Compliance 101 questions and answers 100% guaranteed success.

Compliance 101 questions and answers 100% guaranteed success. Anti-kickback statute - correct answers.Prohibits the solicitation, receiving, offering or paying of any renumeration directly or indirectly in cash or in kind in exchange. Stark Law - correct answers.Prohibits a physician from making referrals of Medicare and Medicaid patients for the furnishing of certain designated health services with which the physician has a financial relationship. Statistical sampling - correct answers.The practice of making statements regarding the characteristics of a large population based on a reasonably thorough review of a representative sample. Three C's of communication - correct answers.Clear Concise Creative Why was HIPAA created? - correct answers.To reduce the administrative costs of healthcare. RAT-STATS - correct answers.Governments statistical rules Deficit reduction act - correct answers.Whistle blowing on fraud and abuse as well as increasing attention on the federal quality of care issues Statute of limitations under the false claims act - correct answers.Either six years after the violation is committed or three years after the date when the facts of the action are noted but no more than ten years after the violation was committed Attorney client privilege - correct answers.A legally accepted policy that communication between a client and attorney is confidential in the course of the professional relationship and that such communication cannot be disclosed without the consent of the client. it's purpose is to encourage full and frank communication between attorneys and their clients. Work product - correct answers.Protection of certain documents from disclosure during the course of discovery Corporate integrity agreement - correct answers.Negotiated settlement between a healthcare provider and the government in which the provider accepts no liability but must agree to implement a strict plan of government supervised corrective action. Compliance program - correct answers.Preserve and enhance a company's reputation Strengthen the relationship of trust with their employees Fulfill its legal duty to government and private payers Help to defend against a fraud investigation Training of employees and contractors - monitors and disciplines those who violate Provides procedures to promptly correct misconduct Mitigate any sanction imposed by the What are three measures of effectiveness of your compliance program? - correct answers.Structure, process and outcome PDCA Appraoach - correct answers.Tried and true quality management technique (Plan, Do, Check, Act) HIPAA - founded and definition - correct answers.1996 - healthcare information portability and accountability act Documentation and billing irregularities - correct answers.The lions share of fraud and abuse offenses Difference between privacy and confidentiality - correct answers.Security regulations only apply to PHI maintained in an electronic medium and the privacy rule applies to all PHI held by a covered entity Healthcare Clearinghouse - correct answers.An org that sends HIPAA standard transactions Business assocuate - correct answers.Person or organization that performs r assists in the performance of a function or activity the use or disclosure of individually identifiable health information on behalf of a covered entity or provides services such as legal, actuarial, accounting, consulting, data aggregation, management administration, Accreditation or financial services to or for a covered entity. Covered entity - correct answers.Health care provider or insurance company Designated record set - correct answers.The amount of PHI that can be used or disclosed in a particular circumstance Upcoding - correct answers.The practice of using billing code that provides a higher reimbursement rate than the billing code that actually reflects the service furnished The three measures of effectiveness of your compliance orogram - correct answers.Structure, process and outcome Who is the current Inspector General? - correct answers.Eric Thorson Qui Tam - correct answers.Whistleblower False Claims Act - correct answers.Empower the government to investigate and bring civil action in fraud cases Balanced Budget Act of 1977 - correct answers.Legislation containing major reform of the Medicare and Medicaid programs especially in the areas of home health and patient transfers. It also mandated permanent exclusion from participation in federally funded health care programs of those convicted of three health care related crimes. Fraud and Abuse Violation - correct answers.HIPAA makes it a criminal offense to submit claims based on incorrect codes or medically unnecessary services Federal sentencing guidelines - correct answers.Provides guidance for assessing fines and detailed methods for calculation of a culpability score Culpability score - correct answers.Provides internal mechanisms for preventing, detecting and reporting criminal conduct Sentencing reform act of 1984 - correct answers.Designed to correct inequities in federal sentences Seven Elements of an effective compliance program - correct answers.Designating a CCO Effective Training Audits and monitoring Process for complaints Disciplinary mechanisms Investigation and remediation of systematic problems DRG Creep - correct answers.The practice of billing using a DRG code that provides a higher payment rate than the DRG code that accurately reflects the service furnished to the patient. Breach - correct answers.Impermissible use or disclosure that poses a significant risk of financial reputational or other harm to the affected individual. Standard transaction and code sets - correct answers.837 - claims/encounter 834 - enrollment/dis enrollment 270 and 271 - eligibility 835 - payment and remittance advice 811 and 820 - premium payments 276 and 277 - claims status 278 - referral certification and authorization Individual rights under he privacy rule - correct answers.Right to access and obtain a copy of their PHI Right to amend their PHI Right to obtain an accounting or listing of disclosures of their PHI Right to receive a Notice of Privacy practices Right to have communications about their PHI conducted Ina confidential manner Right to restrict disclosure on certain uses and dissociates of their PHI Right to file s complaint about a covered entity's privacy practices to the covered entity as well as tot the office of civil rights