Chapter 13, 14, 15 quiz

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Which of the following is not considered to be a vital record?

a. public health certificate
b. fetal death certificate
c. birth certificate
d. death certificate
a. public health certificate
The purpose of the trauma registry is for all of the following except

a. to reduce mortality and morbidity from injuries.
b. to determine where most accidents occur.
c. to develop remedial plans for traffic control.
d. to prosecute those that cause trauma in others
d. to prosecute those that cause trauma in others
Of the following, who must sign a death certificate in most states?

a. physician
b. coroner
c. medical examiner
d. public health official
a. physician
The NPDB requires reporting of all of the following circumstances as related to a healthcare provider on staff at a hospital except which one?

a. Income tax evasion
b. Medical malpractice payment
c. Settlement reports
d. Suspension of privileges
a. Income tax evasion
Which of the following must be reported to the medical examiner?

a. burns
b. accidental deaths
c. causes of injury
d. morbidity
b. accidental deaths
Which of the following generally describes a coroner and a medical examiner, both of whom examine suspicious deaths?

a. medical examiner is elected; coroner is appointed
b. medical examiner is a pathologist; coroner is not a physician
c. medical examiner is appointed by the court; coroner is a physician
d. medical examiner is usually a physician; coroner is appointed or elected and may or may not be a physician
d. medical examiner is usually a physician; coroner is appointed or elected and may or may not be a physician
All but which of the following are examples of unusual events that health care facilities typically must report?

a. falls resulting in fractures
b. wrong site surgery
c. workers' compensation cases
d. medical errors
c. workers' compensation cases
Medical device reporting is allowable without patient authorization under HIPAA for all but which one of the following?

a. conducting credentialing review
b. tracking product recalls
c. conducting post marketing surveillance
d. Collecting or reporting of adverse events
a. conducting credentialing review
Disclosure regarding reportable conditions under state laws and regulations

a. must be included in the AOD maintained by the facility
b. sometimes is included in the AOD maintained by the facility
c. requires patient authorization to be maintained by the facility
d. requires court order to be maintained by the facility
a. must be included in the AOD maintained by the facility
Notification of a designated organ procurement agency in a timely manner after patient death is required by:

a. The Joint Commission
b. federal law
c. individual state laws
b. federal law
Which of the following actions is not included about a physician in the National Practitioner Data Bank?

a. malpractice lawsuits
b. disciplinary actions
c. credentialing information from other facilities
d. personal bankruptcy
d. personal bankruptcy
Cancer registries are established

a. by federal law or state law
b. voluntarily or by state law
c. voluntarily or by federal law
b. voluntarily or by state law
Disclosure of worker's compensation records is governed by

a. medical staff by-laws
b. HIPAA
c. state statutes
d. federal statutes
c. state statutes
Vital records are concerned with all of the following except

a. births
b. adoptions
c. marriages
d. divorces
d. divorces
Required reportable deaths often include all of the following except

a. homicidal
b. suicidal
c. sudden
d. natural
d. natural
Reporting events for the conduct of public health surveillance is allowed under the doctrine of

a. executive order
b. stare decisis
c. CDC authority
d. preemption
d. preemption
A registry is a collection of data on diseases which are collected for the purpose of all of the following except

a. health policy
b. enforcement
c. control
d. prevention
b. enforcement
In all of the following scenarios a healthcare provider may disclose PHI to public health entities without direction by specific law except which of the following?

a. surveillance
b. investigation
c. procurement
d. intervention
c. procurement
Under the privacy rule, the following must be included in a patient accounting of disclosures:

a. state-mandated report of a sexually transmitted disease
b. disclosure pursuant to a patient's signed authorization
c. disclosure pursuant to a subpoena
d. disclosure for internal utilization review purposes
a. state-mandated report of a sexually transmitted disease
Risk management and quality improvement programs are related because of which of the following reasons?

