1) The following individuals are responsible for patient information in the health care practice except a(n):
A) physician.
B) transporter.
C) insurance coder and biller.
D) therapist.
Answer: B
Explanation: A patient's information is easily accessible to those who should have access to it, such as the physician, insurance coder and biller, and therapist.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
2) What are professional coding specialists obligated to do?
A) Comply with the Privacy Rule
B) Work for clearinghouses
C) Release unauthorized private health information
D) Unbundle codes
Answer: A
Explanation: HIPAA requires that all business-covered entities comply with the terms of the law.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
3) What were the HIPAA Privacy Rules written to protect?
A) Coding professionals' rights
B) Physicians' privacy rights
C) An individual's personal health information
D) A business associate's privacy rights
Answer: C
Explanation: HIPAA's Privacy Rule was written to protect an individual's privacy with regard to personal health information.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
4) Blue Cross Blue Shield is an example of a:
A) health care provider.
B) health care clearinghouse.
C) health community liaison.
D) health plan.
Answer: D
Explanation: A health plan is an entity that provides or pays the cost of medical care on behalf of enrolled individuals; it includes group health plans, health insurance issuers, health maintenance organizations, and other welfare benefit plans such as Medicare, Medicaid, CHAMPUS, and Indian Health Services.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 7.d Process insurance claims
Accessibility: Keyboard Navigation
5) Covered entities are defined as businesses that:
A) provide transportation services.
B) have access to the personal health information of patients.
C) create the Health Care Fraud and Abuse Control Program.
D) forbid the submission of health care claims.
Answer: B
Explanation: Under the Department of Health and Human Services HIPAA regulations, covered entities are any health plan, healthcare clearinghouse, or healthcare provider that transmits specific healthcare transactions in electronic form.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 7.d Process insurance claims
Accessibility: Keyboard Navigation
6) In a company workforce, all of the following must obey the rules of HIPAA except ________.
A) full-time employees
B) part-time employees
C) volunteers
D) descendants
Answer: D
Explanation: A covered entity's workforce consists of every person who is involved with the company regardless of employment status—full time, part time, volunteer, intern, extern, physician, nurse, assistant—and this has nothing to do with whether they are paid. Everyone must comply with the terms of this law.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
7) What is protected health information?
A) Any personal identifiable health information
B) The sharing of information between people who are working in the same health care facility
C) The sharing of information between health care professionals working in separate entities or facilities
D) A workforce of covered entities
Answer: A
Explanation: PHI is individually identifiable health information transmitted electronically or maintained in any other form that is created or received by a healthcare provider or any other entity subject to HIPAA requirements.
Difficulty: 1 Easy
Topic: Sources for Legal Guidance
Learning Objective: 40.01
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
8) What does the sharing of information with someone outside of the health care facility require?
A) Written permission for treatment and operation
B) Written permission for payment
C) Oral permission under HIPAA
D) Written permission under HIPAA
Answer: D
Explanation: The health care provider must get a patient's written permission to disclose the PHI.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
9) When Dr. Mason speaks to Nurse Adams about a patient, he is using:
A) incidental use.
B) protected health information.
C) private health record.
D) disclosure.
Answer: B
Explanation: Use of PHI allows sharing of information between people who work together in the same office to better serve the patient.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
10) Providers are not permitted to use or disclose PHI without a patient's written permission in which instance?
A) Treatment
B) Payment
C) Operations
D) Detailed data sets
Answer: D
Explanation: Only limited data sets can be used without a patient's written permission. PHI can be revealed but only after it has been depersonalized.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
11) What must written approvals to release PHI include?
A) Specifically identify the person or organization that will be disclosing the information
B) Give the name of person delivering the information
C) Have no definite expiration date
D) Have no specific date of service
Answer: A
Explanation: The Privacy Rule of HIPAA insists written approvals must specifically identify the person or organization that will be disclosing the information and clearly explain that the person signing this release may retract this authorization in writing at any time.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
12) ________ laws are those governing the behavior of the actions of the population related to health and well-being.
