Ch40 Introduction To Health Care Law And Test Bank + Answers

Let’s Code It!, 1e (Safian)

Chapter 40 Introduction to Health Care Law and Ethics

1) 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.

2) 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

3) 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

4) Blue Cross Blue Shield is an example of a:

A) health care provider.

B) health care clearinghouse.

C) health community liaison.

D) health plan.

5) 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.

6) 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

7) 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

8) 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

9) 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.

10) 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

11) 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

12) ________ 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

13) 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.

14) 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

15) 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

16) 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

17) 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

18) 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

19) 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.

20) 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

21) 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.

22) 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

23) 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

24) 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.

25) Which office strongly recommends or mandates a formal compliance program?

A) AAPC

B) AMIA

C) AHIMA

D) OIG

26) 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.

27) 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

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

A) a dentist.

B) a computer software manufacturer.

C) WebMD.

D) Abbott Health insurance.

29) 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

30) 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.

31) 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

32) 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.

33) 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.

34) 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.

35) 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

36) 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

37) 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.

38) 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.

39) 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.

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.

41) 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.

42) 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

43) An example of a federal law is:

A) AAPC.

B) AHIMA.

C) HIPAA.

D) CMS.

44) 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

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

46) 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

47) HIPAA applies to:

A) an actuary.

B) a realtor.

C) a business retail manager.

D) all health care workers.

48) 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

49) 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.

50) 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.

51) ________ 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

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

A) AG

B) Docket

C) Relator information

D) Qui tam provision

53) ________ 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

54) "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.

55) 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

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