a. They share similar underlying processes.
b. They emphasize the reduction of liability.
c. They are usually located in the HIM department.
d. They lessen the chances of financial loss.
a. They share similar underlying processes.
The systematic means of determining potential losses defines the process of

a. risk analysis.
b. risk identification.
c. risk financing.
d. risk evaluation.
b. risk identification.
A sentinel event in a Joint Commission accredited facility is

a. significant and should be investigated and evaluated every time it occurs.
b. usually related to the structure of care and must be reported to The Joint Commission.
c. a standard that measures the final outcome of care.
d. an important situation that must be carefully documented in the progress notes.
a. significant and should be investigated and evaluated every time it occurs.
The purpose of root cause analysis (RCA) is to:

a. gather information for credentials files.
b. understand the causes of a sentinel event.
c. assure responsible individuals are held accountable.
d. complete a full report for The Joint Commission.
b. understand the causes of a sentinel event.
he Institute of Medicine objectives for improvement include:

a. Safety, Timeliness, Organization, Measurement, Patient-centered care (STOMP)
b. Safety, Timeliness, Efficiency, Effectiveness, Equitable, Patient-centered care (STEEEP)
c. Safety, Timeliness, Utilization, Measurement, Patient-centered care (STUMP)
d. Safety, Leadership, Efficiency, Effectiveness, Equity, Patient-centered care (SLEEEP)
b. Safety, Timeliness, Efficiency, Effectiveness, Equitable, Patient-centered care (STEEEP)
The EMTALA regulations include all but which of the following?

a. Transfers of non-stabilized patients must only occur under certain specific conditions.
b. Every patient arriving at the emergency department must receive an appropriate "medical
screening exam."
c. If an emergency medical condition exists, the hospital must treat and stabilize the emergency condition or transfer the patient.
d. Non-Medicare, indigent patients must be transferred to the nearest Level 1 trauma center.
d. Non-Medicare, indigent patients must be transferred to the nearest Level 1 trauma center.
Which of the following is not an example of a private or governmental group focused on quality?

a. Institute for Healthcare Improvement
b. Safe Practices for All
c. Commonwealth Fund
d. Leapfrog Group
b. Safe Practices for All
An example of a documentation indicator in a health record, signaling a problem, would be

a. information regarding a patient's consent to a surgical procedure is described by the physician.
b. a correction in a record is obliterated so that only the newly added and correct information appears.
c. only factual information is recorded.
d. abbreviations used in the record appear on the approved abbreviations list of the health care facility
b. a correction in a record is obliterated so that only the newly added and correct information appears.
Darling v. Charleston Community Memorial Hospital is most often credited for

a. creating Quality Improvement Organizations.
b. eliminating the doctrine of charitable immunity.
c. challenging the authority of The Joint Commission.
d. creating the risk management process.
b. eliminating the doctrine of charitable immunity.
Quality Improvement Organizations (QIOs) are responsible for all of the following except:

a. improving quality of care for Medicare beneficiaries.
b. protecting beneficiaries by addressing complaints.
c. ensuring that services paid for are medically necessary.
d. requiring that personal health records are used by every facility
d. requiring that personal health records are used by every facility
After an adverse patient event, which of the following should occur with regard to the health record?

a. Documentation in the record should be clarified.
b. Documentation in the record should be altered.
c. The record itself should be secured.
d. The ability to edit a record should be maintained.
c. The record itself should be secured.
The Joint Commission's quality improvement activities for health record documentation include all but which of the following core performance measures for hospitals:

a. acute myocardial infarction
b. hypertension
c. pregnancy and related conditions
d. heart failure
b. hypertension
The Hill-Burton Act

a. provided hospitals with money for construction and modernization.
b. decreased the obligation to provide uncompensated care.
c. exempts hospitals from complying with EMTALA.
d. was passed by Congress in 2000.
a. provided hospitals with money for construction and modernization.
The National Practitioner Data Bank is associated most closely with which hospital function?

a. billing
b. coding
c. credentialing
d. surgeries
c. credentialing
Which of the following was a precursor to Quality Improvement Organizations?

a. Professional Standards Review Organization (PSRO)
b. Medicare Utilization and Quality Control Peer Review Program
c. Healthcare Quality Improvement Program (HCQIP)
d. Leapfrog
a. Professional Standards Review Organization (PSRO)
Which of the following was a precursor to Quality Improvement Organizations?

