metadata From-a-business record standpoint, authentication of a record records refers to - correct answers establishment of it's baseline trustworthiness Forms of evidence include - correct answers all options are correct In general, if Washington and Montana laws conflict - correct answers each state follows its own law one or more advantages of mediation over utilizing the court system to resolve a dispute are - correct answers all of the above When a patient discovers that a hemostat has been left in his abdomen by a surgeon, the patient has a cause of action to bring a lawsuit, the patient must document and serve his allegations to the surgeon. The surgeon must respond via a legal document called - correct answers answer Josie has taken a position as the director of HIM at Acme Healthcare. The organization consists of a main medical center and multiple physician offices. Many of the physician offices possess photocopies of patients' records from the main medical center. These records are - correct answers shadow subpoena duces tecum - correct answers bring records to a legal proceeding When served with a court order directing the release of health records, an individual: - correct answers must comply with it Which of the following discovery methods is directed only toward parties involved in the litigation - correct answers interrogatories