A) Criminal
B) Common
C) Civil
D) Statutory
Answer: A
Explanation: Criminal laws govern the behavior of the actions of the population related to health and well-being.
Difficulty: 1 Easy
Topic: Sources for Legal Guidance
Learning Objective: 40.01
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
13) Someone convicted of violating HIPAA rules can be charged with:
A) civil penalties.
B) malpractice.
C) criminal penalties.
D) both civil penalties and criminal penalties.
Answer: D
Explanation: Congress included specifications for both civil and criminal penalties to be applied against any covered entity that fails to protect its patients' PHI.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
14) What is the responsibility of a privacy officer?
A) To review and validate the qualifications of physicians and other licensed independent practitioners
B) To organize patient care plans that meet the standards set forth by law for managed care plans
C) To recognize there is a risk that a given procedure may include functional impairment, injury, morbidity, or mortality
D) To develop and implement privacy policies and procedures
Answer: D
Explanation: This is a position mandated under the HIPAA Privacy Rule—all covered entities must designate an individual to be responsible for developing and implementing privacy policies and procedures.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
15) In which instance will state law allow disclosure of patient information?
A) The reporting of suspected abuse
B) The reporting of STDs and other contagious diseases
C) In no instance are you allowed to disclose patient information.
D) Both the reporting of suspected abuse and the reporting of STDs and other contagious diseases
Answer: D
Explanation: Public interest is the only instance in which disclosure is mandated by law, for suspected abuse, STDs, and other contagious diseases.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings; 4.b.1 Releasing medical records or information
Accessibility: Keyboard Navigation
16) HIPAA violations are reported to which of the following agencies?
A) Office of Civil Rights in the Department of Health and Human Services
B) Office of Inspector General
C) Office of the National Coordinator of Health Information Technology
D) State's Attorney Office
Answer: A
Explanation: The OCR has the authority to investigate alleged violations of the HIPAA Privacy Rule.
Difficulty: 1 Easy
Topic: Sources for Legal Guidance
Learning Objective: 40.01
Bloom's: Remember
ABHES: 4.b.1 Releasing medical records or information
Accessibility: Keyboard Navigation
17) What amount can one expect to pay in civil penalties for violating HIPAA rules?
A) Up to $50,000
B) Up to $75,000
C) Up to $100,000
D) Up to $25,000
Answer: D
Explanation: The general civil monetary penalty for anyone violating the HIPAA rules is not more than $100 for each violation, with civil fines capped at $25,000 per calendar year for each provision violated.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
18) Which department or act was the Health Care Fraud and Abuse Control Program created by?
A) Health Insurance Portability and Accountability Act
B) State attorneys general offices
C) Office of the National Coordinator of Health Information Technology
D) Health Information Security and Privacy Collaboration
Answer: A
Explanation: The Health Insurance Portability and Accountability Act (HIPAA) created the Health Care Fraud and Abuse Control Program (HCFACP). This program, under the direction of the attorney general and the secretary of the DHHS, acts in accordance with the Office of the Inspector General (OIG) and coordinates with federal, state, and local law enforcement agencies to discover those who attempt to defraud or abuse the health care system, including Medicare and Medicaid patients and programs.
Difficulty: 1 Easy
Topic: Health Care Fraud and Abuse Control Program
Learning Objective: 40.05
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
19) In order to properly code, coders are permitted to:
A) code if the documentation is not there.
B) take a physician's word for a patient's diagnosis.
C) code documentation written in the medical record.
D) code documentation not authored by a clinician.
Answer: C
Explanation: Codes should only support documentation in the medical record.
Difficulty: 1 Easy
Topic: Codes of Ethics
Learning Objective: 40.06
Bloom's: Understand
ABHES: 7.c Perform billing and collection procedures
Accessibility: Keyboard Navigation
20) What does the Federal False Claims Act forbid?
A) Late submission of claims
B) Inaccurate submission of health care claims for financial gain
C) Bundled code submissions
D) Claims submitted with coding, supported by documentation
Answer: B
Explanation: Legislation was passed during the Civil War that prohibits contractors from making a false claim to a governmental program; it is used to reinforce the prevention of healthcare fraud and abuse.
