Question 1

Define compliance.

Accepted Answer

The answer of Define compliance....

Question 2

Exceptions to the right of Privacy Rule include

Accepted Answer

A)  patients carrying human immunodeficiency virus (HIV) or who have acquired immunodeficiency syndrome (AIDS). 
B)  gunshot wound cases. 
C)  all sexually transmitted disease cases. 
D)  all infectious disease cases.

Question 3

A well-designed compliance program should show a ______________ effort to submit claims appropriately.

Accepted Answer

The answer of A well-designed compliance program should show a...

Question 4

"What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about," is attributed to _________.

Accepted Answer

The answer of "What I may see or hear in...

Question 5

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed.

-Altering fees on an insurance claim form to obtain higher payment.

Accepted Answer

A) Abuse 
B) Fraud

Question 6

A HIPAA compliance exception to the right of privacy and privileged communication is a patient's records pertaining to his or her industrial accident case.

Accepted Answer

A) True 
 B)False

Question 7

Since April 14, 2003, when privacy regulations became enforceable, providers are required to document which four things?

Accepted Answer

The answer of Since April 14, 2003, when privacy regulations...

Question 8

What is the best response when telephoning a patient about an insurance matter and the patient's voice mail is reached?

Accepted Answer

A)  Use care in the choice of words when leaving the message. 
B)  Do not leave a message. 
C)  Leave a complete message so that the patient will know why you called and be able to call you back and respond to anyone in the office. 
D)  Leave your name, the practice's name, and the practice's telephone number, but do not leave any other information.

Question 9

The Security Rule that addresses electronic protected health information is divided into which three main sections?

Accepted Answer

The answer of The Security Rule that addresses electronic protected...

Question 10

Explain when a physician's office would be considered a "covered entity."

Accepted Answer

The answer of Explain when a physician's office would be...

Question 11

What does "safe harbor" refer to?

Accepted Answer

The answer of What does "safe harbor" refer to?...

Question 12

Match the positions below with the description of that person or entity.

-Individual who is hired by a medical practice to process claims to a third-party payer.

Accepted Answer

A) Health care provider 
B) Clearinghouse 
C) Covered entity 
D) Business associate 
E) Privacy officer, privacy official

Question 13

A billing practice such as excessive referrals to other providers for unnecessary services is considered ________________________.

Accepted Answer

The answer of A billing practice such as excessive referrals...

Question 14

List five specific risk areas identified by OIG that an office needs to monitor and follow.

Accepted Answer

The answer of List five specific risk areas identified by...

Question 15

The process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry is known as eHealth information management.

Accepted Answer

A) True 
 B)False

Question 16

Qui tam suits are those cases in which a private citizen known as a whistleblower reports a fraudulent activity within his or her organization.

Accepted Answer

A) True 
 B)False

Question 17

The key individual who oversees an organization's compliance program is referred to as the _________________.

Accepted Answer

The answer of The key individual who oversees an organization's...

Question 18

Under HIPAA guidelines, a chiropractor or dentist's office would never be considered a covered entity.

Accepted Answer

A) True 
 B)False

Question 19

Confidential information includes

Accepted Answer

A)  everything that is heard about a patient. 
B)  everything that is read about a patient. 
C)  everything that is seen regarding a patient. 
D)  all of the above.

Question 20

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed.

-Charging excessively for services and supplies.

Accepted Answer

A) Abuse 
B) Fraud

Exam 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Define compliance.

Exceptions to the right of Privacy Rule include

A well-designed compliance program should show a ______________ effort to submit claims appropriately.

"What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about," is attributed to _________.

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed. -Altering fees on an insurance claim form to obtain higher payment.

A HIPAA compliance exception to the right of privacy and privileged communication is a patient's records pertaining to his or her industrial accident case.

Since April 14, 2003, when privacy regulations became enforceable, providers are required to document which four things?

What is the best response when telephoning a patient about an insurance matter and the patient's voice mail is reached?

The Security Rule that addresses electronic protected health information is divided into which three main sections?

Explain when a physician's office would be considered a "covered entity."

What does "safe harbor" refer to?

Match the positions below with the description of that person or entity. -Individual who is hired by a medical practice to process claims to a third-party payer.

A billing practice such as excessive referrals to other providers for unnecessary services is considered ________________________.

List five specific risk areas identified by OIG that an office needs to monitor and follow.

The process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry is known as eHealth information management.

Qui tam suits are those cases in which a private citizen known as a whistleblower reports a fraudulent activity within his or her organization.

The key individual who oversees an organization's compliance program is referred to as the _________________.

Under HIPAA guidelines, a chiropractor or dentist's office would never be considered a covered entity.

Confidential information includes

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed. -Charging excessively for services and supplies.