HW 4;EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS BEST RATED SOLUTION, Exams of Nursing

Download HW 4;EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS BEST RATED SOLUTION and more Exams Nursing in PDF only on Docsity! 1 [Date] Microsoft Word - HW_4.docx HW 4;EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2023 GUARANTEED SUCCESS BEST RATED SOLUTIONS Indicate the answer choice that best completes the statement or answers the question. 1. Which program measures improper payments in the Medicaid program and the State Children’s Health Insurance Program (SCHIP)? a. CERT b. FATHOM c. HPMP d. PERM 2. Which unique identifier is assigned to third-party payers and has 10 numeric positions, including a check digit as the tenth position? a. HPID b. PAYERID c. PlanID d. UPIN 3. Which of the following is an example of fraud? a. billing noncovered services as covered services b. falsifying certificates of medical necessity plans of treatment c. reporting duplicative charges on an insurance claim d. submitting claims for services not medically necessary 4. Which is testimony under oath taken outside of court, such as at the physician’s office? a. deposition b. interrogatory c. subpoena d. subpoena duces tecum 5. Which program assesses and measures improper Medicare fee-for-service payments (based on reviewing selected claims and associated medical record documentation)? a. CERT b. FATHOM c. HPMP d. PERM 6. Which amended Title IX of the Public Health Service Act to encourage voluntary and confidential reporting of events that adversely affect patients, creating organizations that collect, aggregate, and analyze confidential information reported by health care providers? a. Deficit Reduction Act of 2005 2 [Date] Microsoft Word - HW_4.docx b. Improper Payments Information Act of 2002 c. Patient Safety and Quality Improvement Act of 2005 d. Tax Relief and Health Care Act of 2006 5 [Date] Microsoft Word - HW_4.docx a. decision 6 [Date] Microsoft Word - HW_4.docx b. example c. precedent d. statute 20. Which is a legal document containing a list of questions that must be answered in writing? a. deposition b. interrogatory c. subpoena d. subpoena duces tecum 21. Record retention is the of documentation for an established period of time, usually mandated by federal and/or state law. a. destruction b. privacy and security c. release d. storage 22. Drew Baker is referred to a health care provider by an employer for treatment of a fracture that occurred during a fall at work. The physician billed Medicare and did not indicate on the claim that the injury was work related. Medicare benefits were paid to the provider for services rendered. This resulted in Medicare contacting the provider, who is liable for the because of the provider’s failure to disclose that the injury was work-related. a. adjudication b. mediation c. overpayment d. unbundling 23. The American Recovery and Reinvestment Act of 2009 (ARRA) protects whistleblowers, who are individuals that covered by the Act. a. are prosecuted for disclosing protected information b. correct overpayments and other reimbursement issues c. make specified disclosures relating to funds d. receive remuneration for disclosing wrongdoings 24. Which of the following is an example of abuse? a. billing noncovered services/procedures as covered services/procedures b. falsifying health care certificates of medical necessity plans of treatment c. misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment d. submitting claims for services and procedures knowingly not provided 25. Which consists of audits implemented by DHHS that examines the billing practices of physicians at teaching hospitals with the focus on compliance with the Medicare rule affecting payment for physician services provided by residents and whether the level of the physician service was coded and billed properly? a. NCCI 7 [Date] Microsoft Word - HW_4.docx b. PATH 10 [Date] Microsoft Word - HW_4.docx b. EDI 11 [Date] Microsoft Word - HW_4.docx c. NSF d. UB-04 39. HIPAA defines abuse as involving actions that are with accepted, sound medical, business, or fiscal practices, which directly or indirectly result in unnecessary costs to the program through improper payments. a. compatible b. inconsistent c. recurrent d. unvarying 40. Which regulates fraud associated with military contractors selling supplies and equipment to the Union Army? a. False Claims Act b. Federal Claims Collection Act c. Privacy Act of 1974 d. Stark I 