Difficulty: 1 Easy
Topic: False Claims Act
Learning Objective: 40.03
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
21) What can the lack of accuracy of coding affect?
A) It can directly influence reimbursement to providers.
B) It can correctly alter healthcare policies and guidelines.
C) It can direct research endeavors.
D) It can decrease a patient's deductible.
Answer: A
Explanation: Inaccurate coding can cause overpayment or underpayment on a claim.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.02
Bloom's: Understand
ABHES: 7.c Perform billing and collection procedures
Accessibility: Keyboard Navigation
22) What is upcoding?
A) Coding by the insurance company's rules of what it will pay
B) Codes that corroborate the documentation in the medical record
C) A code on a claim form that indicates a higher level of service than that which was actually performed
D) Codes that are identified as those that are not permitted
Answer: C
Explanation: Upcoding is using a billing code that provides a higher reimbursement rate than the code applicable to the service actually furnished to the patient.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.02
Bloom's: Remember
ABHES: 7.c Perform billing and collection procedures
Accessibility: Keyboard Navigation
23) What are the two main coding professional organizations that have published a code of ethics guide?
A) AAPC and AHIMA
B) AAMT and AAMC
C) ACHE and ACS
D) AHRQ and AMIA
Answer: A
Explanation: The two main coding professional organizations are the American Academy of Professional Coders and the American Health Information Management Association.
Difficulty: 1 Easy
Topic: Codes of Ethics
Learning Objective: 40.06
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
24) It is illegal to bill for a component service when:
A) codes corroborate the documentation in the medical record.
B) codes are identified as those that are not permitted.
C) a comprehensive code or combination code is available.
D) a code is identified as a separate procedure.
Answer: C
Explanation: The practice of using multiple codes to bill for various individual steps in a single procedure rather than using a single code that includes all of the steps of the comprehensive procedure is illegal.
Difficulty: 2 Medium
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.02
Bloom's: Understand
ABHES: 7.c Perform billing and collection procedures
Accessibility: Keyboard Navigation
25) Which office strongly recommends or mandates a formal compliance program?
A) AAPC
B) AMIA
C) AHIMA
D) OIG
Answer: D
Explanation: The Office of Inspector General strongly recommends compliance programs. The goal of the compliance programs is to prevent accusations of fraud and abuse, make operations run smoothly, improve services, and contain costs.
Difficulty: 1 Easy
Topic: Compliance Programs
Learning Objective: 40.07
Bloom's: Remember
ABHES: 4.g Display compliance with the Code of Ethics of the profession
Accessibility: Keyboard Navigation
26) Under HIPAA, a covered entity includes all of the following except a:
A) health care provider.
B) health plan.
C) health care school.
D) health care clearinghouse.
Answer: C
Explanation: Covered entities are divided into three categories:
- Health care providers
- Health plans
- Health care clearinghouses
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
27) What does the acronym HIPAA abbreviate?
A) Health Information Protection Act of America
B) Health Insurance Portability and Accountability Act
C) Health Information Prevention Activities Act
D) Health Insurance Prevention Alliance Act
Answer: B
Explanation: The Health Insurance Portability and Accountability Act of 1996 was enacted to provide continuity of health coverage, control fraud and abuse in healthcare, reduce healthcare costs, and guarantee the security and privacy of health information.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
28) An example of a health care provider, under HIPAA, is:
A) a dentist.
B) a computer software manufacturer.
C) WebMD.
D) Abbott Health insurance.
Answer: A
Explanation: A healthcare provider is a provider of diagnostic, medical, and surgical care as well as the services or supplies related to the health of an individual and any other person or organization that issues reimbursement claims or is paid for healthcare in the normal course of business.
Health care providers as defined by HIPAA: physicians, dentists, hospitals, clinics, pharmacies, laboratories, and so on.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
29) Which of the following is not a section of HIPAA?
