CPCO CERTIFICATION EXAM AND PRACTICE EXAMS 2024, Exams of Nursing

Download CPCO CERTIFICATION EXAM AND PRACTICE EXAMS 2024 and more Exams Nursing in PDF only on Docsity! 1 | P a g e CPCO CERTIFICATION EXAM AND PRACTICE EXAMS 2024 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS BY EXPERTS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+ |LATEST UPDATE |GUARANTEED PASS The Federal Anti-Kickback Statute places certain constraints on business arrangements related directly or indirectly to items or services reimbursed by any Federal health care program, including, but not limited to, Medicare and Medicaid. According to the OIG, which of the following would likely be an acceptable practice? A. A physician practice should participate in all aspects of a hospital's compliance program to be sure the anti-kickback statute is not violated. B. The hospital should oversee the physician practice's compliance program at no cost for the physicians in exchange for timely and accurate completion of inpatient records. C. The physician practice should limit participation in a hospital's compliance program to training and education or policies and procedures only. D. A hospital performs an annual claim audit for its affiliated physician practices. There is no charge for the audit as the hospital inc C. The physician practice should limit participation in a hospital's compliance program to training and education or policies and procedures only. Although liability under the anti-kickback statute ultimately turns on a party's intent, it is possible to identify arrangements or practices that may present a significant potential for abuse. Which of the following questions would be helpful to determine whether a proposed action could violate the anti- kickback statute? A. Does the arrangement or practice have a potential to improve clinical decision-making? B. Does the arrangement or practice have a potential to decrease costs to Federal health care programs, beneficiaries, or enrollees? C. Does the arrangement or practice have a potential to decrease the risk of overutilization or inappropriate utilization? D. Does the arrangement or practice raise patient safety or quality of care concerns? C. Does the arrangement or practice have a potential to decrease the risk of overutilization or inappropriate utilization? 2 | P a g e Section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) - Pub. L. 108-173, December 8, 2003 - authorized an exception to the physician self-referral prohibition for certain arrangements in which the physician can receive necessary non-monetary remuneration. What is this exception related to? A. Outpatient services B. E-Prescribing C. Physician investments in specialty hospitals D. None of the above; there are no exceptions in the Stark law. B. E-Prescribing Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), is also known as the physician self- referral law and commonly referred to as the "Stark Law". The Stark Law applies to which of the following individuals or entities? A. Patients and their families B. Physicians and hospitals C. Federal health care programs like Medicare D. Both B and C D. Both B and C The Patient Protection and Affordable Care Act (PPACA) signed into law on March 23, 2010 mandated that all overpayments be returned within this amount of time post-identification? A. 15 days B. 45 days C. 60 days D. 75 days C. 60 days An office manager has misplaced his laptop. The hard drive on the laptop is not encrypted. Which of the following data stored on the laptop would be considered a HIPAA breach if someone gains access to the laptop? A. Employee immunization records B. Medicaid Reports listing patient names and dates of birth. C. Physician schedules for the operating room listing the physician's name and procedure done D. Health records of students B. Medicaid Reports listing patient names and dates of birth. Under the HIPAA privacy rule, which of the following situations would require an authorization from the patient to release records? A. A request from a life insurance company for the patient's medical records. 5 | P a g e convenient for their patients. D. When a new test is performed that is not covered under the practice's current CLIA certificate. C. Good Care medical clinic is excited to be moving to a new location. It is a brand new building right across the street from their current location. They chose this location because it would be the most convenient for their patients. Any health care fraud scheme that disseminate any article or document through a "common mail carrier" may be the basis for a charge of: A. Mail Fraud B. Wire Fraud C. Mail Fraud and Wire Fraud D. False Claims A. Mail Fraud When agreeing to a global civil fraud settlement, what is the most popular reason why a provider agrees to enter into a Corporate Integrity Agreement? A. To avoid exclusion from participation in Federal health care programs B. To obtain a Civil Monetary Penalty reduction C. To obtain a fine reduction D. To avoid incarceration A. To avoid exclusion from participation in Federal health care programs A new orthopedic physician is being hired in a group practice. The group has been searching for quite a while and finally found the perfect candidate. As part of the practice's hiring process, employees must be checked against the OIG and GSA lists for excluded parties. Does this practice also apply to physicians? A. No, this requirement only applies to non-medical employees of the practice. B. No, this requirement only applies to non-medical employees of the practice and vendors. C. Yes, this requirement only applies to physicians. D. Yes, this requirement applies to physicians and employees of the practice. D. Yes, this requirement applies to physicians and employees of the practice. A physician practice hired a consultant to perform external audit services for their practice. After the consultant began working, the OIG and GSA lists were checked and it was found the consultant was excluded from participation. What steps should the practice take? A. Nothing. Because the consultant is not ordering, referring, or performing medical services, there is no problem. B. Report the consultant to the OIG for violating her exclusion status. C. Immediately ask the consultant to stop work. 6 | P a g e D. Contact legal counsel. E. Both C and D E. Both C and D Which entity provides benefit integrity investigations based on billing abnormalities identified by data analysis or allegations of fraud and abuse, as well as conducts reviews that will allow them to compare billing of Medicare claims to Medicaid claims known as the "Medi-Medi" program that helps to identify fraudulent activity between the two programs? A. Medi-Medi Audit Contractors (MACs) B. Recovery Audit Contractors (RACs) C. Medicaid Integrity Contractors (MICs) D. Zone Program Integrity Contractors (ZPICs) D. Zone Program Integrity Contractors (ZPICs) Federal and state investigators are in the process of identifying and copying documents that are identified in the Government's search warrant. Which of the following statements are true regarding document protection? A. Employees should not destroy, change or alter any documents, including paper, tape and electronic records because such actions can lead to criminal liability. B. Documents should not be moved but it is ok to amend records in an attempt to correct the information in them. C. Let the investigator know that some documents will be destroyed because the office policy on routine record destruction cannot be suspended. D. You do not have to give the investigator computer access if you don't want to. A. Employees should not destroy, change or alter any documents, including paper, tape and electronic records because such actions can lead to criminal liability. CMS' Self-Referral Disclosure Protocol (SRDP) sets forth a process for providers of services and suppliers to self-disclose actual or potential violations of the physician self-referral statute (section 1877 of the Social Security Act). Which of the following statements are true about the SRDP? A. The SRDP is intended to facilitate the resolution of only matters that, in the disclosing party's reasonable assessment are actual or potential violations of the physician self-referral statute. B. Participation in the SRDP is only limited to physicians. C. Disclosing parties can disclose the same conduct under both the SRDP and the OIG's Self-Disclosure Protocol. D. To facilitate CMS' verification and validation processes, CMS requires access to all financial statements, notes, disclosures and other supporting documents regardless of the assertion of privileges or limitations on the information produced. A. The SRDP is intended to facilitate the resolution of only matters that, in the disclosing party's reasonable assessment are actual or potential violations of the physician self-referral statute. 7 | P a g e Responsible for the overall fulfillment of the OIGs mission and for promoting effective management and quality of the agency's proceesses and products. Immediate Office of the Inspector General Performs independent audits of HHS programs and/or HHS grantees and contractors to examine their performance. Office of Audit Services Provide's mission and administrative support to the OIG. Office of Management and Policy Conducts national evaluations of HHS programs from a broad issue-based perspective. Office of Evaluation and Inspections Conducts criminal, civil, and administrative investigations of fraud and misconduct related to HHS programs, operations and beneficiaries. They also operate an OIG hotline. Office of Investigations Provides legal advocacy and counsel to the Inspector General and OIG's other components. Office of Counsel to the Inspector General Consists of numerous agencies, including the FBI and the DEA. Department of Justice The DOJs current strategic plan includes: - Prevent terrorism and promote national security consistent with the rule of law -Prevent crime, protect the rights of the American people and enforce Federal law -Ensure and support the fair, impartial, efficient and transparent administration of justice at the federal, state, local, tribal and international levels. This tool is usually used as a part of a civil settlement with a provider or organization when there has been an investigation into the claims submitted to a federal payer. It can also be used when an individual or entity has been found guilty of defrauding a federal healthcare program. CIA - Corporate Integrity Agreement Provider or entities sign agree to the oligations within this agreement, in exchange, the OIG agrees not to see their exclusion from participation in Medicare, Medicaid and other Federal health care programs. Corporate Integrity Agreement - CIA As part of this agreement, providers are required to establish an effective compliance program following the practice's set forth in the guideline. 10 | P a g e If a physician practice uses another entity's standards of conduct, the practice must: A. Implement the standards of conduct as received because they have already been approved. B. Tailor those materials to the physician practice where they will be applied. C. Only select those standards that represent high risk issues for the practice. D. None of the above. Physician practices must create their own standards of conduct. It would be a compliance violation to copy another entity's standards of conduct. B. Tailor those materials to the physician practice where they will be applied. As the compliance contact for your physician practice, you are charged with developing the policies and procedures related to coding and billing. When developing these policies and procedures, which of the following statements should be included? A. If a new physician joins the practice and the new physician's NPI has not been received, services performed should be reported using the practice medical director's NPI. B. For any services billed, documentation must be present in the patient's medical record to support the services. C. To avoid compliance risk, coding for E/M services should be based solely on medical record documentation, even if it appears the level of service is not warranted. D. For denied services, billing staff should notify the physician to change the reported diagnosis to allow for resubmission and payment of the claim. B. For any services billed, documentation must be present in the patient's medical record to support the services. City Orthopedics, a large physician group practice employs several physician assistants and nurse practitioners. There have been several questions by the physicians on how incident to services should be billed. The compliance officer has called the Medicare Administrative Contractor for the practice and was given some information on how incident to services should be billed. Because the practice will be relying on the information received from the Medicare Administrative Contractor, what steps should the compliance officer take at the conclusion of the call according to the OIG Compliance Guidance for Individual and Small Group Physician Practices? A. Call someone else at the Medicare Administrative Contractor to confirm the information received. B. Send a letter to CMS to confirm the information provided by the Medicare Administrative Contractor is correct. C. Both A and B D. Document the conversation and retain th D. Document the conversation and retain the records. Developing effective compliance policies and procedures is an important part of any compliance program. To help your practice mitigate compliance risk, policies and procedures should: A. Only be one page long to promote understanding by all staff. B. Be sure any timeframes or requirements listed can be accomplished given the practice's resources. 