41. An electronic signature will result in a unique bit string (or computer code) called a(n) , which is encrypted and appended to the electronic document. a. electronic transaction b. message digest c. transmitted version d. unique identifier 42. The Patient Protection and Affordable Care Act (PPACA) of 2010 includes a health care reform measure that requires implementation of the hospital program to promote better clinical outcomes and patient experiences of care. a. inpatient quality reporting b. physician quality reporting c. recovery audit contractor d. value-based purchasing 43. The proposed standard for an electronic signature is , which applies a mathematical function to the electronic document. a. decrypted b. digital c. manual d. standard 44. HIPAA requires payers to implement rules called electronic , which result in a uniform language for electronic data interchange. a. data interchanges b. health records c. medical records 12 [Date] Microsoft Word - HW_4.docx d. transaction standards 15 [Date] Microsoft Word - HW_4.docx 52. Which unique identifier is assigned to health care providers as a 10-digit numeric identifier, including a check digit in the last position? a. EIN b. HPID c. NPI d. UPIN 53. Which documents patient information sent to authorized requestors and can be kept in manual or software formats? a. decryption and encryption b. electronic data interchange c. release of information log d. transmittals and manuals 54. Which specifically requires an individual’s authorization prior to disclosure and for which HIPAA has established specific requirements for an authorization form? a. covered entity data and information b. designated record set c. protected health information d. treatment, payment, and operations 55. Which program provides consumers with quality of care information so they can make more informed decisions about health care options? a. Hospital Inpatient Quality Reporting (Hospital IQR) b. Medicaid Integrity Program (MIP) c. Recovery Audit Contractor (RAC) d. Zone Program Integrity Contractor (ZPIC) 56. Which was created by the Centers for Medicare and Medicaid Services for the purpose of assigning unique identifiers to health care providers and health plans? a. CMS b. DEEDS c. EDI d. NPPES 57. Which involves the safekeeping of patient information by controlling access to records, protecting patient information from alteration/destruction/tampering/loss, and providing employee training in HIPAA requirements, which includes the consequences of improper disclosure of patient information? a. authorization b. confidentiality c. privacy d. security 16 [Date] Microsoft Word - HW_4.docx 58. Which is an order of the court that requires a witness to appear at a particular time and place to testify? a. deposition b. interrogatory c. subpoena d. subpoena duces tecum 59. Which are assigned to the MAC jurisdictions (replacing Program Safeguard Contractors) to review billing trends and patterns, focusing on providers whose billings for Medicare services are higher than the majority of providers in the community? a. hospital value-based purchasers b. Recovery Audit Contractors c. whistleblowers d. Zone Program Integrity Contractors 60. Because the diagnosis and procedure codes reported affect the DRG selected (and resultant payment), some hospitals engage in a practice called , which is the assignment of an ICD-10-CM diagnosis code that does not match patient record documentation, for the purpose of illegally increasing reimbursement. a. downcoding b. jamming c. unbundling d. upcoding 61. Federal and state are laws passed by legislative bodies, such as federal Congress and state legislatures. a. policies b. procedures c. regulations d. statutes 62. Which established the CERT, FATHOM, HPMP, PEPPER, and PERM programs? a. Deficit Reduction Act of 2005 b. Improper Payments Information Act of 2002 c. Patient Safety and Quality Improvement Act of 2005 d. Tax Relief and Health Care Act of 2006 63. Which created the Physician Quality Reporting System that established a financial incentive for eligible professionals who participate in a voluntary quality reporting program? a. Deficit Reduction Act of 2005 b. Improper Payments Information Act of 2002 c. Patient Safety and Quality Improvement Act of 2005 d. Tax Relief and Health Care Act of 2006 64. Which is maintained by the Food and Drug Administration (FDA) and identifies prescription drugs and some overthe-counter products? 17 [Date] Microsoft Word - HW_4.docx a. CDT