A) The privacy rule
B) The security rule
C) Health Care Fraud and Abuse Control Program
D) Federal False Claims Act
Answer: D
Explanation: HIPAA is responsible for the privacy and security of health information and fraud and abuse.
The federal False Claims Act (FCA) was enacted by Congress to make the submission of a claim to a federal agency containing false information an illegal act.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act; False Claims Act
Learning Objective: 40.04; 40.03
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
30) A covered entity's workforce, under HIPAA, includes all except a(n):
A) outside computer repair company.
B) full-time employee.
C) intern from local college.
D) volunteer.
Answer: A
Explanation: Under the Department of Health and Human Services HIPAA regulations, covered entities are any health plan, healthcare clearinghouse, or healthcare provider that transmits specific healthcare transactions in electronic form.
The workforces of covered entities are also included under HIPAA. A covered entity's workforce consists of every person who is involved with the company—full time, part time, volunteer, intern, extern, physician, nurse, assistant—and this has nothing to do with whether they are paid. Everyone must comply with the terms of this law.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
31) What is the primary purpose of HIPAA's Privacy Rule?
A) Protecting a patient's health information
B) Assuring legal abortions
C) Providing free care for the poor
D) Obtaining proper reimbursement
Answer: A
Explanation: The Privacy Rule is a federal regulation created to implement the privacy requirements of the simplification subtitle of HIPAA.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
32) When Dr. Sanders "uses" PHI, according to HIPAA, it means he is discussing a patient with the:
A) pharmacist at the drug store.
B) radiologist at the imaging center.
C) appointment scheduler in his office.
D) lab technician at the laboratory.
Answer: C
Explanation: Use is internal to a covered entity or its business associate.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
33) When Dr. Katlyn "discloses" PHI, according to HIPAA, it means she is discussing a patient with:
A) her nurse.
B) her appointment scheduler.
C) her biller/coder.
D) a physical therapist at the hospital.
Answer: D
Explanation: Disclosure is the dissemination of PHI from a covered entity or its business associate.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
34) According to HIPAA, if Dr. Briscoe asks John if he would like his wife to also hear about his test results, this falls under:
A) incidental use and disclosure.
B) opportunity to agree or object.
C) treatment, payment, and/or operations.
D) public interest.
Answer: B
Explanation: The covered entity may orally inform the individual of and obtain the individual's oral agreement or objection to a use or disclosure.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
35) According to HIPAA, if Dr. Rappier diagnoses Charlene with a contagious disease, he must notify the Department of Health. What circumstance does this fall under?
A) Incidental use and disclosure
B) Opportunity to agree or object
C) Treatment, payment, and/or operations
D) Public interest
Answer: D
Explanation: Specific conditions may require that PHI is shared for the purpose of public interest. Public interest may outweigh the need for a patient's personal privacy.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
36) According to HIPAA, if Renee accidentally overhears Dr. Moore talking with Nurse Johnson about her neighbor, what does this fall under?
A) Incidental use and disclosure
B) Opportunity to agree or object
C) Treatment, payment, and/or operations
D) Public interest
Answer: A
Explanation: An incidental use or disclosure is a secondary use or disclosure that cannot reasonably be prevented, is limited in nature, and occurs as a result of another use or disclosure that is permitted by the Rule.
Difficulty: 2 Medium
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
37) According to HIPAA, a Privacy Notice must include:
A) contact information for the Department of Health and Human Services.
B) the exact location where patient records are stored.
C) contact information for the facility's privacy officer.
D) both contact information for the Department of Health and Human Services and contact information for the facility's privacy officer.
Answer: D
Explanation: Health plans and covered healthcare providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices. The notice is intended to focus individuals on privacy issues and concerns and to prompt them to have discussions with their health plans and healthcare providers and exercise their rights.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
38) A $100 fine with no prison time is the penalty for a HIPAA:
A) criminal violation.
B) civil violation.
C) ethical violation.
D) fraud conviction.
