Deck 36: Introduction to Health Care Law and Ethics

Question 1

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 1

A

Question 2

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 2

B

Question 3

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 3

D

Question 4

________ 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

Question 5

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

Question 6

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

Question 7

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

Question 8

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.

Question 9

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.

Question 10

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.

Question 11

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

Question 12

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

Question 13

Blue Cross Blue Shield is an example of a:

A) health care provider.
B) health care clearinghouse.
C) health community liaison.
D) health plan.

Question 14

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

Question 15

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

Question 16

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

Question 17

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

Question 18

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

Question 19

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.

Question 20

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.

Question 21

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.

Question 22

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

Question 23

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

Question 24

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.

Question 25

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.

Question 26

An example of a health care provider, under HIPAA, is:

A) a dentist.
B) a computer software manufacturer.
C) WebMD.
D) Abbott Health insurance.

Question 27

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.

Question 28

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

Question 29

Which office strongly recommends or mandates a formal compliance program?

A) AAPC
B) AMIA
C) AHIMA
D) OIG

Question 30

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.

Question 31

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

Question 32

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

Question 33

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

Question 34

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

Question 35

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.

Question 36

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.

Question 37

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.

Question 38

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.

Question 39

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.

Question 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.

Question 41

________ 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

Question 42

________ 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

Question 43

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.

Question 44

An example of a federal law is:

A) AAPC.
B) AHIMA.
C) HIPAA.
D) CMS.

Question 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

Question 46

HIPAA applies to:

A) an actuary.
B) a realtor.
C) a business retail manager.
D) all health care workers.

Question 47

Which of the following is commonly known as the Whistleblower Statute?

A) AG
B) Docket
C) Relator information
D) Qui tam provision

Question 48

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

Question 49

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

Question 50

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

Question 51

"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.

Question 52

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

Question 53

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.

Question 54

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

Question 55

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.

Question 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