11 | P a g e C. Be written by consultants because they are more familiar with the variety of healthcare regulations that apply to the practice. D. Both B and C B. Be sure any timeframes or requirements listed can be accomplished given the practice's resources. Select the best phrase from the list below to complete the following policy statement: Centennial Medical Associates is committed to following Federal, State, and Local laws, rules, guidelines, and regulations. To promote this effort, Centennial Medical Associates will perform claims audits at least on an annual basis to ____________________. A. Maximize reimbursement for the services performed. B. Optimize reimbursement for the services performed. C. Verify accuracy of coding and reimbursement for the services performed. D. Ensure all services are submitted for reimbursement. C. Verify accuracy of coding and reimbursement for the services performed. You have just been identified as the compliance officer at your practice. The OIG Compliance Guidance for Individual and Small Group Physician Practices suggests six specific duties that may be assigned to you. What is one of those duties? A. Reviewing reports to see that new employees and vendors have been checked against the OIG's list of excluded individuals and entities. B. Making sure no one changes the compliance program so you are able to show how the program was implemented. C. Reviewing all claims being submitted to be sure they do not violate fraud and abuse laws. D. Submitting annual reports to the Office of Inspector General on all compliance activities undertaken during the year. A. Reviewing reports to see that new employees and vendors have been checked against the OIG's list of excluded individuals and entities. For larger physician practices, how frequently does the OIG recommend reporting compliance activities to the Board of Directors and CEO? A. Monthly B. Quarterly C. Annually D. Regularly D. Regularly When conducting compliance training within a physician practice, what is one of the goals that the practice should strive for in this training? A. Only new employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations. 12 | P a g e B. Managers of employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations. C. All employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations. D. All employees will receive training on the definition of compliance. C. All employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations. What is the goal of ongoing auditing and monitoring in a physician's practice? A. Ongoing auditing and monitoring will prevent fraud B. Ongoing auditing and monitoring will enhance revenues by detecting instances of undercoding. C. Ongoing auditing and monitoring will evaluate whether the physician practice's standards and procedures are current and accurate and whether the compliance program is working. D. Ongoing auditing and monitoring will improve the quality of patient care. C. Ongoing auditing and monitoring will evaluate whether the physician practice's standards and procedures are current and accurate and whether the compliance program is working. A compliance program's plan for communication should include a provision for non-retaliation for reporting fraudulent conduct. Which method below helps ensure that an employee would be free from retribution? A. A clearly defined chain of command for reporting potentially fraudulent conduct B. Guaranteed anonymity C. Well-publicized disciplinary actions for retaliation D. A policy that encourages reporting directly to the OIG C. Well-publicized disciplinary actions for retaliation What does the HHS OIG suggest as possible warning signs that non-compliance may exist? A. Significant change in the number or type of claim rejections. B. Getting carrier newsletters pertaining to the types of service that your practice bills. C. Consistent use of certain codes. D. Receipt of carrier requests for documentation. A. Significant change in the number or type of claim rejections. Having the ability to respond to issues enables a practice to develop effective action plans to correct problems and prevent future problems from occurring. What is one step that can be taken to establish compliance effectiveness for responding to and/or preventing compliance issues? A. Create a response team, consisting of representatives from the compliance and audit department. B. Create a response team, consisting of representatives from compliance, audit, and any other relevant functional department. C. Create an investigation team, consisting of representatives from compliance, audit, and any other 15 | P a g e critical or key portions of the service. D. Personally furnished by a physician who is not a resident. D. Personally furnished by a physician who is not a resident. Which of the following settings is the incident-to rule not applicable? A. Hospital B. Solo-Physician office C. Group Practice D. Multi-Disciplinary Group Practice A. Hospital An assignment is a written agreement between beneficiaries, their physicians or other suppliers, and Medicare. The beneficiary agrees to let the physician or other suppliers request direct payment from Medicare for covered Part B services, equipment, and supplies by assigning the claim to the physician or supplier. As a result of a physician accepting assignment, he/she must follow certain requirements. Which of the statements does not accurately reflect the requirements of physicians accepting assignment? A. The physician/supplier who accepts assignment on a claim-by-claim basis or who is a participating physician/supplier is precluded from charging the enrollee more than the deductible and coinsurance based upon the approved payment amount determination. B. Physicians or suppliers who agree to accept assignment from Medicare cannot attempt to collect more than the appropriate Medicare deductible and coinsurance am C. Physicians or suppliers who have chosen to accept assignment may as a result collect from the enrollee or anyone else any amount which, when added to the benefit, may exceed the Medicare allowed amount. According the Social Security Act, Sec. 1877. [42 U.S.C. 1395], prohibitions on certain referral arrangements include those that involve financial arrangements between entities and physician practices. In the law, rental of office space is considered not to be a compensation arrangement under certain conditions and as such are considered exceptions as long as which of the following exists? A. The lease would be commercially reasonable even if no referrals were made between the parties and has a term or rental or lease for at least one 1 year. B. The lease provides for a term of rental or lease for at least 1 year C. The space rented or leased does not exceed that which is reasonable and necessary for the legitimate business purposes of the lease or rental and is used exclusively by the lessee when being used by the lessee D. The rental charges over the term of the lease are set in advance, are consistent with fair E. All of the above According to the Federal Register, the OIG has listed a number of potential risk areas for physician practices. These risk areas include: (a) coding and billing, (b) reasonable and necessary services, and (c) 16 | P a g e documentation. Which of the following scenarios would be considered a risk area or areas for a physician practice? A. Dr. Y bills Medicare using a covered office visit code when the actual service was a non-covered annual physical. This could be considered improper coding or billing and therefore is considered a risk area. B. Dr. X bills Medicare using a CPT surgical code including dressings and instruments for a minor procedure in which dressings and instruments are included in a single fee. This could be considered improper coding or billing and therefore is considered a risk area. C. Dr. Z bills Medicare for a preventive medicine service code when the actual service was a non-covered annual physical. This c A. Dr. Y bills Medicare using a covered office visit code when the actual service was a non-covered annual physical. This could be considered improper coding or billing and therefore is considered a risk area. There can be a variety of risks associated with joint ventures between hospitals and physicians. What law(s) could be violated for improper joint ventures? A. False Claims Act B. Stark Laws C. Anti-kickback Statute D. All of the above D. All of the above Dr. Appleton is an orthopedic surgeon in a large orthopedic practice. Due to the success of their clinic, the practice is opening a new orthopedic hospital that will be owned by all of the physicians in the group. In addition to Stark Law issues, what other compliance concern may be present? A. Dr. Appleton's referral of patients to the orthopedic hospital will violate the False Claims Act and subject him to the associated penalties and fines. B. Dr. Appleton and his colleagues will be paid a set amount of the profits, regardless of the value or volume of referrals. C. Dr. Appleton's ownership in the orthopedic hospital represents a conflict of interest because his decisions on the care needed by his patients may be biased by his potential financial gain for referring patients to the facility. D. There is no compliance concern. By opening a new orthopedic hospital, the practice is helping to assure needed orthopedi C. Dr. Appleton's ownership in the orthopedic hospital represents a conflict of interest because his decisions on the care needed by his patients may be biased by his potential financial gain for referring patients to the facility. Physician Quack just completed a 15-minute psychiatric evaluation of his patient. He intentionally completes his superbill for a 30-45-minute session. Dr. Quack may be liable for: 17 | P a g e A. Abuse B. Neglect C. Fraud D. None of the above C. Fraud The civil False Claims Act provides the Court with the authority to assess: A. One "times the amount of the damages which the Government sustains..." B. Up to two "times the amount of the damages which the Government sustains..." C. Up to three "times the amount of the damages which the Government sustains..." D. Up to four "times the amount of the damages which the Government sustains..." C. Up to three "times the amount of the damages which the Government sustains... Question 1 Under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), what is the name of the national program designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse? Health Care Fraud and Abuse Control Program (HCFAC) Question 2 According to the Federal Sentencing Guidelines, "To have an effective compliance and ethics program..., an organization shall exercise due diligence to prevent and detect criminal conduct." The FSGs also state organizations shall: Promote an organizational culture that encourages ethical conduct and a commitment to compliance with the law. Question 3 If a physician practice uses another entity's standards of conduct, the practice must: Tailor those materials to the physician practice where they will be applied. Question 4 As the compliance contact for your physician practice, you are charged with developing the policies and procedures related to coding and billing. When developing these policies and procedures, which of the following statements should be included? For any services billed, documentation must be present in the patient's medical record to support the services. Question 5 City Orthopedics, a large physician group practice employs several physician assistants and nurse practitioners. There have been several questions by the physicians on how incident to services should be billed. The compliance officer has called the Medicare Administrative Contractor for the practice and was given some information on how incident to services should be billed. Because the practice will be relying on the information received from the Medicare Administrative Contractor, what steps should the 20 | P a g e Question 19 A patient being seen by a physician has unpaid medical bills in excess of $5,000 after insurance payments. The patient has now lost his job and has limited financial resources. The office manager has reviewed the patient's financial situation to assess the patient's ability to pay and has agreed to reduce the fees owed to $2,500. Would this act violate the OIG gift allowance for beneficiaries? No, this would be an exception to the OIG gift allowance because it is based on the patient's ability to pay. Question 20 Services furnished in teaching settings are paid under the Medicare Physician Fee Schedule (MPFS) if the services are: Personally