Chapter 3 quiz with Verified Answers
A health care organization's compliance plan outlines:
a. their standardized process for handling business functions Documentation of a service in the medical record is the service
b. their standardized process for reporting health care outcomes provider's responsibility; however, certified coders can modify
c. their human resource policies and procedures documentation
d. their clinical protocol for treatment of patients - when necessary.
ANSWERS - The correct answer is: Select one:
their standardized process for handling business functions True
False - ANSWERS - The correct answer is 'False'.
Undercoding a service provided has been identified by the
Office of Inspector General as a risk area that may lead to fraud The Office of Inspector General has issued compliance program
investigation. guidelines for various types of health care organizations which is
Select one: published in
True the Federal Register.
False - ANSWERS - The correct answer is 'True'. Select one:
True
False - ANSWERS - The correct answer is 'True'.
Health care organizations who have a compliance program, can
be assured they will not face penalties in the event that
fraudulent billing Health care organizations should conduct general compliance
activities are identified in an audit. training at least annually.
Select one: Select one:
True True
False - ANSWERS - The correct answer is 'False'. False - ANSWERS - The correct answer is 'True'.
Health care fraud and abuse violations can result in criminal Legislation which prohibits the submission of claims for services
and civil liability for: or referral of patients if the referring provider has financial
a. health care workers interest with the
b. health care organizations entity that provides the service.
c. health care providers a. Anti-Lickback Law
d. all are correct - ANSWERS - The correct answer is: b. Exclusion Statute
all are correct c. Stark Law
d. Civil False Claims Act - ANSWERS - The correct
answer is:
To bill Medicare beneficiaries at a higher rate than other Stark Law
patients is considered
a. illegal
b. fraud Hospitals and other institutional health care organizations are
c. abuse required to submit annual cost reports to CMS, which contain
d. negligence - ANSWERS - The correct answer is: information such
abuse as utilization, costs, charges by cost center and financial
settlement data.
Select one:
Credit balances that occur when payments and allowances True
exceed the amount of the charge, can be held by the health False - ANSWERS - The correct answer is 'True'.
care organization, and
used towards a future service.
Select one: Any health care worker identified in intentional or negligent
True misconduct should immediately be terminated from employment.
False - ANSWERS - The correct answer is 'False'. Select one:
True
False - ANSWERS - The correct answer is 'False'.
EMTALA requires that anyone who comes to an emergency
room must be evaluated and stabilized unless they are
uninsured. Incidents or practices by health care organizations that conflict
Select one: with accepted sound medical business or fiscal practices is
True considered to be:
False - ANSWERS - The correct answer is 'False'. a. kickback
b. fraud
1/2
A health care organization's compliance plan outlines:
a. their standardized process for handling business functions Documentation of a service in the medical record is the service
b. their standardized process for reporting health care outcomes provider's responsibility; however, certified coders can modify
c. their human resource policies and procedures documentation
d. their clinical protocol for treatment of patients - when necessary.
ANSWERS - The correct answer is: Select one:
their standardized process for handling business functions True
False - ANSWERS - The correct answer is 'False'.
Undercoding a service provided has been identified by the
Office of Inspector General as a risk area that may lead to fraud The Office of Inspector General has issued compliance program
investigation. guidelines for various types of health care organizations which is
Select one: published in
True the Federal Register.
False - ANSWERS - The correct answer is 'True'. Select one:
True
False - ANSWERS - The correct answer is 'True'.
Health care organizations who have a compliance program, can
be assured they will not face penalties in the event that
fraudulent billing Health care organizations should conduct general compliance
activities are identified in an audit. training at least annually.
Select one: Select one:
True True
False - ANSWERS - The correct answer is 'False'. False - ANSWERS - The correct answer is 'True'.
Health care fraud and abuse violations can result in criminal Legislation which prohibits the submission of claims for services
and civil liability for: or referral of patients if the referring provider has financial
a. health care workers interest with the
b. health care organizations entity that provides the service.
c. health care providers a. Anti-Lickback Law
d. all are correct - ANSWERS - The correct answer is: b. Exclusion Statute
all are correct c. Stark Law
d. Civil False Claims Act - ANSWERS - The correct
answer is:
To bill Medicare beneficiaries at a higher rate than other Stark Law
patients is considered
a. illegal
b. fraud Hospitals and other institutional health care organizations are
c. abuse required to submit annual cost reports to CMS, which contain
d. negligence - ANSWERS - The correct answer is: information such
abuse as utilization, costs, charges by cost center and financial
settlement data.
Select one:
Credit balances that occur when payments and allowances True
exceed the amount of the charge, can be held by the health False - ANSWERS - The correct answer is 'True'.
care organization, and
used towards a future service.
Select one: Any health care worker identified in intentional or negligent
True misconduct should immediately be terminated from employment.
False - ANSWERS - The correct answer is 'False'. Select one:
True
False - ANSWERS - The correct answer is 'False'.
EMTALA requires that anyone who comes to an emergency
room must be evaluated and stabilized unless they are
uninsured. Incidents or practices by health care organizations that conflict
Select one: with accepted sound medical business or fiscal practices is
True considered to be:
False - ANSWERS - The correct answer is 'False'. a. kickback
b. fraud
1/2
