Cross Final Chiro Exam Questions and Correct Solutions

fraud - _______ = an INTENTIONAL misrepresentation where these conditions are present: -There must be a cause of deception -The act or acts must show an intentional misrepresentation of fact -The provider stands to gain financially from the deception and misrepresentation of fact no! there must be financial gain for it to be fraud if pt/insurance is not charged = not fraud - If a chiropractor uses Ultrasound as therapy on EVERY patient, regardless of whether they need it or not, but provides the service free of charge, is this fraud? abuse - _____ = incidents that are inconsistent with accepted sound clinical, business, or fiscal practices but that are not knowingly or intentionally misrepresented facts to obtain payment The difference between fraud and abuse is the individual's intent. - What is the difference between fraud and abuse? -Clinic name on each page, with page numbers -Adopted or Approved date on each page/procedure -Scope (optional, but recommended) -Title -Policy -Procedure (CASTPP) - What is required for "legal" policy and procedures format? Scope - (its optional but recommended) - Which of the following is not required for "legal" policy and procedures format? a. Title b. Policy C. Adopted date D. Scope An attestation - stating that they have read the entire manual - Each employee must read the policy and procedures manual and sign a __________. True - T/F - Federal regulations now forbid exposure of protected patient health information (PHI) to anyone with specific criminal backgrounds. -a drug related misdemeanor in the past 3 years -a felony of any type in the past 5 years -a felony involving medicare or medicaid fraud within the past 10 years. or "excluded" from a program in past 10 yr - If an employee comes in contact with a PHI, what felonies must they not have been convicted of? simply checking the work and personal references provided by the prospective employee, and doing the simple exclusions data base search. May include verification of education and training - What would be considered a level one background check? Level One plus a consumer credit check - What would be considered a level two background check? One and Two plus a criminal background check - What would be considered a level three background check? Standards of Conduct - _________________ are to be written "that clearly state the contractor's commitment to comply with all applicable statutory, regulatory and medicare program requirements. Self Audits and Corrective Action Plans (there are many others but self audits was red) - What must be included in compliance program elements? ALL PHI IS CONFIDENTIAL, all confidential may not be PHI. - Know the difference between PHI and Confidential. Names, addresses (anything set up by law, anything identifiable) - What is an example of PHI? anything in office/ in patients medical chart - What is an example of something confidential? yes - Is a NAME considered PHI? yes - Is an identifiable tattoo on someones leg considered PHI? no - Is a marital status considered PHI? OSHA - Which Act protects employees from contacting blood borne pathogens? a. OSHA b. FLSA yes - able to identfy the person from it - Is a full face photograph PHI? employees - IS OHSA to protect the employees or patients? C. It was created to protect the patients (it was created to protect employees) - Which of the following is FALSE regarding the OSHA? A. It must be in writing B. If anything is touched by the patient, it is considered contaminated C. It was created to protect the patients D. Gloves, face, eye protection and gowns must be provided for all employees d. Employees must sign a waiver before each radiograph = false *know that emloyees working in the area must wear personal rad monitor badges* - Which of the following is FALSE regarding the OSHA and radiation? a. Employees working in the area must wear PERSONAL rad monitor badges b. Offices must limit employee exposure by exposure by restricting the area c. All rooms and equipment may need to be labeled with caution signs d. Employees must sign a waiver before each radiograph d. There must be a diagram but it does not need to be visible. - false - WOTF is FALSE regarding OSHA and Exit Routes? a. There must be a "gathering point" diagram in a visible location b. Must be adequate for all employees and patients c. Must be clearly marked d. There must be a diagram but it does not need to be visible. Occupational Safety and Health Administration - What does OSHA stand for? Fair Labor Standards Act - What does FLSA stand for? a. FLSA - Which Act states that Lisenced professionals are exempt from overtime? a. FLSA b. OSHA