furnished by a physician who is not a resident. Question 21 Which of the following settings is the incident-to rule not applicable? Hospital Question 22 Assignment is a written agreement between beneficiaries, their physicians or other suppliers, and Medicare. The beneficiary agrees to let the physician or other suppliers request direct payment from Medicare for covered Part B services, equipment, and supplies by assigning the claim to the physician or supplier. As a result of a physician accepting assignment, he/she must follow certain requirements. Which of the statements does not accurately reflect the requirements of physicians accepting assignment? Physicians or suppliers who have chosen to accept assignment may as a result collect from the enrollee or anyone else any amount which, when added to the benefit, may exceed the Medicare allowed amount. Question 23 According the Social Security Act, Sec. 1877. [42 U.S.C. 1395], prohibitions on certain referral arrangements include those that involve financial arrangements between entities and physician practices. In the law, rental of office space is considered not to be a compensation arrangement under certain conditions and as such are considered exceptions as long as which of the following exists? A. The lease would be commercially reasonable even if no referrals were made between the parties B. The lease provides for a term of rental or lease for at least 1 year C. The space rented or leased does not exceed that which is reasonable and necessary for the legitimate business purposes of the lease or rental and is used exclusively by the lessee when being used by the lessee D. The rental charges over the term of the lease are set in advance, are consistent with fair market value, and are not determined in a manner that takes into account the volume or value of any referrals or other business generated between the parties Question 24 According to the Federal Register, the OIG has listed a number of potential risk areas for physician 21 | P a g e practices. These risk areas include: (a) coding and billing, (b) reasonable and necessary services, and (c) documentation. Which of the following would be considered a risk area or areas for a physician practice? Dr. Y bills Medicare using a covered office visit code when the actual service was a non-covered annual physical. This could be considered improper coding or billing and therefore is considered a risk area. Question 25 There can be a variety of risks associated with joint ventures between hospitals and physicians. What law(s) could be violated for improper joint ventures? False Claims Act, Stark Laws, Anti-kickback Statute Question 26 Dr. Appleton is an orthopedic surgeon in a large orthopedic practice. Due to the success of their clinic, the practice is opening a new orthopedic hospital that will be owned by all of the physicians in the group. In addition to Stark Law issues, what other compliance concern may be present? Dr. Appleton's ownership in the orthopedic hospital represents a conflict of interest because his decisions on the care needed by his patients may be biased by his potential financial gain for referring patients to the facility. Question 27 Physician Quack just completed a 15 minute psychiatric evaluation of his patient. He intentionally completes his superbill for a 30-45 minute session. Dr. Quack may be liable for: Fraud Question 28 The civil False Claims Act provides the Court with the authority to assess: Three "times the amount of the damages which the Government sustains..." Question 29 The Federal Anti-Kickback Statute places certain constraints on business arrangements related directly or indirectly to items or services reimbursed by any Federal health care program, including, but not limited to, Medicare and Medicaid. According to the OIG, which of the following would likely be an acceptable practice? The physician practice should limit participation in a hospital's compliance program to training and education or policies and procedures only. Question 30 Although liability under the anti-kickback statute ultimately turns on a party's intent, it is possible to identify arrangements or practices that may present a significant potential for abuse. Which of the following questions would be helpful to determine whether a proposed action could violate the anti- kickback statute? Does the arrangement or practice raise patient safety or quality of care concerns? 22 | P a g e Question 31 Section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) - Pub. L. 108-173, December 8, 2003 - authorized an exception to the physician self-referral prohibition for certain arrangements in which the physician can receive necessary non-monetary remuneration. What was this exception related to? E-Prescribing Question 32 Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), is also known as the physician self- referral law and commonly referred to as the "Stark Law". The Stark law applies to which of the following individuals or entities? B. Physicians and hospitals C. Federal health care programs like Medicare Question 33 The Patient Protection and Affordable Care Act (PPACA) signed into law on March 23, 2010 mandated that all overpayments be returned within this amount of time post-identification? 60 days Question 34 An office manager has misplaced his laptop. The hard drive on the laptop is not encrypted. Which of the following data stored on the laptop would be considered a HIPAA breach if someone gains access to the laptop? Medicaid Reports listing patient names and dates of birth. Question 35 Under the HIPAA privacy rule, which of the following situations would require an authorization from the patient to release records? A request from a life insurance company for the patient's medical records. Question 36 The HIPAA security rules require covered entities to put safeguards in place to protect personal health information. A medical facility hired a Security Officer who had done a risk analysis to identity potential security risks of the computer system. He has implemented policies and procedures on computer access and password management. Administrative safeguards Question 37 A safeguard the security officer puts in place is that all employees were given name tags to wear while on duty. Policies were put in place to restrict access to employee areas. Policies were also written to establish the proper use of computer workstations for business and antivirus software was added. What type of safeguard does this action describe? Physical safeguards 25 | P a g e Dashboard Which personality trait indicates how a person approaches the outside world? Judging/perceiving __________ are small data files stored on your hard drive or in device memory that store information about your use of the site or app. Cookies A regional carwash business uses direct mail and other print media services to send monthly specials. How can they add social media to communicate product information to their customers? Post blogs and customer reviews. Which social media platform has the highest number of active monthly users? Facebook Which one of the following is a standard model for exchanging data on the Web? RDF Which metric is often used to determine quality scores? Click through rate Which type of social media user watches other users' activities on a social network site but rarely participates? Larker While developing your social media presentation, you consider using the Myers-Briggs Type Indicator (MBTI) to assess the audience's: Personality Which type of data collection that is generated online includes health and fitness trackers? Sensor generated As the company's Social Media Strategist, you meet with the human resource department to determine their social media goals. How does social media affect the recruitment of employees? A robust and active social media presence can attract job seekers to open positions at a company. Which of the following statements describes the relationship between search engine optimization (SEO) and social media optimization (SMO)? SEO is just a single-part SMO. Large financial services companies have been trying to adapt and accommodate the growth of social media. Which of the following has likely had the most significant impact on these financial entities? 26 | P a g e Companies have had to develop extensive policies and training regarding personal use of social media by employees. A flash flood has closed a highway that runs near a metropolitan area. The county public services announce the closure on microblogging sites and major social media sites. They get several responses from tourists requesting detour assistance. This behavior is commonly referred to as: crowdshaping. Which of the following statements are true regarding Facebook Messenger? 1. It is an instant messaging service that is built into Facebook on the desktop. 2.You can add notes and labels to organize your messages and conversations 3. It is a great way for businesses to take conversations off the main business page and engage directly with an audience member. Which chart type is best for showing the percentage of a whole as allocated across several variables? Pie What are the questions to consider when looking at sentiment? What are people saying about your competitors? Is sentiment positive, negative, or neutral for the brand? What are people saying about your company or brand? Which of the following statement is true regarding social media optimization (SMO)? It includes optimizing your strategies, tactics, content, and profiles. Arcelia works for an online company selling surfing equipment. She is conducting a SWOT analysis of the company's social media plan. What could be determined during the SWOT analysis? T Decide if goals are possible to achieve. Lauren is the Marketing Director of an online clothing company. She is creating a social media strategy plan to drive sales in the fall line of clothes. She is reviewing several personas and ranking them based on the possible level of interest in the fall line and may shop at the online store. Which stage of the social media strategy plan cycle is he in? Identify the target audience A local skateboard business posts weekly tips about tricks and skateboarding events. These social media posts are written by employees of the business, and are often publicly shared by their followers. What kind of social media communication is this? Owned communication The ________ audience is the initial group of people who view or listen to your presentation and share it with other people. 27 | P a g e primary Which of the following platforms connect most with professionals in general and thus one of the major platforms in B2B social media? LinkedIn When identifying influencers, consider Brian Solis's three Rs in mind. What are those three Rs? Reach, Relevance, Resonance Which of the following steps would you follow at first in the social media planning cycle while creating a strategy? Listen and analyze Which of the following social features are a part of media sharing sites? Profiles, Tagging, and Comments Instagram is owned by which of the following social media platforms? Facebook Which of the following Facebook targeting options denotes age, gender, education, language, and so forth? Demographics Jordan has launched a new jewelry company and will offer his bracelet line to potential new customers using a social media campaign. He has recently seen his competitors successfully use influencers to help promote their products to new customers. What should he try when identifying the right potential influencers for his audience? Reach, relevance, and resonance What company guidelines and policies should you cover in social media? What kinds of things employees are allowed to say and share on social platforms?, What kinds of things do employees need to keep secret?, What are the consequences for violations? Which of the following tips is not considered while creating a good report? Begin with defining goals. While performing a social media audit you discover there are two social media sites with little or no activity. What is the best way to proceed? Develop a good profile placeholder for these sites. Tyrone owns a skateboard company and wants to improve his social media presence. He wonders if an Instagram account would benefit his business. What demographic information should he consider when making this decision? 30 | P a g e Ask your customers for stories about using your products and services. Answer questions as quickly and thoroughly as possible. Actively participate in conversations with the community. Which of the following is not a process that Matthew Barby, a digital marketing consultant, uses to build relationships with influencers and contributors? Identify major influencers or contributors and then start a sentiment campaign to build relationships with them. In the 90-9-1 rule, what percentage of the community of people participate and contribute sometimes? 9 Which format of the rule of three in a presentation should reiterate the most important points in the presentation but not repeat the introduction word for word? conclusion A podcast is a series of media files, including audio or video files that are downloadable through: Web syndication In the 90-9-1 rule, what percentage of the community is very active and does the bulk of the participation and contribution? 