Question 1

Which are assigned to the MAC jurisdictions (replacing Program Safeguard Contractors)  to review billing trends and patterns, focusing on providers whose billings for Medicare services are higher than the majority of providers in the community?

Accepted Answer

A)   hospital value-based purchasers
B)   Recovery Audit Contractors
C)   whistleblowers
D)   Zone Program Integrity ContractorsE) A) and B)
F) A) and C)

Question 2

Which unique identifier is assigned to third-party payers and has 10 numeric positions, including a check digit as the tenth position?

Accepted Answer

A)   HPID
B)   PAYERID
C)   PlanID
D)   UPINE) A) and B)
F) All of the above

Question 3

Which is a hospital payment monitoring program that contains hospital-specific administrative claims data for a number of CMS-identified problem areas to compare their performance with that of other hospitals?

Accepted Answer

A)   CERT
B)   FATHOM
C)   PEPPER
D)   PERME) B) and C)
F) A) and B)

Question 4

Which program measures, monitors, and reduces the incidence of Medicare fee-for-service payment errors for short-term, acute care, inpatient PPS hospitals?

Accepted Answer

A)   CERT
B)   FATHOM
C)   HPMP
D)   PERME) None of the above
F) A) and D)

Question 5

Which of the following is an example of fraud?

Accepted Answer

A)   billing noncovered services as covered services
B)   falsifying certificates of medical necessity plans of treatment
C)   reporting duplicative charges on an insurance claim
D)   submitting claims for services not medically necessaryE) B) and D)
F) A) and B)

Question 6

Which was implemented to protect the privacy of individuals identified in information systems maintained by federal government hospitals and to give individuals access to records concerning themselves?

Accepted Answer

A)   False Claims Act
B)   Federal Claims Collection Act
C)   Privacy Act of 1974
D)   Stark IE) All of the above
F) None of the above

Question 7

The Patient Protection and Affordable Care Act established a Medicare shared savings program to facilitate the __________ to improve the quality of care for Medicare fee-for-service beneficiaries and to reduce unnecessary costs.

Accepted Answer

A)   coordination and cooperation among health care providers
B)   declining investment in infrastructure and redesigned care processes
C)   lack of coordinated care for services under Medicare fee-for-service
D)   reduction in accountability for the care of beneficiariesE) A) and B)
F) None of the above

Question 8

Which involves the safekeeping of patient information by controlling access to records, protecting patient information from alteration/destruction/tampering/loss, and providing employee training in HIPAA requirements, which includes the consequences of improper disclosure of patient information?

Accepted Answer

A)   authorization
B)   confidentiality
C)   privacy
D)   securityE) None of the above
F) A) and C)

Question 9

Which regulates fraud associated with military contractors selling supplies and equipment to the Union Army?

Accepted Answer

A)   False Claims Act
B)   Federal Claims Collection Act
C)   Privacy Act of 1974
D)   Stark IE) C) and D)
F) A) and C)

Question 10

HIPAA defines abuse as involving actions that are __________ with accepted, sound medical, business, or fiscal practices, which directly or indirectly result in unnecessary costs to the program through improper payments.

Accepted Answer

A)   compatible
B)   inconsistent
C)   recurrent
D)   unvaryingE) All of the above
F) B) and D)

Question 11

The HIPAA Security Rule adopts standards and safeguards to protect health information that is collected, maintained, used, or transmitted __________.

Accepted Answer

A)   electronically
B)   manually
C)   personally
D)   physicallyE) B) and C)
F) A) and C)

Question 12

Which was established to require facilities to identify and reduce improper Medicare payments and the Medicare payment error rate and also established Clinical Data Abstracting Centers?

Accepted Answer

A)   COBRA
B)   PATH
C)   PEPP
D)   TEFRAE) B) and C)
F) A) and B)

Question 13

Which program measures improper payments in the Medicaid program and the State Children's Health Insurance Program (SCHIP) ?

Accepted Answer

A)   CERT
B)   FATHOM
C)   HPMP
D)   PERME) A) and B)
F) A) and C)

Question 14

The American Recovery and Reinvestment Act of 2009 (ARRA)  protects whistleblowers, who are individuals that __________ covered by the Act.

Accepted Answer

A)   are prosecuted for disclosing protected information
B)   correct overpayments and other reimbursement issues
C)   make specified disclosures relating to funds
D)   receive remuneration for disclosing wrongdoingsE) A) and B)
F) A) and C)

Question 15

Which is a hospital payment monitoring program data analysis tool that provides administrative hospital and state-specific data for specific CMS target areas?

Accepted Answer

A)   CERT
B)   FATHOM
C)   PEPPER
D)   PERME) None of the above
F) B) and C)

Question 16

Breach of confidentiality involves the unauthorized release of patient information to a third party, such as health care employees who __________.

