ANCC IQ domain 5
1. 1. You see a patient for a routine medication visit. At the end of the
session, the patient asks questions and the session ends up 50 minutes in
length. You normally charge for the 30-minute appointment, but instead
you charge for the 1-hour appointment. The 1-hour appointment includes a
full body assessment that you did not perform. This violation is known as:
- Over-coding
- Super-coding
- Down-coding
- Up-coding: - Up-coding
Rationale: Up-coding is a fraudulent practice in which the provider services are
billed at higher procedure codes than were actually performed, resulting in a
higher payment by Medicare or other third-party payers.
,2. 1. During a session, your patient asks to be able to contact you via
your Facebook page on the internet. You reply:
- I cannot do that because I have a concealed Facebook identity; and I
cannot reveal that to my patients
- I would be happy to communicate with you. It makes it easier for me to
reach you this way.
- I would be happy to use Facebook but you will have to use a
private message so that you can be anonymous
- I cannot do that because Facebook does not protect your Private Health
Information: - I cannot do that because Facebook does not protect your
Private Health Information
Rationale: Using Facebook breaks patient-provider confidentiality, in addition to
blurring ethical boundaries of the therapeutic relationship. Facebook does not
protect private health information. Information on the site is available for anyone
to see or hack into even if private messaged.
,3. 1. The Mental Health Parity and Addiction Equity Act of 2008
(MHPAEA) insures which of the following?
- Small employers who insure 50 or fewer covered lives are exempt from
the provisions of this MHPAEA law.
- Annual or lifetime dollar limits on mental health and substance use
disorder benefits are no lower than any such dollar limits for medical and
surgical benefits offered by a group health plan.
- Mental health and substance use disorder benefits must be available
through both in-network providers and out-of-network providers by a
group health plan.
- Group health plans may obtain an exemption if they can demonstrate ex-
, pected cost increase resulting from implementation of the parity
provisions greater than a 5% increase in the cost under existing plan.: -
Annual or lifetime dollar limits on mental health and substance use disorder
benefits are no lower than any such dollar limits for medical and surgical benefits
offered by a group health plan.
Rationale: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
provides federal legislation that requires any annual or lifetime limits on medical
and surgical benefits be the same for mental health and substance use disorder
benefits. Small employers who insure 2 to 50 employees can apply for an "opt-
out" waiver, but they are not automatically exempt from the MHPAEA
requirements. The group health plan will be required to provide in-network and
out-of-network mental health and substance use disorder benefits only if it
provides both in-network and out-of-network medical and surgical benefits. The
group health plan my obtain
1. 1. You see a patient for a routine medication visit. At the end of the
session, the patient asks questions and the session ends up 50 minutes in
length. You normally charge for the 30-minute appointment, but instead
you charge for the 1-hour appointment. The 1-hour appointment includes a
full body assessment that you did not perform. This violation is known as:
- Over-coding
- Super-coding
- Down-coding
- Up-coding: - Up-coding
Rationale: Up-coding is a fraudulent practice in which the provider services are
billed at higher procedure codes than were actually performed, resulting in a
higher payment by Medicare or other third-party payers.
,2. 1. During a session, your patient asks to be able to contact you via
your Facebook page on the internet. You reply:
- I cannot do that because I have a concealed Facebook identity; and I
cannot reveal that to my patients
- I would be happy to communicate with you. It makes it easier for me to
reach you this way.
- I would be happy to use Facebook but you will have to use a
private message so that you can be anonymous
- I cannot do that because Facebook does not protect your Private Health
Information: - I cannot do that because Facebook does not protect your
Private Health Information
Rationale: Using Facebook breaks patient-provider confidentiality, in addition to
blurring ethical boundaries of the therapeutic relationship. Facebook does not
protect private health information. Information on the site is available for anyone
to see or hack into even if private messaged.
,3. 1. The Mental Health Parity and Addiction Equity Act of 2008
(MHPAEA) insures which of the following?
- Small employers who insure 50 or fewer covered lives are exempt from
the provisions of this MHPAEA law.
- Annual or lifetime dollar limits on mental health and substance use
disorder benefits are no lower than any such dollar limits for medical and
surgical benefits offered by a group health plan.
- Mental health and substance use disorder benefits must be available
through both in-network providers and out-of-network providers by a
group health plan.
- Group health plans may obtain an exemption if they can demonstrate ex-
, pected cost increase resulting from implementation of the parity
provisions greater than a 5% increase in the cost under existing plan.: -
Annual or lifetime dollar limits on mental health and substance use disorder
benefits are no lower than any such dollar limits for medical and surgical benefits
offered by a group health plan.
Rationale: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
provides federal legislation that requires any annual or lifetime limits on medical
and surgical benefits be the same for mental health and substance use disorder
benefits. Small employers who insure 2 to 50 employees can apply for an "opt-
out" waiver, but they are not automatically exempt from the MHPAEA
requirements. The group health plan will be required to provide in-network and
out-of-network mental health and substance use disorder benefits only if it
provides both in-network and out-of-network medical and surgical benefits. The
group health plan my obtain