1 Being an experienced social media strategist, when you begin to create your presentation you keep the rule of three in mind. The rule of three states that: your presentation should have a beginning, a middle, and an end. What metrics can you use on Snapchat? story fallout ratio snap completion rates story snap views Which of the following statements are true regarding podcasts? The podcatcher accesses a Web feed that lists the available files for a podcast series. The term podcast originates from a combination of "iPod" and "broadcast." For podcasts, the user's computer or device needs special software called a podcatcher. What happens when social media features are added to a webinar platform? The communication becomes two-way between the presenter and the audience. The communication starts between one presenter to many audience members. What is the role of a reformer? Appreciates their own judgment and does what they want 31 | P a g e Which type of audience is a group of people who view or listen to your presentation when it is shared with them by an initial audience member? Secondary The downside to allowing questions during your presentation is that: it can send you off on a tangent or waste time answering questions that will be covered later in the presentation Which of the following guidelines will not help you in producing high-quality visual aids? Include multiple concepts per visual aid. As a social media strategist, you want your audience to remember your presentation and perform the follow-up actions so you can achieve your objectives. To increase post-presentation engagement in a way that can be monitored by your company, you: give the audience a hashtag that is specific to your presentation. A researcher at a pharmaceutical company has been sharing information on a new drug with another coworker via posts on their favorite social media site. The researcher did not understand the privacy settings and has inadvertently shared confidential company information publicly to his entire social network. What organizational weakness put this company at risk? Ambiguous policies As a social media strategist, you put a lot of time and effort into building a social media community. You have completed the first three phases of building and you are now at the last phase, which is: Leverage the community As the Social Media Strategist at a large company, you are delivering a social media presentation and you are very nervous. You know that it is best to use a natural, conversational style when delivering your presentation so you do which of the following? Focus on one person at a time and speak to them. A local golf resort has been regularly posting on their social media sites, offering coupons, pointing out course features, and announcing special events such as tournaments. As a result, they have seen their number of followers and the number of people playing golf, steadily increase in the last twelve months. What stage of social community building is this? Growth What happens when you rehearse for a presentation in front of other people? You can get a feel for the types of questions your audience might ask and prepare your responses. Which of the following is not a good tip for creating presentation deliverables? Follow the different structures you used during the presentation when creating your deliverables. 32 | P a g e Social media can result in the unintentional release of sensitive information about the company or about its customers and partners. What kind of risk is this? Disclosure of intellectual property Which of the following are the weakness a company might have? System vulnerabilities Which of the following statements are true regarding the reputation damage of the company? It can occur from how the public views or perceives the company. It can occur when social media users post something negative about the brand. As a ___________, you should maintain a global perspective on legal and regulatory issues. social media strategist You are sending out emails to your social media followers and you plan on tracking when the messages are opened, which links were clicked, and if recipients forwarded the email. Your apprentice asks you how will you achieve this. You inform him that you will use: Web beacons In which stage of risk analysis, do we assess and evaluate risk? Second A ______ establishes an agreement between a user and the content owner, whether a writer, artist, programmer, magazine, corporation, Website, and so on. license What are the guidelines which are included in a code of conduct? Be respectful. Assume the public can see your posts. Be transparent. Which method sends an excerpt of the content with the notification? Trackback A food Website is considering whether to implement a rating and review feature for its members. Members could grade foods they have tried on a five-star scale and then write a review of their food. The legal team and social media risk manager are advising against implementing this feature. Why would they object? Because the organization has no way to verify the reviews are accurate and don't want to be held liable Question :Which of the following statements regarding copyright is not true? One of the main areas of copyright protection is the analog transmission of Website content. 35 | P a g e Response Which of the following advantages are true regarding paid social media? It builds your audience faster. It figures out what content is performing the best. You might not be sure that your message is reaching your target audience because organic social media relies on sharing. What things should every company monitor on social media to help detect a crisis? A patient report that during a previous blood draw he felt lightheaded and almost passed out. What should the phlebotomy technician do? Perform the draw with the patient reclined or in a supine position. A phlebotomy technician at a primary care clinic is performing venipuncture on a patient with suspected influenza. The patient is wearing a mask. What PPE should the technician wear? Gloves and a mask. A requisition calls for the following tests: CBC, CMP, and PTT. Which of the following reflects the proper order of draw? Citrate (blue top), SST (red top), and EDTA (lavender). Blood exits the heart through the body's largest artery, the _________ Aorta. What part of the evacuated tube system allows multiple collection tubes to be filled with one puncture? The interior needle/tube holder. When drawing a specimen for an ammonia test, what should a phlebotomy technician have ready for specimen transportation? An Ice slurry. A phlebotomy technician asks a patient to state and spell his name. He says, "Chris Morgan, C-H-R-I-S M- O-R-G-A-N." The name listed on the requisition is "Criss Morgan." What should the phlebotomy technician do? Call the ordering provider to resolve the issue and get a new requisition with the correct spelling if the spelling was an error. When a blood culture is ordered along with other tests, which tube is filled first? Yellow SPS. 36 | P a g e Which of these patient reactions should be documented, but is not a cause for discontinuing a draw or likely to affect analytes? Petechiae. A phlebotomy technician is performing a venipuncture collection on a young adult and needs to draw a citrate tube, a serum separator tube, and an EDTA tube. The citrate tube and SST fill quickly. The EDTA tube fills partway and then blood flow stops. What is the most likely explanation? The tube's vacuum is compromised. Scars cover the arms and hands of a patient whose requisition requires CBC and electrolytes. After finding no acceptable venipuncture site on either arm or hand, the phlebotomy technician sees that the scarring does not extend to the fingertips. Which of the following is true? The phlebotomy technician can do a capillary draw and document that where the blood was collected and why. When is a sharps receptacle considered to overfilled according to OSHA standards? When it is more that 3/4 full. Of the three veins commonly assessed for venipuncture, which is considered the least favorable? The basilic vein. An emergency room physician directs a phlebotomist to draw blood from an unconscious patient of unknown identity. This is... Legal under the concept of implied consent. When performing a draw on an inpatient with a recent mastectomy, the phlebotomy technician finds that an IV is running in the arm on the non-mastectomy side. Which site should the phlebotomy technician use? A site distal to the IV on the non-mastectomy side. An infant's blood volume may be approximated by multiplying the child's ... by .... Weight in kilograms, 80. Two sets of blood culture bottles are to be filled for a patient. Which of the following is true? The sets must be filled from two different venipuncture site. After assembling the ETS and double-checking that he has the correct tubes gathered for a venipuncture draw, a phlebotomy technician realizes that he forgot to remove the tourniquet after site selection. He knows that it has been in place for more than one minute. If he continues with the draw, what is one possible consequence? The specimens collected will not produce accurate test results. 37 | P a g e Which of the following information on a requisition form is essential for a phlebotomy technician to match exactly with information provided by the patient? Complete date of birth. Disposable tourniquets are intended to be used... On one patient only. How should a phlebotomy technician respond if, after a site is selected and cleaned and equipment prepared, the patient pushes down his sleeve and clutches his arm to his chest? She should ask the patient if he has concerns she can address or if he would like to talk to his doctor. Which of the following is a HIPAA violation? Failing to log out of a patient record on a visible screen before calling the next patient in. A patient with a DNR order in place becomes unresponsive during the course of a blood draw. The phlebotomy technician should... Discontinue the blood draw and immediately call for help. Which of the following is within the range of common micro collection tube volumes? 0.5 mL In which of the following cases should a phlebotomy technician seek out interpretation services? A patient does not speak English and is accompanied by her 10-year-old grandson who speaks fluent English. Capillary blood gas testing is ordered on a newborn infant. Where and how should the specimen be drawn? From the lateral or medial plantar surface of the foot by a capillary puncture. Which set of differences is true of the collection of donor blood as compared to routine venipuncture for diagnostic testing? A larger needle is used and the patient is first given a brief medical exam. Blood flow slows and then stops while a phlebotomy technician is halfway through drawing a citrate tube. After adjusting the needle gently forward and backward, the technician is not able to restore the flow. What should he do? Try a second citrate tube; if the second tube does not fill, perform a second venipuncture at a new site. Using liquid controls to test point-of-care devices is effective because..... It tests the device using analytes of known composition. A lancet designed for heel stick on a full-term infant usually punctures at a depth of... 1.0 mm 40 | P a g e When a phlebotomy technician begins work at a facility, the employer must offer this protection against bloodborne pathogens: A free hepatitis B vaccine. A patient with measles is in an airborne infection isolation room. When drawing blood from this patients, a phlebotomy technician will need to wear: An N95 respirator. Where is venipuncture most commonly performed if no suitable site can be found in the antecubital are of either of the patient's arms? The dorsal aspect of one of the patient's hands. When passing another phlebotomy technician's drawing station a PBT overhears him telling the patient that if she does not extend her arm, he will have to extend it for her and strap it down for the draw. What is the passing PBT's best course of action? Politely ask the coworker to pause for a moment, then immediately find a supervisor to intervene. The Needlestick Safety and Prevention Act requires that employers... Involve staff in the selection of safer medical devices. If a patient asks a phlebotomy technician for her opinion about the doctor who ordered his tests, the phlebotomy technician should... Politely decline to offer any opinion. How is a five-year-old child most likely to be positioned for venipuncture? In a parent or guardian's lap. Which of these choices lists lab tests in the order in which tubes would be drawn to conduct the tests? Thyroid panel, complete blood count, glucose. A transfer device allows blood to be safely transferred from... to... A syringe, evacuated tubes. After introducing herself, confirming the patient's identity and matching it to the requisition, what should a phlebotomy technician do? Explain the procedure to the patient. In which of the following situations must a phlebotomy technician ask nursing staff to complete a blood draw? A hospitalized patient's chart indicates blood should only be taken from a central port. Which of these statements is true? Citrate tubes must be filled to at least 90% capacity. 