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AntiKickback Statute Highlights - Answer 1. Criminal/Civil (you go out of business 2. Any federal health program (Medicare, Medicaid, Tri-Care) 3. Requires proof of improper intent (DOJ-Criminal) 4. Applies to any referral source 5. 24 Safe Harbors 6. OIG Advisory Opinions Stark Highlights - Answer 1. Civil only (no prison time) 2. Medicare only 3. Strict Liability (does not consider knowledge or intent. if X happens, then you are held liable regardless of intent.) 4. Must be a...

Affordable Care Act - Answer Allowed more hospital construction bc it allowed hospitals to more confidently predict their finances. More infrastructure, tech and finance influence construction also. FGI: Guidelines (2014 Edition 2) - Answer FACILITY GUIDELINES INSTITUTE: Guidelines for the design and construction of hospitals and outpatient care facilities. >Used to be published by the Federal Government >Was required to be followed to get a grant under the Hill-Burton Act of 1946...

A compliance professional is trying to determine if attorney client privilege should be requested. The compliance professional's policy should require attorney-client privilege to be established in which of the following situations: a. Violation of employee that occurred outside of the organization, and not within the roles and responsibilities this employee has to the organization. b. Illegal or unethical business practices by a Chief Executive Officer or other Executive Management c. Overp...

7 elements - Answer Policies & Procedures Oversight Responsibilities/Assignments Oversight Responsibilities/Due Care Education and Training Monitoring and Auditing Enforcement and Discipline Response and Prevention ECHO - Answer Economic, Clinical and Humanistic Outcomes Economic Outcomes - Answer Comparison between the cost of what was received and the benefit derived from alternatives Clinical Outcomes - Answer Changes to moribity/mortality rates as a result of healt...

Compliance Program - Answer Following rules and regulations Integrity Program - Answer Values doing the right thing Current Compliance activities in many organizations - Answer Equal Employment Opportunity Commission (EEOC), Employee Retirement Income Securities Act (ERISA), Wage and Hour Rule, Occupational Safety and Health Administration (OSHA), Nuclear Regulatory Commission, Joint Commission on Accreditation of Healthcare Organization (JCAHO), Research Compliance What is a C...

Education & training: When designing curriculum for the audit learner - Answer Understand whether the concepts or ideas will be in concert or in conflict with the learner. If State law is more/less strict than HIPAA - Answer The more strict law governs HIPAA stands for - Answer Health Insurance Portability and Accountability Act of 1996 HIPAA is enforced by - Answer OCR, CMS & DOJ HIPAA General Rule 164.502 - Answer A covered entity may not use or disclose protected he...

A compliance professional has been working with a department director to implement a new policy regarding timely completion of medical records. Which of the following should be completed by the department manager to promote compliance with the new policy? a. Statistically valid sampling audit b. Monitoring c. Discovery Audit d. Retrospective Audit - Answer b. Monitoring For monitoring activities, OIG uses the term regularly to describe the frequency of review. Which factors should an o...

Concern - Answer Health outcomes and disparities in healthcare distribution Health Policy - Answer ► A policy is a course of action to be followed by a government, business or institution to obtain a desired effect. ► So a HEALTH POLICY can be defined as a healthcare goal and the PLAN for achieving that goal. **Includes rules that govern!! Health Programs - Answer ► A health program is the providing or administration of health-related services. This may include offering h...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer 1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the...

What is the purpose of HIPAA? -Answer • Protect PHI from unauthorized disclosure/use; • Prevent fraud, waste and abuse (via Administrative Simplification); • Make health insurance portable under ERISA; • Move health care onto a nationally standardized electronic billing platform Ref. More on HIPAA: HIPAA resides in which CFR section? -Answer 45 CFR sections 164.102 through 164.534 What are the subparts of HIPAA part 164? -Answer HIPAA - 45 CFR 164, subparts: ...

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Absorption Rate - Answer the rate at which alcohol penetrates the membranes of the mouth, stomach and intestines and is processed by the body. Alcohol Poisoning - Answer the state at which the intake of alcohol has surpassed the body's processing time and the body is saturated with alcohol. Depending on the degree of intoxication, most of the time if treated, a person can live through alcohol poisoning. However, if the person is left unattended, they will die. Behavioral Clues - Answe...

SET stands for - Answer Sober, enough, too much Which of the following is NOT a characteristic of anxiety - Answer Verbal fights If the customer Insists on driving and refuses all offers for alternative transportation is your obligation to notify - Answer Police When should you leave intoxicated patrons alone? - Answer Never When checking IDs which of the following is not a question to ask yourself - Answer why does this customer look familiar Why do minors tend to gathe...

The Keys to Being a Responsible Seller-Server of Alcohol include all of the following EXCEPT: - Answer a) Know The Law c) Know Your Customers d) Know How And When To Say "No" True or False: It is illegal for a minor, someone under the age of 21, to purchase - Answer True True or False: You may serve alcohol to a person who is showing signs of intoxication but who will not be driving afterwards - Answer False What can you do to keep customers from becoming intoxicated? - Answer ...

Alcohol - Answer The product of distillation of any fermented liquid, whether rectified or diluted, whatever may be the origin thereof, and includes synthetic ethyl alcohol Alcoholic Liquor - Answer Includes alcohol, spirits, wine and beer, and every liquid or solid, patented or not, containing alcohol, spirits, wine or beer, and capable of being consumed as a beverage by a human being. BAC - Answer Abbreviation for blood alcohol content, which is a measurement of the concentration o...

2 Procedures for Reporting Violations to ILLC - Answer 1) seller training school 2) underage drinking, suspected sales, intoxicated persons Seller-server certification is valid for ____ years unless earlier revoked - Answer 3 Every licensee shall cause his or her license or licensees to be framed and hung in plain view in a conspicuous place on the - Answer licensed premises In order to be responsible seller-server of alcohol, you will need to: - Answer -know the law -know you...

A customer may legally pay for her drinks by all of the following means EXCEPT: - Answer Diamond earrings What is the maximum amount of distilled (hard) liquor any one drink may contain? - Answer 4 ounces Bars and restaurants are at risk of losing their liquor license if they do not keep liquor invoices for at least: - Answer Two years If there is an act of violence on their premises, licensees must file detailed reports with the Department within: - Answer Seven days Acts of...

Keys to being a responsible seller/server of alcohol - Answer know the law, know the customers, know how and when to say no keys laws to alcohol sales - Answer prevent selling to minors, prevent selling to intoxicated, prevent alcohol related fatalities keys to customer observation - Answer how they look, what they do, how they react, how much alcohol has been purchased or consumed keys to intervention - Answer be quick, clear and firm, and consistent intervention - Answer ...

True or False: You should not accuse a customer of being intoxicated because some illnesses may be mistaken for or have affects that mimic intoxication. - Answer True To decide if a sale of alcohol is legal, watch your customers to: a) See how they act b) See what time it is c) See if they see you d) All of the above - Answer a) See how they act All of the following are signs and symptoms of Alcohol Poisoning except: a) Vomiting b) Slow breathing c) Increased awareness d) Hypo...

A food handler was assigned to clean the slicer that was to too difficult to move the slicer was unplugged then the removable parts were taking off the slicer and clean and sanitized in a three-compartment sink. food bits on the slicer were removed after the machine was wiped down the detergent and water it was sanitizied and allowed to air-dry then the food handler put the machine back together. What mistake did the food handler make? - Answer Fail to rinse the machine after wiping it down wi...