Accepted Answer

A)   access patient health care information with an appropriate job-related reason
B)   communicate patient information to family members with the patient's consent
C)   discuss patient information outside an exam room where other patients are present
D)   ensure that patient information is not available on a computer screen displayE) B) and D)
F) A) and D)

Question 17

The Patient Protection and Affordable Care Act (PPACA)  of 2010 includes a health care reform measure that requires implementation of the hospital __________ program to promote better clinical outcomes and patient experiences of care.

Accepted Answer

A)   inpatient quality reporting
B)   physician quality reporting
C)   recovery audit contractor
D)   value-based purchasingE) A) and B)
F) None of the above

Question 18

Which prohibits physicians from referring Medicare patients to clinical laboratory services in which the physicians or their family members have a financial ownership/investment interest and/or compensation arrangement?

Accepted Answer

A)   False Claims Act
B)   Federal Claims Collection Act
C)   Privacy Act of 1974
D)   Stark IE) B) and D)
F) A) and B)

Question 19

Which is a legal newspaper published every business day by the National Archives and Records Administration (NARA) , and is available in paper form, on microfiche, and online?

Accepted Answer

A)   Coding Clinic
B)   Code of Federal Regulations
C)   Federal Register
D)   Medicare BulletinE) A) and B)
F) B) and C)

Question 20

HIPAA requires payers to implement rules called electronic __________, which result in a uniform language for electronic data interchange.

Accepted Answer

A)   data interchanges
B)   health records
C)   medical records
D)   transaction standardsE) A) and B)
F) A) and C)

Exam 5: Legal and Regulatory Issues

Which program measures improper payments in the Medicaid program and the State Children's Health Insurance Program (SCHIP) ?

Correct AnswerverifiedShow Answer

Which prohibits physicians from referring Medicare patients to clinical laboratory services in which the physicians or their family members have a financial ownership/investment interest and/or compensation arrangement?

Correct AnswerverifiedShow Answer

Which is a hospital payment monitoring program that contains hospital-specific administrative claims data for a number of CMS-identified problem areas to compare their performance with that of other hospitals?

Correct AnswerverifiedShow Answer

The American Recovery and Reinvestment Act of 2009 (ARRA) protects whistleblowers, who are individuals that __________ covered by the Act.

Correct AnswerverifiedShow Answer

Which of the following is an example of fraud?

Correct AnswerverifiedShow Answer

Which is a legal newspaper published every business day by the National Archives and Records Administration (NARA) , and is available in paper form, on microfiche, and online?

Correct AnswerverifiedShow Answer

HIPAA defines abuse as involving actions that are __________ with accepted, sound medical, business, or fiscal practices, which directly or indirectly result in unnecessary costs to the program through improper payments.

Correct AnswerverifiedShow Answer

Which unique identifier is assigned to third-party payers and has 10 numeric positions, including a check digit as the tenth position?

Correct AnswerverifiedShow Answer

HIPAA requires payers to implement rules called electronic __________, which result in a uniform language for electronic data interchange.

Correct AnswerverifiedShow Answer

Which are assigned to the MAC jurisdictions (replacing Program Safeguard Contractors) to review billing trends and patterns, focusing on providers whose billings for Medicare services are higher than the majority of providers in the community?

Correct AnswerverifiedShow Answer

The Patient Protection and Affordable Care Act established a Medicare shared savings program to facilitate the __________ to improve the quality of care for Medicare fee-for-service beneficiaries and to reduce unnecessary costs.

Correct AnswerverifiedShow Answer

Which was implemented to protect the privacy of individuals identified in information systems maintained by federal government hospitals and to give individuals access to records concerning themselves?

Correct AnswerverifiedShow Answer

Which involves the safekeeping of patient information by controlling access to records, protecting patient information from alteration/destruction/tampering/loss, and providing employee training in HIPAA requirements, which includes the consequences of improper disclosure of patient information?

Correct AnswerverifiedShow Answer

Breach of confidentiality involves the unauthorized release of patient information to a third party, such as health care employees who __________.

Correct AnswerverifiedShow Answer

Which program measures, monitors, and reduces the incidence of Medicare fee-for-service payment errors for short-term, acute care, inpatient PPS hospitals?

Correct AnswerverifiedShow Answer

Which is a hospital payment monitoring program data analysis tool that provides administrative hospital and state-specific data for specific CMS target areas?

Correct AnswerverifiedShow Answer

The Patient Protection and Affordable Care Act (PPACA) of 2010 includes a health care reform measure that requires implementation of the hospital __________ program to promote better clinical outcomes and patient experiences of care.

Correct AnswerverifiedShow Answer

Which regulates fraud associated with military contractors selling supplies and equipment to the Union Army?

Correct AnswerverifiedShow Answer

The HIPAA Security Rule adopts standards and safeguards to protect health information that is collected, maintained, used, or transmitted __________.

Correct AnswerverifiedShow Answer

Which was established to require facilities to identify and reduce improper Medicare payments and the Medicare payment error rate and also established Clinical Data Abstracting Centers?

Correct AnswerverifiedShow Answer

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
verified