41 | P a g e Chain of custody documentation is required when a test: May be used in legal proceedings. What action should be taken immediately after a phlebotomy needle has been removed? The phlebotomist should apply pressure to a gauze square over the venipuncture site. What is the maximum angle at which a venipuncture needle should be inserted when drawing blood from a patient who is obese? 30 degree. Glucose challenge tests are routinely performed on what patient population? Pregnant women. If blood is taken from a collection tube to perform a peripheral blood smear, what type of tube should be used? Lavender top. For which of the following tests commonly performed on newborns should an amber micro collection tube be used? Bilirubin. A patient whose veins must be preserved for medical interventions such as chemotherapy may have blood tests conducted on: Blood taken from capillaries. When can a phlebotomy technician puncture the patient's skin for either venipuncture or capillary puncture? After the site has been cleaned and has dried. If, after centrifuging a specimen, a phlebotomist notices a pink or red tint to the serum, the specimen is likely... Hemolyzed. Which of these tasks is typically considered within a phlebotomy technician's scope of practice? Creating peripheral blood smear slides drawing blood, performing a throat culture and drawing blood from the dorsal aspect of the hand using a syringe and transfer device. Blood pulsing into collection tubes is an indication that: The needle has truck an artery. A phlebotomist needs to collect gold, pink, and green-topped tubes by venipuncture. Which order is correct? Gold, green, pink. 42 | P a g e Collection tubes with... should not be used for therapeutic drug testing. Separator gel. Which of the following will help a phlebotomy technician avoid having a patient's vein roll away when the needle is inserted? Anchoring the site from below, using the thumb to pull toward the wrist. Facility policy states that no more than 5% of a patient's blood may be drawn in 20 days. What is the maximum amount of blood than can be drawn from an 9-pound infant in a month? 16 mL. A patient's chart indicates that her veins are thin, fragile, and frequently collapse. A total of 5 mL of blood needs to be drawn for various tests. Which of the following techniques would be best for drawing blood from this patient? Venipuncture using a 23-gauge butterfly needle and syringe/transfer device. Which of the following is a significant difference between midstream and routine urine specimen? The area around the urethra is cleaned before collecting a midstream specimen. Hemoconcentration may be caused by... Leaving a tourniquet in place for too long. A patient begins to experience a seizure during a blood draw. What should be the phlebotomist's first response? Too remove and sheathe the needle. Which of these tests is an entry-level phlebotomy technician most likely to be trained to perform in its entirety? Testing urine with a dipstick. Which of these items may be reused between patients with proper cleaning? A phlebotomy wedge. One effective method to help control healthcare associated infection is Using facility-approved disinfectants to clean reusable items like point-of-care testing devices. Just as a needle is removed from a patient's arm, the patient has a coughing fit and the phlebotomy technician is accidentally stuck with the needle. What should the phlebotomy technician do after placing the needle in the sharps container? Wash the injury with soap under running water for 15 minutes. Which of the following is one acceptable way of confirming a patient's identity? 45 | P a g e Drug. After centrifuging a specimen that does not have a separator gel, when should the liquid portion of the specimen be removed from the solid portion? Immediately. How should a vein be anchored before venipuncture? By placing the thumb of the nondominant hand 1-2 inches below the venipuncture site and pulling firmly but gently toward the wrist. Drawing a patient's blood for routine testing after she has expressed that she does not wish to have the procedure performed may be considered. Battery. Most collection tubes should be centrifuged within... of collection. Two hours. Some swabs are transported in a tube with a(n)... that must be... to release liquid. Ampule, crushed. which of the following equipment has an expiration date that must be checked prior to use? Point-of-care test strips. Adhesive bandages are never placed on Patients under 2 years of age. Which set of adaptations is appropriate when drawing blood from a pediatric patient? Use of a higher gauge needle, removing any sharp or potentially dangerous objects from within the patient's reach, and never leaving the patient alone at the drawing station. ______ is an organization that develops standards of practice for laboratories worldwide. CLSI. Drawing blood from... is usually considered to be beyond the scope of practice for entry-level phlebotomy technicians. Arteries. A patient who uses a cane or walker is at a higher risk for this type of hazard: Uneven walkways and tripping hazards. The following tests may be related to assessing kidney health: Renal panel, 24-hour urine collection. 46 | P a g e What step immediately follows removing the needle from a venipuncture site? Activating the needle's safety mechanism. Which of the following is true of labeling aliquot tubes? Each one should be labeled with the patient's identifying information. An endocrinologist has ordered a thyroid panel and fasting blood glucose tests for a patient. Which of these choice represents a possible tube choice? SST tube and sodium fluoride/oxalate tube. The area of the foot used for infant heel stick is known as the Lateral or medial plantar surface. CLSI standards for patient identification include asking a patient to... State and spell. In which of the following ways can a phlebotomy technician help to prevent iatrogenic anemia? By performing draws carefully and avoiding the need for redraws. When is a bandage applied to venipuncture site? After bleeding has stopped. If a patient has orders for therapeutic drug monitoring and must have blood drawn at trough medication levels, when should her blood be drawn? Within 10 minutes before next dose. After completing a blood draw the phlebotomy technician should always... Thank the patient. Death is a possible consequence of: Misidentifying a patient. A blade-style lancet should be held at a... angle to a patient's fingerprint whorls when performing capillary collection. 90 degree. Which of the following techniques is an acceptable way to make a patient's veins appear more prominently? Place a warm pack over the antecubital area for 3-5 minutes. Electrolytes and complete blood count are ordered for a patient who must have blood collected by capillary puncture. Th collect tubes to use, in the correct order, would be tubes to use, in the correct order, would be: 47 | P a g e EDTA, serum. Blood for newborn metabolic screening is collected: On filter paper printed with circles for each blood drop. This venipuncture site poses the lowest risk for nerve or artery involvement, and is generally well anchored: The median cubital vein. If a tourniquet has been left on the arm for more than one minute, how long should it remain off the arm before it is reapplied? Two minutes. A patient is being tested for various vitamin levels. Which of the following is true? The tubes should be protected from light. When an order is marked STAT it should be collected: Within 10 minutes, as soon as possible. Which of the following is true of patient fasting? If it extends beyond 14 hours it may produce inaccurate test results. Hemolysis can occur when the phlebotomist: Draws a syringe plunger back forcefully. Which fingers are best suited for capillary blood collection? The ring finger and the middle finger. The patients who are performing stool guaiac testing at home should be instructed not to eat... in the days leading up to and during the test. Red meat. The number associated with all documents and specimens connected to a particular requisition is known as the... Accession number. One of the most important elements of an effective compliance program is to have a compliance officer or committee who is__________. empowered 50 | P a g e Joint ventures The following is not a level of non-compliance: Mistake in billing For potential criminal violations, a practice should have immediate discussions with a criminal attorney who Is well versed in Healthcare Fraud and Abuse law The Compliance Officer's main two responsibilities are to ____________the practice/organization's compliance program. develops and then implement Judy is the Compliance Officer for Apple Medical Group. The providers of the group ask Judy to design a new Compliance Plan. Should Judy ask some other practices in town for a copy of their Compliance Plan? Do all Compliance Programs have to be the same regardless of the practice size or specialty? Why? No, compliance programs need to be tailored to fit the unique needs of every organization or physician practice USSC is important as it related to the Federal Sentencing Guidelines and thus related to the core elements of compliance. What does the USSC acronym stand for? United States Sentencing Commission Kathy, the Compliance Officer at a small provider office, is notified that a non-English speaking patient will be arriving today. A LEP person/patient who needs an interpreter to translate to and from the person's primary language must be provided. at no cost to the patient or insurance carrier In addition to hospitals, what other type of facility did the OIG provide supplemental compliance program guidance for? Nursing Facilities What is (are) considered a significant element(s) in fraud? Knowingly and Intent Department of Labor requires compliance with employee and employer laws including: FLSA, OSHA, CRA, ERISA Which government branch was created to fight waste, fraud and abuse in all federal health care programs especially Medicare, Medicaid? Office of Inspector General (OIG) Dr. X is a very through provider. He always runs a full blood panel on each patient every year for their physical. This is an example of: 51 | P a g e Waste The current strategy for the DOJ includes all of the following except: Ensure the privacy of patient records with the use of HIPAA Which options are key elements for an effective Compliance Program? I. Conducting external auditing and monitoring. II. Implementing compliance and practice standards. III. Designating a Compliance Officer or contact. IV. Outsourcing appropriate training and education. V. Responding appropriately to detected offenses and developing and implementing corrective action. VI. Developing open lines of communication. VII. Enforcing disciplinary standards through well-publicized guidelines. II, III, V-VII CPUP) The first large fraud case that involved a teaching hospital where Residents and Fellows worked was located in: Pennsylvania The Office of Evaluation and Inspections is part of what Agency or Department? OIG The hospital that John works for was just issued a CIA. What is the typical five years Kathy is thinking about specializing in healthcare compliance. Which entities below must have a OIG compliance plan? a. Laboratories, DME and Ambulance providers b. Home Health, Hospice and Nursing Homes c. Small and Large Provider Groups, Hospitals and Nursing Homes Which component of the OIG has a duty of conducting audits, which result in reducing waste, abuse, and mismanagement? Office of Audit Services Kim is the Compliance Officer for a large provider group. One of the billers for the group enters codes from the encounter form every evening before she goes home and then finishes in the morning when she returns. She often enters an encounter twice. She usually catches the mistake when the insurance checks are sent to the office and returns the overpayment to the insurance carrier. This is an example of: 52 | P a g e Abuse Which OIG office conducts criminal, civil and administrative investigations of fraud and misconduct related to HHS programs, operations and beneficiaries? Office of Investigations Dr. A hires a nurse without looking to see if she was on the OIG's Excluded List. The nurse had committed fraud in the past and was Excluded from working with any entity or individual that uses Federal or State funds. Which of the statements below is true? Dr. A will have to pay a CMP The OIG Five Principal Strategy is made up of the following Enrollment, Payment, Compliance, Oversight and Response According to Inspector General Daniel Levinson, what can help reduce enforcement on a provider from a CIA to a CCA? a robust and effective compliance program What does the acronym LEP stand for? Limited English Proficiency John works at a large hospital in the Compliance Department. He just heard that the hospital was issued a CIA. What does CIA stand for? Corporate Integrity Agreement What year did the GAO identify Medicare claims to be at high risk for fraud and abuse which resulted in the OIG initiating an audit of HCFA (CMS) payment system? 