a. Institute of Medicine
b. Hospital Compare
c. Peer Review Organization
d. National Quality Forum
c. Peer Review Organization
Pay for Performance

a. is linked to reimbursement by all payers.
b. applies only to nursing home reimbursement.
c. will encourage better health outcomes.
d. was eliminated by Medicare in 2006.
c. will encourage better health outcomes.
Risk management programs are more commonly governed by

a. state law.
b. federal law.
c. accreditation standards.
a. state law.
If an HIM department acts in deliberate ignorance or in disregard to official coding guideline, it may be committing

a. abuse.
b. fraud.
c. malpractice.
d. kickbacks.
b. fraud.
If an HIM department receives gifts from vendors in exchange for purchasing a specific encoder software, this is
a. abuse.
b. negligence.
c. malpractice.
d. kickback
d. kickback
Exceptions to the Federal Anti-Kickback Statute that allow legitimate business arrangements and are not subject to prosecution are

a. qui tam practices.
b. safe practices.
c. safe harbors.
d. Exclusions.
c. safe harbors.
The federal physician self-referral statute is also known as the

a. Sherman Anti-Trust Act.
b. Deficit Reduction Act.
c. False Claims Act.
d. Stark Law
d. Stark Law
The OIG has specific compliance guidance for all of the following entities except

a. hospitals.
b. home health agencies.
c. hospices.
d. pharmacies.
d. pharmacies.
Examples of high risk billing practices which create compliance risks for healthcare organizations include all but which of the following?

a. altered claim forms
b. returned overpayments
c. duplicate billings
d. unbundled procedures
b. returned overpayments
This law establishes criminal penalties for paying to induce business for which payments from federal healthcare programs may be received.

a. False Claims Act
b. Federal Physician Self-Referral Act
c. Federal Anti-Kickback Statute
d. Sherman Anti-Trust Act
c. Federal Anti-Kickback Statute
The OIG states that insufficient or missing documentation and which one of the following are
responsible for 70% of bad claims submitted to Medicare.
a. local coverage decisions
b. unbundling of procedures
c. failure to document medical necessity
d. overcoding
c. failure to document medical necessity
Which of the following types of activities is not one that should be audited and monitored in a compliance program?

a. problem-prone
b. high risk
c. high volume
d. referrals
d. referrals
The Deficit Reduction Act of 2006

a. encouraged voluntary compliance programs
b. did not address healthcare fraud and abuse
c. made compliance programs mandatory
d. affects entities that make or receive at least $9 million in Medicaid payments
c. made compliance programs mandatory
Healthcare fraud is all but which of the following:

a. unnecessary costs to a program
b. false representation of fact
c. failure to disclose a material fact
d. damage to another party that reasonably relied on misrepresentation
a. unnecessary costs to a program
This act is used to combat Medicare fraud by penalizing those that submit incorrect information to the program.

a. Qui Tam Act
b. Medicare Act
c. False Claims Act
d. Fraud Prevention Act
c. False Claims Act
Corporate compliance programs became common after adoption of which of the following:

a. False Claims Act
b. Federal Sentencing Guidelines
c. Office of the Inspector General for HHS
d. Federal Physician Self-Referral Statute
b. Federal Sentencing Guidelines
Healthcare abuse relates to practices that may result in

a. false representation of fact.
b. failure to disclose a fact.
c. medically unnecessary services.
d. altered claim forms.
c. medically unnecessary services.
Services that are statutorily non-covered by Medicare can be located on the

a. list of CPT codes.
b. Medicare claim forms.
c. Medicare Non-Covered Services Manual.
d. Medicare Notice of Exclusions From Medicare Benefits.
d. Medicare Notice of Exclusions From Medicare Benefits.
Responsibility for the filing of accurate claims ultimately belongs to the

a. billing staff.
b. payers.
c. provider.
d. Office of the Inspector General.
c. provider.
Coding and billing documentation must be based on the

a. wishes of the patient.
b. highest available reimbursement amount.
c. most efficient utilization of resources.
d. provider's documentation.
d. provider's documentation.
Unbundling refers to

a. failure to use a comprehensive code to inappropriately maximize reimbursement.
b. failure to use multiple procedure codes to inappropriately maximize reimbursement.
c. combined billing for pre and post-surgery physician services.
a. failure to use a comprehensive code to inappropriately maximize reimbursement.
Which federal law mandated the creation of recovery audit contractor services?

a. federal sentencing guidelines
b. False Claims Act
c. Tax Relief and Health Care Act
d. Health Care Recovery Act
c. Tax Relief and Health Care Act
The Fraud Enforcement and Recovery Act expands

a. the government's investigative powers.
b. the office of the OIG.
c. the office of the RACs.
d. the role of HIPAA in compliance.
a. the government's investigative powers.
The Stark law:

a. prohibits physicians from billing for lab services.
b. prohibits physicians from ordering test on family members.
c. prohibits physicians from ordering from entities that they have financial relationship.
d. prohibits physicians from ordering lab services at hospitals.
c. prohibits physicians from ordering from entities that they have financial relationship.