Answer: B
Explanation: Congress included specifications for both civil and criminal penalties to be applied against any covered entity that fails to protect its patients' PHI.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.b Institute federal and state guidelines
Accessibility: Keyboard Navigation
39) Choosing codes according to insurance company policies rather than what actually occurred with the patient is called:
A) upcoding.
B) unbundling.
C) mutually exclusive coding.
D) coding for coverage.
Answer: D
Explanation: Coding for coverage is coding according to what the insurance company will pay.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.02
Bloom's: Remember
ABHES: 7.c Perform billing and collection procedures
Accessibility: Keyboard Navigation
40) Choosing a code that represents a more intense procedure than that which was actually provided is called:
A) upcoding.
B) unbundling.
C) mutually exclusive coding.
D) coding for coverage.
Answer: A
Explanation: Upcoding is using a billing code that provides a higher reimbursement rate than the code applicable to the service actually furnished to the patient.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.02
Bloom's: Remember
ABHES: 7.c Perform billing and collection procedures
Accessibility: Keyboard Navigation
41) Using three codes to report procedures rather than one combination code is called:
A) upcoding.
B) unbundling.
C) mutually exclusive coding.
D) coding for coverage.
Answer: B
Explanation: Unbundling is the practice of expanding into individual units a group of diagnostic or procedural test codes—based on the 4th edition of Current Procedural Terminology (CPT) coding.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.02
Bloom's: Remember
ABHES: 7.c Perform billing and collection procedures
Accessibility: Keyboard Navigation
42) Before placing a code on a claim, what must a professional coding specialist make certain he or she has?
A) An Internet connection
B) A hospital affiliated with the procedure
C) Supporting documentation
D) A notarized testimony from the patient
Answer: C
Explanation: It is very important that the codes indicated on the health claim form represent the services actually performed and the reasons why they are provided as supported by the documentation in the patient's health record. Don't use a code on a claim form without ensuring the supporting documentation is there in the file. If it is not documented, it cannot be coded.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.02
Bloom's: Remember
ABHES: 7.c Perform billing and collection procedures
Accessibility: Keyboard Navigation
43) An example of a federal law is:
A) AAPC.
B) AHIMA.
C) HIPAA.
D) CMS.
Answer: C
Explanation: The Health Insurance Portability and Accountability Act of 1996 was enacted to provide continuity of health coverage, control fraud and abuse in healthcare, reduce healthcare costs, and guarantee the security and privacy of health information.
The federal law commonly called HIPAA's Privacy Rule (Health Insurance Portability and Accountability Act) empowers a health care provider to use his or her judgment whether or not to reveal protected health information to authorities when a patient is diagnosed with a contagious disease.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act; Sources for Legal Guidance
Learning Objective: 40.04; 40.01
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
44) It is fraudulent for a coder to:
A) code for services not rendered.
B) change the date of service.
C) overcode.
D) All of these
E) None of these
Answer: D
Explanation: Altering, overcoding, and coding for services not rendered are all cases of fraud.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.06
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
45) A release of information form must:
A) include words in plain language.
B) have a definite expiration date.
C) specify exactly what information is to be released.
D) All of these
E) None of these
Answer: D
Explanation: A release of information form must include words that are in plain language, have a definite expiration date, and specify what information is to be released.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.b.1 Releasing medical records or information
Accessibility: Keyboard Navigation
46) What is an example of a health plan, under HIPAA?
A) County health department
B) Aetna health insurance
C) WebMD Network Services
D) Home health aide
Answer: B
Explanation: A plan is an entity that provides or pays the cost of medical care on behalf of enrolled individuals; it includes group health plans, health insurance issuers, health maintenance organizations, and other welfare benefit plans.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
47) HIPAA applies to:
A) an actuary.
B) a realtor.
C) a business retail manager.
D) all health care workers.
Answer: D
Explanation: HIPAA applies to all covered entities and business associates.
Difficulty: 1 Easy
Topic: Health Insurance Portability and Accountability Act
Learning Objective: 40.04
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
48) What does a compliance program officially do?
