HEALTH CARE COMPLIANCE Exam Latest

HEALTH CARE COMPLIANCE Exam Latest Update 2024-2025 Actual Exam 500 Questions and 100% Verified Correct Answers Verified by Professor

• right to access/obtain copy-right to amend-accounting of disclosures-right to npp-right

to have communications limited-right to reasonably restrict uses and disclosures-right to file complain with OCR

• Audit - retrosepctive audit
• Health Care Operations pt 3

C. individual rights under HIPAA - CORRECT ANSWER: C. individual rights under

HIPAA

-government has the authority to exclude providers from participation in federal healthcare programs, such as Medicare and Medicaid-excluded providers may not bill for treating patients and their employers may not bill for their services

• Exclusion Statue
• Corporate Integrity Agreement (CIA)
• False Claims Act (FCA)
• Health Insurance Portability and Accountability Act (HIPAA) - CORRECT ANSWER:
• Exclusion Statue

• - inadvertent; $100-$50,0002 - reasonable cause, but not willful neglect; $1000-

$50,0003 - willful neglect and problem was resolved; $10,000-$50,0004- willful neglect and problem was not resolved; minimum $50,000

• Audit , concurrent
• Culpability Score
• Attestation

D. enforcement levels - CORRECT ANSWER: D. Enforcement levels

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• established standards and procedures2. high-level individual must be charged with

compliance3. do not delegate compliance responsibilities to individual with propensity to engage in illegal activities4. communicate standards and procedures effe

• Seven Elements of a compliance program
• Balanced budget act of 1997
• General services administration (GSA)

D. Exclusion statute - CORRECT ANSWER: A. Seven elements of a compliance

program

• Group of records maintained by or for a covered entity that is:* the medical and billing

records about individuals maintained by or for the covered health care provider* the enrollment, payment, claims adjudication and case or medical management records systems maintained by or for a health plan* used, in whole or part, by or for covered entity to make decisions about individuals

• Civil Monetary Penalties Law
• False Claims Act *FCA)
• Designated record set pt 1
• Federal Sentencing Guidelines - CORRECT ANSWER: C. Designated record set pt 1

1974 federal act that exempts self-insured health plans from state laws governing health insurance and requires health plans to provide certain information to enrollees

• Civil Monetary Penalties Law
• Corporate Integrity Agreement (CIA)
• False Claims Act (FCA)

D. Employee Retirement Income Security ACT - CORRECT ANSWER: D. Employee

Retirement Income Security ACT

A coder who has satisfied certification requirements as established by the American Academy of Professional Coders

• Health Care Operations pt 6
• Certified Professional Coder (CPC)
• Federal Sentencing Guidelines 2 / 4

D. Equal Employee Opportunity Commission (EEOC) - CORRECT ANSWER: B.

Certified Professional Coder (CPC)

A component of the U.S. Department of Health and Human Services that administers the Medicare, Medicaid and State Children's Health Insurance Programs.

• Health Care provider
• CMS (Centers for Medicare and Medicaid Services)

C. Occupational Safety and Health Administration (OSHA) - CORRECT ANSWER: B.

CMS (Centers for Medicare and Medicaid Services)

a comprehensive inspection or records, policies, and procedures done usually in anticipation of launching a compliance and ethics program. All potential problems are identified and then investigated (e.g.; published financial statements, historical audit)

• Health Care Operations pt 1
• Health Care Operations pt 3
• Audit - Retrospective audit
• Individual Rights under HIPAA - CORRECT ANSWER: C. Audit - Retrospective audit

A health plan, a healthcare clearinghouse, or a healthcare provider who transmits any health information in electronic form in connection with a transaction

• DRG Creep
• Covered entity
• Chain of Command

D. ICD - 9/10 - International Classification of Diseases - CORRECT ANSWER: B.

Covered entity

A legally accepted policy that communication between a client and attorney is confidential in the course of the professional relationship and that such communication cannot be disclosed without the consent of the client. Its purpose is to encourage full and frank communication between attorneys and their clients.

• Attestation
• ICD-9/10-International Classification of Diseases 3 / 4

• Hotline

D. Attorney - Client Privilege - CORRECT ANSWER: D. Attorney - Client Privilege

A negotiated agreement between the OIG (gov) and a covered entity (CE) , organization in which the CE agrees to certain obligations in return for the OIG's agreement not to exclude the CE from participation in federal health care programs.

• Prospective payment system (PPS)
• Self - referral statute ; Stark Law
• Balanced budget act of 1997

D. Corporate Integrity Agreement (CIA) - CORRECT ANSWER: D. Corporate Integrity

Agreement (CIA)

a provider of medical or other health services, or any other person furnishing health care services or supplies

• Treatment
• Health Care
• Health Care Provider

D. Health Care Operations pt 2 - CORRECT ANSWER: C. Health Care Provider

adherence to laws and regs as well as principles of ethical conduct.

• Compliance
• Workforce

C. unbundling - CORRECT ANSWER: A. compliance

adopted by congress in 1863 during civil war to discourage suppliers from overcharging the feds; legislation that prohibits anyone from knowingly submitting or causing to be submitted a false or fraudulent claim

• Anti-kickback Law
• Self-Referral Statute , Stark Law
• False Claims Act
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