CHC Random Study Questions 1 with correct Answers

Compliance means (Compliance Program) - Answer- Adherence to laws and regulations, as well as principles of ethical conduct OIG urges the ____________ to assist in the implementation of the compliance program and serves as advisors. A. Board B. CEO C. Compliance Committee D. Quality Committee - Answer- C. Compliance Committee A compliance professional is reviewing the policies and procedures for exclusion verifications. The policy does not state frequency of exclusion verifications. How frequent should exclusion verifications be performed? a. Annually b. Bi-annually c. Monthly d. Semi-annually - Answer- c. monthly (as recommended by OIG to avoid risk) A hospital medical staff office is conducting its monthly review of the Excluded Parties List System (EPLS). The compliance officer is called by the manager of the medical staff office and informed that Dr. Smith, a surgeon who took call 5 times last month for the Emergency Department, was excluded on a date prior to those dates when the surgeon took call. In other words, the effective date of the exclusion involving the surgeon was 4/1/2019 and the surgeon took call and provided surgical services to patients in the ED on 4/13/19, 4/20/19, and 4/27/2019. What is the NEXT action the compliance officer should do? a. Contact the ED and make sure that the involved surgeon is removed from taking any more on call shifts. b. Have the medical office check if the surgeon is listed on other exclusion lists. c. Contact legal counsel to alert of the need to pay back reimbursement received for services provided by an excluded individual. d. Hold all surgical service related bills associated with the ED so that none are released to any payers which may involve this surgeon. - Answer- b. Have the medical office check if the surgeon is listed on other exclusion lists OIG can impose mandatory exclusion for a minimum of..? - Answer- 5 years True or False: An excluded individual is automatically reinstated at the end of an exclusion term - Answer- FALSE - An excluded individual must apply for reinstatement at the end of their exclusion term A privacy professional is reviewing a program for an academic medical center that include a faculty group practice, hospital, student health center, and self-funded group health plan. The privacy professional should evaluate if the program has notices for: a. GINA b. FMLA c. HIPAA d. FISMA - Answer- c. HIPAA A health system implemented an EHR in 55 clinics. The privacy professional is told employees are inconsistently interpreting the policy addressing employee access to EHR. Which of the following is the privacy professional's BEST strategy? a. Collaborate with HR to ensure appropriate discipline b. Perform an audit under Attorney-Client Privilege c. Conduct surveys of clinic employees concerns d. Audit a random sampling of clinics across the organization - Answer- c. Conduct surveys of clinic employees concerns Under the US Federal Sentencing Guidelines, there is an expectation that effective compliance programs include due diligence in discretionary authority and hiring. Which of the following is MOST important process to include? a. Periodic background checks b. Drug Testing c. Monthly exclusion verifications through OIG database d. Monthly exclusion verifications through SAMS GSA Exclusion database - Answer- d. Monthly exclusion verifications through SAMS GSA Exclusion database. Explanation: Starting from the top: GSA administers SAM, which contains debarment actions taken by various Federal agencies, including OIG's exclusions. The LEIE contains only the exclusion actions taken by OIG. What are the 2 types of OIG exclusions? - Answer- Mandatory and Permissive. See definitions: Concurrent Audit - Answer- Real time - Ongoing review/inspection of records, policies and procedures. More difficult to execute but best way to change behavior. Identify and address problems as they arise - Example: Auditing claims before claims are billed What is DRG Creep - Answer- Using a Diagnosis Related Group (DRG) code that provides a higher payment rate than the DRG code that accurately reflects the service furnished to the patient. In Compliance Auditing & Monitoring, Contemporaneous Reviews: a. Involves matter that either have not yet been billed by provider or have not yet been paid by the third party payor b. Appropriate to determine an initial baseline view of a particular billing practice or activity c. Can uncover existence of past problems e. All of the above f. A and B only - Answer- e. All of the above Retrospective Audit - Answer- Baseline assessment of where you are at a period of time in the past Snapshot or Laundry list of things needed to be fixed Need to know a milestone to go back to in time (e.g.; published financial statements, historical audit) Retrospective vs Concurrent Audit can be characterized by... - Answer- Retrospective milestone to go back to in system, you know the sample unit from system. Concurrent any time up to the final, real time The claims department needs to determine the initial baseline view of a particular billing practice to represent the beginning of a review process. What type of audit should be conducted? a. A probe audit b. Retrospective Audit c. A contemporaneous review d. Retroactive audit - Answer- c. A contemporaneous review The Compliance Officer is working with the Compliance Committee to develop goals of a review from a compliance perspective. What is the first thing that should be done? a. Conduct a probe audit on claims b. Take a "snapshot" to develop a baseline to assess the current state of compliance c. Conduct a contemporaneous review d. Conduct a concurrent audit - Answer- b. Take a "snapshot" to develop a baseline to assess the current state of compliance The type of audit used to identify potential errors prior to completing the process or transaction under review is: a. Operational audit b. Concurrent audit c. Retrospective audit d. Baseline audit - Answer- b. Concurrent audit Upcoding - Answer- Using a billing code that provides a higher reimbursement rate than the billing code that actually reflects the service furnished. Major focus of OIG enforcement efforts and HIPAA added additional civil monetary penalty to OIG sanctions. True or False: Encryption is required under HIPAA - Answer- FALSE - It is an addressable implementation specification. Which of the following is one objective of a baseline audit? a. Evaluate compliance program operations b. Investigate an alleged violation c. Offer recommendations regarding necessary remediation d. Create a mission statement for the compliance department that is consistent with the mission statement - Answer- c. Offer recommendations regarding necessary remediation What is a Corporate integrity agreement; also consent decrees? - Answer- A negotiated settlement between the ORG and GOV, which providers present no liability while implementing a strict compliance program plan imposed by the GOV. Corporate Integrity Agreement (CIA) characteristics: - Answer- • 3-5 year duration • extensive reporting requirements • negotiated in order to avoid litigation • admits no fault or liability • submits to government for corrective action FSG - Culpability Score, when calculated, this is used to determine: - Answer- Calculation of the degree of blame or guilt used to determine: fines, restitution, forfeiture, and probation FSG - Culpability Score - Answer- Part of the US Sentencing Commission Guidelines. It's a system that adds or substracts points for aggravating or mitigating factors accordingly to determine the fines imposed for