A) Absolves anyone in the organization from following the law
B) Affects only clinicians and does not apply to coders
C) Creates policies and procedures to be followed within an organization
D) Establishes performance bonuses for all health care workers
Answer: C
Explanation: Compliance programs have been recommended by the OIG to help all healthcare facilities line up with the laws and agree to follow the direction of those laws.
Difficulty: 1 Easy
Topic: Compliance Programs
Learning Objective: 40.07
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
49) To know the correct code to use, you should:
A) disregard the rules of ethical and legal coding.
B) follow all guidelines.
C) participate in fraud.
D) unbundle codes.
Answer: B
Explanation: All coders should follow all guidelines and rules of ethical and legal coding.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.06
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
50) As a coder, if you are involved in fraud in your facility, you can:
A) not be found responsible if the physician told you to do it.
B) be fined.
C) go to jail.
D) both be fined and go to jail.
Answer: D
Explanation: HIPAA authorized the OIG to investigate cases of healthcare fraud that involve private health plans as well as federally funded programs. Once fraudulent activities are discovered, financial penalties and possible jail time can be assessed.
Difficulty: 1 Easy
Topic: Rules for Ethical and Legal Coding
Learning Objective: 40.02
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
51) ________ is the act of knowing due to their job position, training, or responsibilities within the organization with regard to filing the claim but purposely don't ask about the validity of the information, or ignoring the falsity of the information.
A) Actual knowledge
B) Willful ignorance
C) Disregard
D) Qui tam
Answer: B
Explanation: Willful ignorance, also known as deliberate ignorance … those who should know due to their job position, training, or responsibilities within the organization with regard to filing the claim but purposely don't ask about the validity of the information, or ignore the falsity of the information.
Difficulty: 1 Easy
Topic: False Claims Act
Learning Objective: 40.03
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
52) Which of the following is commonly known as the Whistleblower Statute?
A) AG
B) Docket
C) Relator information
D) Qui tam provision
Answer: D
Explanation: The qui tam provision within the FCA, commonly known as the Whistleblower Statute, empowers private citizens (typically those who work within organizations that do not comply) to file a lawsuit on behalf of the federal or state government against the facility for noncompliance.
Difficulty: 1 Easy
Topic: False Claims Act
Learning Objective: 40.03
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
53) ________ are known as the official policies issued by the President of the United States.
A) Administrative Laws
B) Common Laws
C) Executive Orders
D) Statutory Laws
Answer: C
Explanation: Executive Orders are known as the official policies issued by the President of the United States.
Difficulty: 1 Easy
Topic: Sources for Legal Guidance
Learning Objective: 40.01
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
54) "It's not my concern. I just do what I am told" is an example of ________.
A) Actual knowledge.
B) Willful ignorance.
C) Disregard.
D) Qui tam.
Answer: C
Explanation: An example of disregard of the truth is "It's not my concern. I just do what I am told."
Difficulty: 1 Easy
Topic: False Claims Act
Learning Objective: 40.03
Bloom's: Understand
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
55) By catching those who submitted fraudulent claims, approximately ________ was won or negotiated by the federal government during fiscal year 2014.
A) $1.3 billion
B) $2.3 billion
C) $3.1 billion
D) $5.3 billion
Answer: B
Explanation: By catching those who submitted fraudulent claims, approximately $2.3 billion was won or negotiated by the federal government during fiscal year 2014.
Difficulty: 1 Easy
Topic: Health Care Fraud and Abuse Control Program
Learning Objective: 40.05
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
56) The statistics show that for every $1 spent to pay for health care fraud and abuse investigations and prosecutions, the government actually brings in about ________ in money returned.
A) $2
B) $3
C) $4
D) $5
Answer: C
Explanation: The statistics show that for every $1 spent to pay for health care fraud and abuse investigations and prosecutions, the government actually brings in about $4 in money returned.
Difficulty: 1 Easy
Topic: Health Care Fraud and Abuse Control Program
Learning Objective: 40.05
Bloom's: Remember
ABHES: 4.f Comply with federal, state, and local health laws and regulations as they relate to healthcare settings
Accessibility: Keyboard Navigation
