Domain 4 – Compliance Exam Questions
and Answers 100% Solved | Rated A+
In a joint effort of the Department of Health and Human Services (DHHS),
Office of Inspector General (OIG), Centers for Medicare and Medicaid
Services (CMS), and Administration on Aging (AOA) which program was
released in 1995 to target fraud and abuse among healthcare providers? -
✔✔Operation Restore Trust
All of the following should be part of the core areas of a coding compliance
plan except:
a. Physician query process
b. Correct use of encoder software
c. Coding diagnoses supported by medical record documentation
d. Tracking length of stay - ✔✔d. Tracking length of stay
Common forms of fraud and abuse include all of the following except:
a. Uncoding
b. Unbundling or "exploding " charges
c. Refiling claims after denials
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, d. Billing for services not furnished to patients - ✔✔c. Refiling claims after
denials
What is the primary use of the case-mix index? - ✔✔Defines how a hospital
compares to peers and whether the facility is at risk.
A(n)_________is considered the most innocent of improper payments
because there is no intent to falsely receive a payment from the payer: -
✔✔Mistake
To combat fraud and abuse in coding, one strategy is to: - ✔✔Use best
practices to write a query to clarify documentation.
What is the process used to transform text into an unintelligible string of
characters that can be transmitted via communications media with a high
degree of security and then decrypted when it reaches a secure
destination? - ✔✔Encryption
Using uniform terminology is a way to improve? - ✔✔Data reliability
The________mandated the development of standards for electronic
medical records. - ✔✔Health Insurance Portability and Accountability Act
(HIPPA) of 1996
Messaging standards for electronic data interchange in healthcare have
been developed by: - ✔✔HL7
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
and Answers 100% Solved | Rated A+
In a joint effort of the Department of Health and Human Services (DHHS),
Office of Inspector General (OIG), Centers for Medicare and Medicaid
Services (CMS), and Administration on Aging (AOA) which program was
released in 1995 to target fraud and abuse among healthcare providers? -
✔✔Operation Restore Trust
All of the following should be part of the core areas of a coding compliance
plan except:
a. Physician query process
b. Correct use of encoder software
c. Coding diagnoses supported by medical record documentation
d. Tracking length of stay - ✔✔d. Tracking length of stay
Common forms of fraud and abuse include all of the following except:
a. Uncoding
b. Unbundling or "exploding " charges
c. Refiling claims after denials
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, d. Billing for services not furnished to patients - ✔✔c. Refiling claims after
denials
What is the primary use of the case-mix index? - ✔✔Defines how a hospital
compares to peers and whether the facility is at risk.
A(n)_________is considered the most innocent of improper payments
because there is no intent to falsely receive a payment from the payer: -
✔✔Mistake
To combat fraud and abuse in coding, one strategy is to: - ✔✔Use best
practices to write a query to clarify documentation.
What is the process used to transform text into an unintelligible string of
characters that can be transmitted via communications media with a high
degree of security and then decrypted when it reaches a secure
destination? - ✔✔Encryption
Using uniform terminology is a way to improve? - ✔✔Data reliability
The________mandated the development of standards for electronic
medical records. - ✔✔Health Insurance Portability and Accountability Act
(HIPPA) of 1996
Messaging standards for electronic data interchange in healthcare have
been developed by: - ✔✔HL7
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
