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A comprehensive set of study questions and answers related to healthcare compliance, focusing on the key elements of compliance programs, relevant regulations, and ethical considerations. It covers topics such as the aca, hhs-oig guidelines, medicare appeals processes, and the roles and responsibilities of compliance officers. The material is designed to help individuals prepare for compliance certification exams and enhance their understanding of healthcare compliance best practices. It includes practical insights into policy development, risk management, and employee training, making it a valuable resource for professionals in the healthcare industry. This study pack is tailored to provide a thorough review of essential compliance topics, ensuring a solid grasp of the principles and practices necessary for effective compliance management. It is an essential tool for anyone seeking to excel in the field of healthcare compliance.
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True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment withMedicare, Medicaid, and Children's Health Insurance Program (CHIP). ANSWER :->>True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation inCompliance? (hint: protections) ANSWER:->>1.Protect our programs
d. Social Security Act section 1128 ANSWER:->>c. Balance Budget Act of 1997 Also known as a BBA "three strikes rule" Which statement is TRUE regarding compliance programs? a. Compliance programs are considered more dangerous if they are developed but not implemented. b. Compliance programs can detect but not prevent criminal conduct c. Compliance programs are only required by law for healthcare entities that have more than $500,000 in annual revenue. d. Compliance programs are not mandated by law. ANSWER:->>a. Compliance programs are considered more dangerous if they are developed but not implemented. Formal statement outlining a plan for a specified subject area. It usually cites state and/or federalrequired actions or standards. a. CAP b. Procedure document c. Policy document d. Legal standards ANSWER:->>c. Policy document CAP - outlines corrective action plan
Procedure - describes process/steps under a certain criteriaLegal standards - mandatory action or rule Life cycle of records management ANSWER:->>Creation Use Maintenance Retention Disposition Standards of Conduct (written P&Ps) ANSWER:->>Demonstrate the organization's ethical attitude and its"enterprise-wide" emphasis on compliance with all applicable laws and regulations Code of Conduct: Content Checklist ANSWER:->>• Demonstrate system wide emphasis on compliancewith all applicable laws and regulations
organization operates? ANSWER:->>Code of Conduct In the course of an audit, you find that disciplinary actions against certain physicians and high level executives for non-compliance in the organization have been unfair and inconsistent withcurrent policies & procedures. What is your first course of action .a. Work with legal counsel to enforce proper disciplinary actions b. Get HR involved and recommend the use of progressive discipline policies c. Immediately terminate these individuals d. Get local and federal labor department involved for unfair discipline. ANSWER:->>b. Get HR involvedand recommend the use of progressive discipline policies OIG recommends setting forth the degrees of disciplinary actions. Progressive discipline provides a structure and a set of discipline standards for managers/supervisors to follow to ensure discipline is fair, equitable and consistent. Documentation ANSWER:->>• A&M should be documented
b. Pull a sample off the internet and insert hospital name to save time as it was most likelywritten by experts. c. Rewrite the CoC in plain and concise language tailored to the hospital so employees can use ageneral guidance. d. Rewrite the CoC with detailed restating hospital's P&Ps, and all laws and regulations possible so that employees can't say they were not aware of requirements. ANSWER:->>c. Rewrite the CoC in plain and concise language tailored to the hospital so employees can use a general guidance. Explanation:
D. Meet with legal to discuss how to best self-disclose to the OCR that the hospital was inviolation of the NPP requirements and has since corrected the deficiency ANSWER:->>B. Make arrangements to have the new notice distributed to new patients that come to the hospital Remember: The NPP must describe the following individual rights: https://www.law.cornell.edu/cfr/text/45/164.
b. federally administered and state monitored c. audited by MACs d. created to combat Medicare provider FWA ANSWER:->>a. established by the DRA of 2005 (section6034) https://www.ssa.gov/OP_Home/comp2/F109-171.html Notes: b. federally administered and state monitored (the opposite) c. audited by MACs (MIPs are audited by MICs) d. created to combat Medicare provider FWA (Medicaid, not Medicare) Reporting systems should be: a. marketed to contractors b. outsourced to a vendor c. operated by management d. publicized to all employees ANSWER:->>d. publicized to all employees Are providers financially liable if their billing services commit fraud without the provider'sknowledge?
Yes No ANSWER:->>Yes - they are financially liable for all claims submitted on their behalf that contain their identification number An employee reports a potential problem with the attending physician's presence for surgery.Which of the following is the compliance professional's BEST action? a. investigate the issue b. approach the surgeon c. notify the OIG d. request copies of the records ANSWER:->>a. investigate the issue The False Claims Act contains a whistleblower-protection provision for persons reporting fraudand abuse. What does this mean? a. Persons reporting fraud or abuse may be subject to the same penalties as the persons committing the fraud or abuse. b. Persons reporting fraud or abuse can be discharged or demoted. c. Persons reporting fraud and abuse who are discharged, demoted, suspended, harassed, or discriminated against have protection from such actions.
d. B and C ANSWER:->>d. B and C Sue works for ABC Family Physicians. The providers at this office ask her to research the department that helps protect patients from unfair treatment or discrimination. What departmentor agency would that be? a. Equality in Employment Agency b. Office for Civil Rights c. Department of Justice d. Office of Inspector General ANSWER:->>b. Office for Civil Rights (OCR) DOL oversees employment discrimination DOJ enforces federal criminal law and implements criminal law policiesOIG combats FWA in Medicare, Medicaid and HHS Programs Note: practice question from AAPC CPCO Ch Which government department is comprised of thousands of employees who enforce the nation'sfederal criminal laws and help develop and implement criminal law policies? a. Office of Inspector General b. Centers for Medicare & Medicaid Services
c. Healthcare Lawyers Association d. Department of Justice ANSWER:->>d. Department of Justice OIG combats FWA in Medicare, Medicaid and HHS Programs CMS administers the nation's major healthcare programs including Medicare, Medicaid, andCHIP to eliminate FWA HLA is an edu org (not a gov department) Note: practice question from AAPC CPCO Ch Which department is the largest inspector general's office in the federal government? a. HHS Office of Inspector General b. Office of Civil Rights c. Department of Justice d. Centers for Medicare & Medicaid Services ANSWER:->>a. HHS Office of Inspector GeneralNote: practice question from AAPC CPCO Ch What term would be used for actions that, either directly or indirectly, results in unnecessary costs to the Medicare program? a. Fraud