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CHC Exam – Definitions Questions with Answers Best Rated
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CHC Exam – Definitions Questions withAnswers Latest Update.
Anti-Kickback Law - Correct answer Prohibits the solicitation, receiving, offering, or
paying of any remuneration directly or indirectly in cash or in kind in exchange.
Audit - Baseline - Correct answer A systematic inspection of records, policies, and
procedures with the goal to establish a set of benchmarks for comparison for future
inspections.
Audit - Concurrent - Correct answer An ongoing inspection of records, policies, and
procedures at a given point in time in which identified potential problems are
investigated as they arise
Audit - Retrospective - Correct answer A comprehensive inspection of records, policies,
and procedures done usually in anticipation of launching a compliance and ethics
program. All potential problems are identified and then investigated.
Balanced Budget Act of 1997 - Correct answer Legislation containing major reform of
the Medicare and Medicaid programs. Especially in home health and patient transfers.
Mandated permanent exclusion from participation in federally funded health care
programs of those convicted of three health care related crimes (3 strikes you're out)
Benchmarking - Correct answer The measurement of performance against "best
practice" standards.
Best Practices - Correct answer Generally recognized superior performance by
organizations in operational and/or financial processes.
Business Associate - Correct answer Person or organization that performs or assists in
the performance of a function or activity involving the use or disclosure of identifiable
health information on behalf of a convered entity or provides services such as legal,
actuatial, accounting, consulting, data aggregation, management administration,
accreditation or financial services to or for a covered entity.
Caremark International Derivative Litigation - Correct answer The 1996 U.S. Civil
settlement of Caremark INternational, Inc. in which an imposed corporate integrity
agreement precluded Caremark form providing health care in certain forms for a period
of five years. Also suggests that the failure of a corporate director to attempt in good
faith to institute a compliance and ethics program in certain situations may be a breach
of a director's fiduciary obligation.
, CMS - Centers for Medicare and Medicaid Services - Correct answer A component of
the U.S. Department of Health and Human Services that administers the Medicare,
Medicaid and State Children's Health Insurance Programs.
Civil Monetary Penalties Law (CMPL) - Correct answer Regulations which apply to any
claim for an item or service that was not provided as claimed or that was knowingly
submitted as false and which provides guidelines for the levying of fines for such
offenses.
Corporate Integrity Agreements (CIA) - Correct answer Also; consent decrees. A
negotiated settlement between a organization and the government in which the provider
accepts no liability but must agree to implement a strict plan of government-supervised
corrective action.
Covered Entities - Correct answer Health Plan
Health Care Clearinghouses
Healthcare provider who transmits any health information in electronic form in
connection with a transaction covered by this subchapter.
Culpability Score - Correct answer Part of the U.S. Sentencing Commission guidelines
for the Sentencing of Organizations, a system that adds points for aggravating factors
and subtracts points for mitigating factors in the determination of fines imposed for fraud
or abuse.
Cumulative Sanction Report - Correct answer An internet-based, OIG produced report
listing health care providers who have been excluded from participation in the Medicare
and Medicaid programs.
Designated Record Set - Correct answer Any item, collection, or grouping of information
that includes protected health information and is maintained, collected, used, or
disseminated by or for a covered entity.
Diagnosis-Related Groups - Correct answer Classifications of diagnoses determined by
the average cost of treating a particular condition, regardless of the number of services
rendered or the length of a patient stay; Medicare reimbursement is assigned by DRG.
DRG Creep - Correct answer Illegal, intentional billing of a DRG with higher payment
rate than an accurate DRG.
Disclosure - Correct answer Release, transfer, provision of, access to, or divulging in
any manner of information outside the entity holding the information.
Employee Retirement Income Security Act - Correct answer A 1974 federal act that
exempts self-insured health plans from state laws governing health insurance and
required health plans to provide certain information to enrolles.
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