Question 1

Which statement below was NOT a primary issue that Congress focused on when creating the 1996 legislation known as HIPAA?

 

  Hospitals own hospital records

 

Courts have ruled that patients have no right to own the x-rays or slides

 

Physicians own the portion of the hospital record on which they document care

 

Patients have right of access to medical records but do not own the original record

5 points  

Question 2

PHI includes information which is created or received by several types of organizations. Which of the following organizations is (are) not one of those that creates PHI?

 

Physicians

 

Health insurer

 

Employers

 

All of the above create PHI

5 points  

Question 3

According to the Department of HHS website, which of the following privacy rule compliance issues are not among those most often investigated?

 

Impermissible use and disclosure of PHI

 

Lack of patient access to their PHI

 

Transferring PHI through electronic means

 

Distributing more than the minimal information necessary for the purpose

5 points  

Question 4

How did one court rule in a case that involved a hospital where nurses were permitted to ‘chart by exception’ in postoperative monitoring?

 

The court found that the record keeping was incomplete, which inferred negligence

 

The court found that the patient was not informed and the hospital was negligent

 

The court found that charting by exception was adequate as the practice was common at the hospital and was documented in hospital policies and procedures

 

The court found that paper notes kept by the nurse in her pocket were an adequate means of record keeping and communicating with others

5 points  

Question 5

Computerized recordkeeping provides advantages and disadvantages that include

 

More standardization of datakeeping

 

They assist in the reduction of medical errors

 

Computerized systems are costly

 

All of the above

5 points  

Question 6

When a provider accepts a pre-established amount to provide services over a period of time, this is known as a method of payment called

 

capitation

 

fixed

 

premium

 

sub-capitation

5 points  

Question 7

When the provider agrees to accept as payment in full whatever amount the insurance allows or approves, the provider is agreeing to

 

accept assignment

 

assignment of benefits

 

authorize services

 

coordination of benefits

5 points  

Question 8

Which document is used to generate the patient’s financial and medical record?

 

Encounter form

 

Patient insurance card

 

Patient ledger

 

Patient registration form

5 points  

Question 9

Case law is based on court decisions that establish precedent, and is also called ______ law.

 

common

 

regulatory

 

mandated

 

statutory

5 points  

Question 10

The recognized difference between fraud and abuse is

 

cost

 

intent

 

payer

 

timing

5 points  

Question 11

The ICD-9-CM system classifies

 

morbidity

 

mortality data

 

provider services

 

supplies and services

5 points  

Question 12

The following is true about Medicare

 

 It is a two part program with Part A and B and the program includes Parts C and D

 

It only consists of Parts A and B

 

It is a two part program where Part A pays for doctor’s services

 

It consists of Part A only

5 points  

Question 13

The Medicare physician fee schedule amount for code 99213 is $100. The participating provider’s usual charge for this service is $125. Calculate the Medicare reimbursement amount.

 

$76

 

$80

 

$109.25

 

$115

5 points  

Question 14

A claim is being adjudicated when &..

 

The claim is being transmitted to the payers and clearing hours for processing

 

The claim is being sorted into groups based on the payer of the claim

 

The claim is denied and is being resubmitted

 

The claim is being compared to the payer edits and the patient’s benefits for verification

5 points  

Question 15

The first-listed diagnosis reported on a CMS-1500 claim form is

 

used in the outpatient setting

 

is determined in accordance with ICD-9-CM’s rules and general coding guidelines

 

a and b

 

none of the above

5 points  

Question 16

The concept of linking diagnosis codes with procedure/service codes is

 

medical matching

 

medical necessity

 

prospective payment

 

reimbursement

5 points  

Question 17

Medicare is available to an individual who has worked at least

 

5 years in Medicare-covered employment, is at least 65 years old, and is a permanent resident of the United States.

 

10 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the United States

 

10 years in Medicare-covered employment, is at least 65 years old, and is a citizen or permanent resident of the United States

 

25 years in Medicare-covered employment, is at least 62 years old, and is a citizen of the United States

5 points  

Question 18

Which statement below is correct about a managed care contract and gag clause?

 

Medicare and many states prohibit managed care contracts from containing gag clauses

 

There is federal law that restricts any type of gag clauses in all medical contracts.

 

Only HMO’s are allowed to have gag clauses, but the law only covers restricting discussion between a doctor and patient about of surgery’s that the plan does not cover.

 

There are no specific laws about if a managed care company may or may not have gag clauses in the contracts between the doctor and the company.

5 points  

Question 19

The government agency that functions as the insuring body to cover workers’ compensation claims is called the

 

Office of Federal Employees’ Compensation Act

 

Office of Federal Employment Liability Act

 

Office of State Insurance Fund.

 

Office of Workers’ Compensation Board

5 points  

Question 20

The OWCP administers programs for those injured at work and

 

that provide wage replacement benefits

 

that provide medical treatment

 

that provide vocational rehabilitation

 

all of the above

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