1992 Dr. Smith asks you, the Compliance Officer, what is the typical term of a CCA? three years Larry is the Compliance Officer for a small hospital. A staff member of the hospital thinks that employment discrimination has occurred. Which governmental office could give Larry more information? Department of Labor All expenses related to developing and implementing a compliance program are considered the cost of doing business and are tax deductible for the organization, except: when the expenses are a result of the imposition of a penalty. Compliance programs are more dangerous if they are developed but not implemented. 55 | P a g e Workers' compensation Where can a Compliance Officer from a family practice look for information on risks specifically associated with his/her practice type? American Academy of Family Physicians Which Code of Federal Regulation section is important to Compliance Officers and why? 42; it covers the Medicare and Medicaid programs Why is the annual OIG Work Plan so important to Compliance Officers when they are developing their risk assessments? Because it shows results of previous year's audit findings and the current year's focus The __________ is the entity where HIPAAis found. OCR The Medicare Learning Network (MLN) began in ________ 2004 The major sections of the Social Security Act address ________, ________, and ________ disability, unemployment, and social security CMS is a division of ________. HHS What is the most significant state program for healthcare? Medicaid The nationwide network of MACs dates back to ________. 2006 CMS is headquartered in Baltimore and has ________ regional offices around the country, which primarily oversee enrollment and certification issues. 10 ____________ provides opinions for the Stark Law CMS The aim of this program was to ensure that every child under the age of 18 had medical coverage. SCHIP Changes in ownership must be reported within how many days to the Medicare program? 30 56 | P a g e The OIG's ______________ to Congress keeps the Secretary of the HHS and Congress currently informed about OIG's most significant findings, recommendations, and activates for specific six-month periods. Semi-annual report Section 42 CFR contains federal regulations issued by CMS. The bulk of the federal regualtions in 42 CFR Part 4 cover the _____________________________________. Medicare and Medicaid programs MACs are responsible for administering the what for Medicare Services? Payments Form CMS-R-131 is better known as? Advance Beneficiary Notice of Non-Coverage The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established what comprehensive program to combat fraud committed against all health plans, both public and private? HCFAC (Health Care Fraud and Abuse Control) Incident-to services are defined as those services that are furnished incident to physician professional services in the physician's office (whether located in a separate office suite or within an institution) or in a patient's home. Incident-to services are provided by a ____________. non physician provider MACs are responsible for administering the payment of Medicare services. Providers and suppliers submit their claims to the MAC and are paid based on _________________. locally influenced fee schedules Physicians need to report any change in their name, taxpayer identification numbers, and bank arrangement within how many days? 90 Providers must be enrolled in government programs to participate. They can do this either by paper versions or online through ______________. PECOS (Provider Enrollment, Chain and Ownership System) What percentage of OIG's resources are historically directed towards Medicare and Medicaid? 80% The HCFAC program is designed to coordinate federal, state, and local law enforcement activities with respect to healthcare _________________________. fraud and abuse 57 | P a g e A person studying for the CPCO should review compliance guidance for __________________________________________________________? individual and small group physician practices, third party billing companies, clinical laboratories, and hospitals The OIG's ______________ sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General. work plan Federal government agencies such as HHS, CMS, and the OIG publish regulations in the ___________________> Federal Register Audit MICs can audit a Medicaid provider throughout the ______________. country What sets ZPIC audits apart from other Medicare audits? The audits are targeted by potential Medicare fraud. What does Medicare Part D cover? Prescription Drugs What type of software process identifies potential claim errors? Data mining What description below best describes ZPICs? ZPICs are private companies contracted by CMS, used to conduct audits for Medicare and Medicaid overpayments. Comprehensive Error Rate Testing Program (CERT) started in what year? 2001 RACs perform what type of reviews? Automated and complex What is the level 3 of the RAC claims appeal process? Hearing by an Administrative Law Judge (ALJ) Medicaid Fraud Control Units (MFCUs) operate under the direction of __________. Office of Inspector General (OIG) How many regions are part of the Medicaid Fraud Control Unit? 60 | P a g e Medicaid Fraud Control Units During the monthly new hire training, Sarah , the Compliance Officer for Apple Hospital, explains that as an element of a billing and reimbursement compliance program is essential. Employees must be aware of the compliance issues and the applicable laws and regulations especially those that pertain to what? their specific job descriptions The Medicare reassignment rules contain a number of exceptions governing who can bill the Medicare program. If a group practice is using a billing agent, what type of payment arrangement is necessary? Lockbox Carol, Compliance Officer for XYZ Internal Medial Group needs to hire some physicians when a few of the owner physicians want to take a long vacation. The short term physicians hired are called____________________. locum tenens In certain cases, a provider, practitioner or supplier who routinely waives Medicare copayments or deductibles also could be held liable under what law? Anti-Kickback Statue When is it acceptable to bill an office visit based on time? If over half the visit is spent counseling the patient An initial review of all areas of possible non-compliance within the practice/organization is necessary to reveal what areas of the practice/organization are currently in compliance with, and which areas are not. This assessment is called what? baseline If physicians sign a participating (PAR) agreement with Medicare, they agree to what? Accept Medicare's allowed charge as payment in full As specified in the Code of Conduct, no employee or agent of the practice/organization may have a relationship if they have a criminal conviction related to health care or __________________________? have been excluded from participating in federally funded healthcare plans. Incident rules can be complicated and present additional risks to a practice/organization. If a provider is available only via pager or telephone, incident-to billing the ____________________? requirements are not met Hannah is the Compliance Officer for Orange Hospital. She is explaining to her mother that Medicare Part B pays for what type of services? Physician 61 | P a g e Medicare requires that physicians or mid-level (NPP) providers certify the need for physical, occupational, and speech therapy. The first certification is needed within 30 days of the patient starting therapy. After that, certifications are needed every _____ days. 90 or 30 The Medicare program has program manual instructions on overpayments. Generally, overpayments are returned to the____________? MAC Once Hannah, Orange Hospital Compliance Officer identifies the risk levels, what is the next step a compliance officer should take? prioritize which risks will be addressed Any contribution and participation of a student to the performance of a billable service must be performed in the physical presence of the teaching physician, except for what? Review of Systems (ROS) or past family or social history (PFSH) Larry is a Non Physician Provider (PA) and he is explaining that the services he delivers to patients must be delivered under the provider's direct supervision and the provider must be ____________ if he is going to bill Incident To. in the same office suite The Patient Protection and Affordable Care Act (PPACA) enacted a civil monetary provision that requires the return of overpayments within how many days of identifying an overpayment? 60 Improper advertising can get the physician in trouble with whom? The state licensing board Steve, Director of Compliance for Small Rural Hospital Group explains to the physicians that some of the most common reasons for claims not being paid in the current reimbursement environment are related to _______ Diagnosis Code Regulations state that services provided by teaching physicians in teaching\settings are generally payable under the physician fee schedule only if the services are personally furnished by a physician who is ______. not a resident To avoid a conflict of interest, the OIG specifically states that the compliance officer should not report directly to whom? CFO 62 | P a g e Medical practices should be aware of risks identified in the past and then establish policies and procedures for what? Continual monitoring The Compliance Officer is responsible to find areas of non-compliance and then formulate solutions to rectify the problems. This is known as what? Corrective Action Plan Sarah, Compliance Officer for Apple Hospital explains to the providers the meaning of ___________________, which is the practice of a physician billing for multiple components of a service that must be included in a single fee. unbundling Medicare requires physicians and mid-level providers to certify the need for physical, occupational, and speech therapy. The first certification is needed within how many days of starting therapy 30 After initial education and training have been implemented, what does the OIG recommends a benchmark audit be performed? 3 months If a state or federal agent arrives at your office and presents a search warrant, it is best practice to what? Contact your attorney immediately The __________ usually requires that police officers have probable cause before they search a person's home, their clothing, car, or other property. This also relates to businesses and the search of their premises. Fourth Amendment Work the attorney does in creating reports, interview memos, or research is called what? Attorney-client work-product The ________ is one of the primary investigation agencies that assist the federal prosecutors. FBI MACs can initiate an investigation if there is a complaint, or if something about the billing profile is triggering flags. If quality concerns are an issue, what type of organization may be involved? QIO (Quality Improvement Organization) The OIG defines the term "reportable event" in its CIA by noting that it could be: All of the above 65 | P a g e 26 weeks What year was the ADA amendment enacted? 2008 A Board member at the XYZ Community Hospital inquires what the term EAP refers to? Employee Assistance Plans Which is true with regard to internet usage? Inform employees that internet usage is monitored Under COBRA the employer must permit qualified beneficiaries to elect to continue their health insurance under their current plan for up to _______ depending on the qualifying event. 18, 29, 36 months Larry, Compliance Officer for Orange County Family Medical Group is asked by one of the providers if it is alright to tell sexual jokes with the staff if they object. Larry replies: No. The provider is someone in authority and this is not acceptable. A Board member at Apple Rural Health Center wants to know if the ADA mandates an interpreter for patient appointments if needed? Ye, if needed What agencies oversee ERISA? IRS, PBGC, DOL When can an employer do a drug screen on employees? When the employer has reasonable concerns of impairment What is an EAP? Employee Assistance Plan Kim, Compliance Officer for Apple Rural Health Center explains to the Board that EEOC is referred to in the HR policy and stands for: Equal Employment Opportunity Commission What is one way to discourage whistleblowers found in this chapter? Conduct performance reviews What is one way to discourage whistleblowers? Acknowledge previous concerns in writing and explain investigation What should never be tolerated by an employer? 66 | P a g e Discrimination Which of these statements is true? IRS, DOL, PBGC all have separate penalty assessments The Orange County Family Medicine Group employs 30 men and women. Are they required to offer FMLA to these employees? No, they fall under the limit of 50 employees How many employees does an employer need to not be held to FMLA policies? 49 or less Under the Federal Guidelines, a person may take up to ________ weeks off for FMLA: 12 When is the recommended timeframe for a performance review? 