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
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
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
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
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
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
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
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
Question 9
Case law is based on court decisions that establish precedent, and is also called ______ law.
common
regulatory
mandated
statutory
Question 10
The recognized difference between fraud and abuse is
cost
intent
payer
timing
Question 11
The ICD-9-CM system classifies
morbidity
mortality data
provider services
supplies and services
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
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
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
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
Question 16
The concept of linking diagnosis codes with procedure/service codes is
medical matching
medical necessity
prospective payment
reimbursement
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
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.
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
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