90 days What goes together with compliance issues? Human Resources Which of the following is NOT an example of sexual harassment? Asking another employee to date Kim, Compliance Officer at Apple Rural Health Center, authorizes a drug screen to be done on an employee that she feels is impaired. The employee states that this is discrimination. Drug screens can be done on an employee if there is reasonable suspicion that the employee is impaired. HR policies will need to __________________________________? Make sense for the needs of the medical facility Which president signed the Family Medical Leave Act (FMLA)? Clinton What year did OSHA publish the Bloodborne Pathogens Standard? 1991 Can an employee transfer a chemical to another container? Yes, as long as the secondary container label is used and meets regulatory requirements. How does a GFCI function? It will shut off in the event of a ground fault. 67 | P a g e Which of the following is considered the primary means of minimizing employee exposure? Engineering controls What federal agency is in charge of employee safety? Occupational Safety and Health Administration (OSHA) Primary safety concerns in the medical setting include bloodborne pathogens, radiation, bio-hazardous waste, and _______. chemicals How many percutaneous injuries involving contaminated sharps occur annually? 600,000 What is an example of using the process of complete elimination or destruction of all forms of microbial life? Sterilization What is the maximum amount of money an employer can charge for personal protective equipment? Free of charge What would require a high-level disinfection? Endoscope If an employee is injured at work with a "sharp" that might be contaminated with another person's blood, the minimum information needed from the injured person? Type and brand of device involved in the incident; location of incident; description of incident What employees DO NOT fall under Category II? security officers, nursing, physicians, respiratory therapists, rehabilitation, lab, etc. What employees DO NOT fall under Category II? Environmental services personnel What employees fall under Category III? Employees not exposed to blood borne pathogens What are not part of Exit Route requirements for a medical facility? posting evacuation routes on the company web site. Why did OSHA publish a Bloodborne Pathogens standard? Because of significant exposures to viruses and other microorganisms 70 | P a g e Whenever the employee decides to get the vaccine Why must an employer implement an Exposure Control Plan? To ensure proper employee protection measure Are Compliance Officers required to know all OSHA laws? No, but the CO should know where to find the information Employers with fewer than __________ employees are exempt from the federal OSHA record keeping requirement. 10 Kim, the Compliance Officer at Apple Rural Health Center, must report the OSHA incidents on Form 301 every year between the months of ___________________________________? Feb-April 30th What is the routine cleaning guidelines for BP cuffs? Provide disposable cuffs to all isolation patients What does NIOSH stad for? National Institute for Occupational Safety and Health What information should NOT be included in a Hazardous Waste Policy? Regulated waste information Which of the following is NOT an example of safety measures? A security alarm system with same access ID for everyone Joan is the Compliance Officer for XYZ Community Hospital. She gives OSHA Blood Borne Pathogens training to all of the following groups or people: All paid and non-paid workers at XYZ that might come into contact with Blood Borne Pathogens What is a OSHA 300 for used for? It provides a total for job-related injuries for the year Which of the following is not a requirement for MSDS sheets? What quantity the medical facility purchases yearly Why wouldn't a medical facility need an Ionizing Radiation Policy? When they do not have an X-ray machine Cylinders containing flammable gases such as hydrogen or acetylene must NOT be stored __________________________________. 71 | P a g e by aisles or walkways How often should Health Care Workers (HCW) receive TB testing in a medium risk facility? Upon hire and every year Under EMTALA, all Medicare participating hospitals are required to provide at least a medical screening exam to a patient who comes to the emergency department ... regardless of the patient's insurance or ability to pay. Any laboratory performing testing on specimens derived from a human being for purposes of providing diagnosis, prevention, treatment, or assessment of health, regardless of whether they participate in Medicare, must: enroll In the CLIA program If I'm only doing blood draws, do I need a CLIA number? No, a CLIA number is not required if the facility only collects specimens and performs no testing The 250-yard zone rule does not apply to: all hospital-owned physician practices A physician who fails to respond to an emergency situation when she is assigned as the on-call physician: May be in violation of EMTALA, and may subject herself and the hospital to a penalty. The purpose of EMTALA is to prevent: Hospitals from rejecting patients in a discriminatory manner, by refusing treatment, or transferring patients to "charity hospitals" or "county hospitals," because they are unable to pay. After enacting CLIA, what percentage did the total number of quality deficiencies decrease from the first laboratory survey to the second? 40% Which certificate is issued to a laboratory that enables the entity to conduct moderate- to high- complexity laboratory testing until the entity is determined by survey to be in compliance with the CLIA regulations? Certificate of Registration A Certificate for Provider-performed Microscopy (PPM) procedures is issued to a laboratory in which a physician, midlevel practitioner, or dentist performs no tests other than: Waived tests and PPM procedures. What was established for all laboratory testing by Congress passing the Clinical Laboratory Improvement Amendments (CLIA) in 1988? 72 | P a g e Quality standards Does a provider who is only performing waived tests need a CLIA number? Yes, the law requires that no matter what type of testing is performed, a CLIA number is required CLIA is funded by whom? Users __________________ testing labs must have systems in place to monitor equipment, ensure proper test performance and results, and monitor the overall quality of the lab's operation. Moderate and high complexity Which certificate is issued to a laboratory that enables the entity to conduct moderate- to high- complexity laboratory testing until the entity is determined by survey to be in compliance with the CLIA regulations? Certificate of Registration If a patient presents to an emergency room the provider must not delay the screening process to ask about what? Insurance What is required on all CMS-1500 forms when billing for laboratory testing? All of the above ________ publishes the CLIA rules and regulations. CMS Who is charged with the implementation of CLIA? The Centers for Medicare and Medicaid Services (CMS) Physicians who negligently violate EMTALA are subject to civil monetary penalties and for repeated or gross and flagrant violations risk__________? exclusion from Medicare Urine dipsticks and finger-stick blood tests performed in a physician's office subject the office to CLIA regulations. These are called _______________________. waived tests To enroll in the CLIA program, laboratories must first register by completing an application, pay fees, be surveyed, if applicable and become what? Certified States and territories must adhere to the federal CLIA. If the state guidelines are more stringent, then ____________ must be followed. 75 | P a g e Yes. Mrs. Smith can request an amendment, however it is up to Dr. Jones if he will grant it and make the change. Are deceased patient records treated differently? No, they are treated the same except providing to Funeral Directors Which person can receive records of Minors with Custodial / Non-Custodial Parents? Both parents have legal rights, unless ordered by judge otherwise The medical records department at Apple Rural Health Center asks Kim, the Compliance Officer how far back do they need to go to give a patient an accounting of the PHI disclosures on their account? Kim answers: 6 years Tim is a patient at ABC Internal Medicine Group. Tim is HIV positive. John, the Compliance Officer explains to Tim that the medical group will have to release information to the State Health Department - that is the law. What does HITECH stand for? Health Information Technology for Economic and Clinical Health Kim, Compliance Officer for Apple Rural Health Center, explains to the staff that PHI can be used for the following: Treatment, Payment, or Operations On what date do all covered entities need to be in compliance with HIPAA Omnibus Rules? Sept 23 2013 What type of office notes need to have special security? Psychotherapy notes Can a patient restrict a provider from disclosing his or her PHI to family members when in the hospital? Yes, they can restrict who knows about their condition When can PHI NOT be disclosed without a patient's consent? To let your brother know his neighbor may have a contagious disease What safeguard covers maintenance of security measures to protect ePHI, and to manage the conduct of the covered entity's workforce in relation to the protection of ePHI? Administrative safeguards What rights do patients have when paying cash? they can restrict the use of their PHI 76 | P a g e Which of these responsibilities is not one of a Compliance Officer? Create all policies and procedures Can an individual provide a verbal authorization to release PHI? No What does not need to be included in a Notice of Privacy Practice (NPP)? Explanation of the patient's treatment plan What year did HITECH Act get implemented? 2009 Kim is the Director of Compliance for Apple Rural Health Center. One of the front office staff contacts her to ask what the term "minimum necessary" refers to. How would Kim answer? This means covered entities should use or disclose the minimum amount of PHI needed for the intended purpose. Joan, Compliance Officer for XYZ Community Hospital gives a New Hire Orientation and explains to everyone that the following is the only information that is allowed to be given out to anyone that calls the hospital about the patient: Patient Name, Location of Facility and General 1-word statement about the condition of the patient. Mr. and Mrs. Jones are divorced. They have a child named Jane. Mr. Jones Does Not pay child support. Only Mrs. Jones takes care of Jane. Does Mr. Jones have any rights to Jane's medical records? yes, hes the father Which one of the following is considered a patient's right? Patients can request an amendment to their medical record How many years should providers keep track of disclosures? 6 or more years How soon are practices or medical organizations required to process patient's record request when the information is maintained or accessible on-site? within 30 days What safeguard is defined as a measure to protect ePHI? Technical safeguards Can a patient restrict the disclosure of their PHI? Yes, but the practice or medical organization doesn't have to abide by it Did the HIPAA Omnibus Rule affect Business Associates? 77 | P a g e Yes, they are more accountable for their client's PHI John, Compliance Officer at ABC Internal Medicine Group, explains to the front office staff that release of information authorizations must: Contain an expiration date and a statement regarding right to revoke. Patient Records of patients that have died are protected for how many years? 50 years An emergency doctor at XYZ Community Hospital asks the Compliance Officer - Joan - if he is allowed to treat a patient that comes in to the ER but is alone and has dementia. He needs to release the PHI to the pharmacy for medicine. Joan replies: Yes- PHI can be disclosed to another person or entity if the individual is incapacitated, or otherwise unable to agree or object to a disclosure due to emergency circumstances What is the main purpose of the HIPAA Omnibus Rule? Provides individuals new rights with regard to their health information Which one of these situations will a provider not be able to deny a request for Release of Information Authorization? When the patient signed more than 30 days prior When an individual makes a request for an accounting of disclosures, the accounting for each disclosure must include _________________________________________. Brief statement of purpose that reasonably informs the individual of the purpose or a copy of the authorization or a copy of the written request for disclosure John is the Compliance Officer for the ABC Internal Medicine Group. His Board of Directors wants to know what the Final Compliance Date was for the HIPAA Omnibus Rule that made it mandatory to report ALL breaches if there was a risk to the patient. The date was: September 2013 Which one of the following is NOT a component of PHI? Spouse's name What are two requirements for an authorization to disclose PHI? The authorization should have a right to revoke and should have an expiration The Release of Information (ROI) Specialist at Orange County Family Medicine group asks Larry, the Compliance Officer, if she is allowed to release all records at the facility as long as there is a signed patient release. Larry answers: No- certain notes such as psychotherapy notes cannot be released. 80 | P a g e A basic concept in the Anti-Kickback safe harbors and Stark exceptions is that financial transactions between potential referring parties be conducted under what condition? fair market value Which type of fraud covers any criminal fraudulent activity that has been determined to have involved electronic communications of any kind? Federal wire fraud (18 USC1343) If physician recruitment arrangements are not properly structured it can result in Significant fines and penalties. Tim is the HR Director at XYZ Family Provider Group. He wants to avoid liability for employing excluded entities or providers. He should check the OIG List of Excluded Individuals Entities on the OIG website how often? Prior to hiring and monthly thereafter Stark law bans certain financial arrangements between a referring physician and an entity that bills the Medicare or Medicaid programs. An example of this is if a physician or his ____________ has a financial relationship with an entity: Wife (only for family cousin is not included.) Which law increases the severity of penalties for violations involving organized crime? RICO Act The Apple Internal Medicine Group is having a board meeting. Tim, the Compliance Officer explains that ________ is the most important concern for the Apple Internal Medicine Group Human Resource Department: Patient Safety and Information Security John is a student reviewing the information regarding compliance and wants to know "Who" or what agency is responsible for oversight of the Medicare and Medicaid Programs? The U.S. Department of Health & Human Services (HHS) A qui tam complaint is initially sealed for how many days? 60 Hospitals are prohibited from making payments, directly or indirectly, to a physician as an inducement to reduce or limit services provided to Medicare or Medicaid patients. The hospital is subject to a civil money penalty of not more than how much for each individual for whom a payment is made? $2,000 Tim is the Compliance Officer for the Apple Internal Medicine Group. He conducts the in-service training for all new employees. He discusses the 5 most important federal fraud and abuse laws. These are: 81 | P a g e FCA, AKS, Stark, Exclusion, CMPL Joan is an employee at XYZ Family Practice. She asks the Compliance Office what should you do when you find out one of your employees has been excluded from government programs? Suspend the employee, request documentation, and investigate the matter. Which Act authorized the imposition of Civil Monetary Penalties against health care providers and entities that employ or enter into contracts with excluded individuals or entities to provide items or services to federal program beneficiaries? The Balanced Budget Act (BBA) Hannah is afraid that if she reports the allegation of fraud that she thinks is occurring at her medical office that she will be fired. Could this occur? Yes, but the employer would be in violation of the Whistleblower Protection Law. If the government intervenes in the qui tam action, the relator is entitled to receive how much of the amount recovered by the government through the qui tam action? between 25 and 30 percent Which law provides for a civil monetary penalty (up to $15,000 per service) and exclusion from government programs in any case where a person submits an improper claim, which was known to have been, or should have been known to have been, provided through a prohibited referral, and has not refunded the payment? Stark Texas orthopedics submits false Medicare claims through its electronic data interchange to its Medicare Administrative contractor based in Oklahoma. Can the orthopedic office be charged with federal wire fraud? Yes, because false claims were submitted electronically across state lines. Penalties for mail fraud where the person knowingly and willfully schemes to defraud a health care benefit program includes fines and imprisonment of up to how many years? 10 years FERA expands the grounds for liability under which Act. False Claims Act The Office of Civil Rights (OCR) has enforcement power for violations occurring as a result of willful neglect. The OCR can now impose civil monetary penalties of up to how much per HIPAA privacy regulations violation. $50,000 82 | P a g e Judy is the front office assistant at XYZ Family Practice Group. She wants to know why she can't waive co-pays on a regular basis if the patient can't pay. Routine waiver of co-payments or deductibles for patients under Medicare Part B is in violation of what Statute? Anti-kickback The reason for developing and dispersing the fraud alerts include: (1) to inform other HHS agencies and investigators of fraudulent and abusive practices within the healthcare industry; (2) to inform the healthcare industry and the general public of fraudulent and abusive practices within the healthcare industry; and (3)? to inform the healthcare industry and general public of how and where to report information about suspected fraudulent and abusive practices What can result in imprisonment and penalties for providers and covered entities? Medical fraud Kim at Apple Hospital is explaining to her compliance committee about the components that are required by the OIG in order to have an effective Compliance Program. How many components does she tell them? Seven What OPPS rule requires hospitals to include on the same claim all OPPS services provided at the same hospital to the same patient, on the same day, unless certain conditions are met? Same-day rule Joan is the CO for ABC Provider Group. One of her providers asks her which Federal agency provides compliance program guidance to providers and covered entities? Joan tells the provider: Office of Inspector General Jackie is a coder/biller for ABC Provider Group. She often puts modifiers on various CPT codes so that they get paid, regardless of the meaning of the modifier. This is an example of: Misuse of modifiers Third party health care audits should be designed to address the company's ___________________. Marketing services A lab's requisition form should include the following: diagnosis information for all test ordered What will show a third party that they have good faith towards remediation? Prompt reporting Can the government take back money from a nursing facility for failure of patient care? Yes, there is a direct link to quality of care and billing for services 85 | P a g e The _______________________ addresses compliance concerns, such as compensation paid by laboratories to referring physicians and physician group practices for blood specimen collection, processing and packaging and for submitting patient data to registry or database. Special Fraud Alerts What is an essential component for the lawful behavior and success of nursing facilities? Quality of Care As the new CPCO for XYZ Billing Company, Tim knows that a third-party health care company should start a compliance program: Now, to be proactive Lim, a student that is studying for his CPCO researches to find out what third-party health care provider is becoming a vital part of the health care industry. What does he discover? Medical Billing Companies Joan at ABC Provider Group has a provider (Dr. X) that is going on vacation. The group has hired another provider that will start this week. The new provider is from a different state and will need to apply for a license to practice medicine. Dr. X says that it is alright to let the new provider use his billing and license numbers while he is on vacation. This is an example of: knowing misuse of provider identification numbers What Federal department will consider self-reporting of misconduct as a mitigating factor? Office of Inspector General (OIG) What is the maximum amount of days after determining that there is credible evidence of fraudulent conduct should a billing company take to notify federal and state authorities regarding the violation? 60 When it is the intention of an organization to provide a safe environment to patients, it is good to design: Patient Bill of Rights There are many benefits of having an effective compliance program. One such benefit is: It shows the practice is making a good faith effort to be compliant. Fraud, waste, and abuse are all areas that must be controlled when providing services to beneficiaries. Fraudulent billing is: A willful act. All expenses related to developing and implementing a compliance program are considered the cost of doing business and are tax deductible for the organization, except" When the expenses are a result of the imposition of a penalty. 86 | P a g e Payers expect all providers to refund monies that are overpayments. By law, this must occur within..... 60 days of identification of overpayment. Compliance programs are..... More dangerous if they are developed but not implemented. What is the most important aspect of a compliance program? Implementation The Patient Protection and Affordable Care Act of 2010 (ACA) requires that all providers adopt a compliance plan as a condition of ______ with Medicare, Medicaid, and CHIP? enrollment Which of the following designated individuals should be the best choice to review claims in a prospective audit before they are submitted to the payer? compliance officer When Judy, Compliance Officer for the Apple Medical Group, designs the compliance plan she will follow what OIG has described in the Federal Register. How many basic components of an effective compliance program is listed for a small physician practice? seven What does the OIG consider the minimum requirements for a well-publicized guideline that includes disciplinary steps? Including the disciplinary steps in the company's in-house training and procedure manuals Failure to respond quickly to suspected or alleged instances of non-compliance threatens the organization's reputation as trustworthy, law-abiding, and ______________? the organization's ability to participate with federally funded healthcare plans and/or third party payers. Lon, the billing manager, sometimes uses the term "double billing". What does this phase refer to? Charging the patient for a membership fee to see the provider as well as billing for the actual office visit that day. When Kim from ABC Provider Group is conducting a risk assessment, one of the most important and key sources of information that a Kim as the Compliance Officer should utilize is____________ the Office of Inspector General's Annual Work Plan What is more important to have in place for enforcing and disciplining individuals who violate the practice's compliance or other practice standards? procedures 87 | P a g e Kelly is the Compliance Officer for a teaching hospital. The hospital has providers that specialize in Dermatology, Pediatrics, Urology, Family Medicine, Internal Medicine and Infectious Disease. Only the Pediatricians accept Medicaid. The Family Practice groups also employs Nurse Practitioners whereas the other specialties only have MD's or DO's. How should Kelly address these special issues? Kelly should give specialized training to coders and billers that code/bill for the Pediatricians and Family Practice that takes into account the Medicaid insurance and Nurse Practitioners because this is creating extra work for two out of the six specialties. The OIG guidance recommends new employees should be trained in standards and procedures_____________ as part of their orientation to the practice. as soon as possible he following is not a level of non-compliance: Mistake in billing Judy at Apple Medical Group wants to know why Hot Line allegations should be tracked? Establish patterns or trends that need to be followed If the practice uses an outsourced compliance officer the OIG recommends_____? designating a liaison from the practice to communicate with the outside compliance officer; and that the practice has a business service agreement with the outside compliance officer John is the new Compliance Officer for a small community medical practice of 10 providers. He wants to design a great compliance plan for the group. What does the OIG consider the most important aspect of a Compliance Program? Implementation The Compliance Officer is also responsible for the coordinating and/or screening of employees, agents, and independent contractors. Why is this important? Organizations cannot do business with individuals who have been excluded from participating in federally funded healthcare plans Joan, as an employee of a healthcare organization, has _________to report erroneous conduct, without repercussions, so that it may be corrected immediately. a duty Judy, Compliance Officer for Apple Medical Group, wants the entire organization to be included in the initial audit to identify current compliance and areas of non-compliance. What type of audit is this? baseline What might one reason be for Medicare not to pay for a service provided to a Medicare beneficiary? the service was not covered