Chapter.13 Test Bank Audits And Inspections

Chapter 13: Audits and Inspections

1. A non-compliant event that is not obvious or easily seen is known as a/n:

a. Internal problem.

b. Overt problem.

c. Covert problem.

d. Extrapolation.

Feedback: A non-compliant event that is not obvious or easily seen is known as a covert problem.

Page Ref: 218

2. An assessment to determine compliance performed by an authorized agency or organization is known as a (an):

a. External audit.

b. Retrospective audit.

c. Internal audit.

d. Trend analysis.

Feedback: An assessment to determine compliance performed by an authorized agency or organization is known as an external audit.

Page Ref: 221

3. The determination of results by projecting existing experience or known data is known as:

a. Upcoding.

b. Statistical assessment.

c. Extrapolation.

d. Sampling.

Feedback: The determination of results by projecting existing experience or known data is known as extrapolation.

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4. The review and assessment of data taken over a period of time with the intention of identifying patterns is known as performing a/n:

a. Retrospective audit.

b. Internal audit.

c. Sampling audit.

d. Trend analysis.

Feedback: A trend analysis is the review and assessment of data taken over a period of time with the intention of identifying patterns.

Page Ref: 218

5. You have just received a subpoena duces tecum. This means you must:

a. Testify in court.

b. Deliver specified documents to the court.

c. Be available to the court for 30 days.

d. Serve on a jury.

Feedback: Subpoena duces tecum refers to a court order for specified documents to be delivered to authorities.

Page Ref: 225

6. An assessment conducted on a statistically valid portion of the entire body of data is known as a:

a. Sampling audit.

b. Retrospective audit.

c. Concurrent audit.

d. Covert audit.

Feedback: An assessment conducted on a statistically valid portion of the entire body of data is known as a sampling audit.

Page Ref: 220

7. A non-compliant event that is deeply hidden and cannot be identified without an in-depth investigation is known as a/n:

a. Overt problem.

b. Covert problem.

c. Occult problem.

d. All of the above.

Feedback: A non-compliant event that is deeply hidden and cannot be identified without an in-depth investigation is known as an occult problem.

Page Ref: 218

8. The first few phases of an external audit are completed:

a. In person at your office.

b. In person at the investigator’s office.

c. Over the telephone.

d. Electronically.

Feedback: The first few phases of an external audit are completed electronically.

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9. Multiple agencies from ___ have the authority to audit your facility.

a. private insurance companies

b. state government

c. federal government

d. All of these

Feedback: Multiple agencies from private insurance companies, state government, and the federal government have the authority to audit your facility.

Page Ref: 221

10. One of the best ways to prepare for an external audit is to:

a. Hire a good attorney.

b. Perform an internal audit.

c. Erase all applicable files from the server.

d. All of the above

Feedback: One of the best ways to prepare for an external audit is to perform an internal audit.

Page Ref: 220

11. The three categories of problems that need to be uncovered and addressed include:

a. Covert problems.

b. Safety protocols.

c. Restitution.

d. Uncovering excuses.

Feedback: Three categories of problems that need to be uncovered and addressed include covert problems.

Page Ref: 218

12. An example of an overt problem is:

a. A physician who is a functioning alcoholic.

b. Upcoding on claim forms.

c. Medical assistants gossiping about patients.

d. A nurse stealing drugs.

Feedback: An overt problem is a non-compliant event that is obvious or easily seen—for example, medical assistants gossiping about patients.

Page Ref: 218

13. One method for identifying overt problems is to:

a. Ask around the cafeteria.

b. Take patient complaints seriously.

c. Interrogate all staff members.

d. Complete a staff survey.

Feedback: One method for identifying overt problems is to take patient complaints seriously.

Page Ref: 218

14. An investigation focused on analyzing and evaluating certain amounts of data is known as:

a. An evaluation.

b. A scope document.

c. An audit.

d. An internal investigation.

Feedback: An investigation focused on analyzing and evaluating certain amounts of data is known as an audit.

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15. Included in the audit process, a review of all applicable ________ must be done.

a. laws

b. regulations

c. guidance

d. All of these

Feedback: Included in the audit process, review of all applicable laws, regulations, and guidance must be done.

Page Ref: 219

16. An audit was performed using data from the last 3 years, current year not included. This is known as a:

a. Concurrent audit.

b. Retrospective audit.

c. Comprehensive audit.

d. Common sampling audit.

Feedback: A retrospective audit is an assessment conducted on activities or events that have occurred in the past.

Page Ref: 220

17. An audit was planned to review a small percentage of a facility’s files by randomly choosing which records to analyze. This is known as a:

a. Comprehensive audit.

b. Concurrent audit.

c. Sampling audit.

d. Retrospective audit.

Feedback: A sampling audit is an assessment conducted on a statistically valid portion of the entire body of data.

Page Ref: 220

18. Every employee in the Pediatrics Department is directed to submit to a drug test. This is an example of a:

a. Comprehensive audit.

b. Concurrent audit.

c. Sampling audit.

d. Retrospective audit.

Feedback: A comprehensive audit is an assessment of the entire body of data to determine compliance with previously identified standards.

Page Ref: 220

19. You instruct your assistant to review the records of all employees who work in the clinic to ensure all vaccinations are up-to-date. This is an example of:

a. External audit.

b. Internal audit.

c. Manufactured audit.

d. Abuse of power.

Feedback: An internal audit is an assessment to determine compliance performed by and initiated by the organization or facility itself, to look for improprieties, errors, and other wrong-doing.

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20. A valid internal audit will include all of the following steps except:

a. Determination of the scope of the audit.

b. Letting the audit team take as much time as they want.

c. Not requiring a written report.

d. All of the above

Feedback: A valid internal audit will include all of these steps: identifying the elements to be audited, determining the scope of the audit, selecting the audit team, providing a secure space, specifying the length of time for the audit to occur, and the format of the audit report.

Page Ref: 221

21. One of the reasons that many external audits are done retrospectively is that they go beyond finding errors; they look at the:

a. Education levels of all staff.

b. Gender of all staff.

c. Names and religion of all staff.

d. Ongoing repetition of the same error.

Feedback: One of the reasons that many external audits are done retrospectively is that they go beyond finding errors; they look at the ongoing repetition of the same error.

Page Ref: 221

22. For an audit to have value, the results must be:

a. Kept confidential.

b. Acted upon.

c. Publicized.

d. Copied to the Attorney General of your state.

Feedback: For an audit to have value, the results must be acted upon.

Page Ref: 221

23. An external audit of your facility may be initiated by:

a. Random selection.

b. A prescheduled annual event.

c. An alert of specific activity.

d. All of these.

Feedback: An external audit of your facility may be a matter of random selection, prescheduled annual or semi-annual event, or triggered by specific activity.

Page Ref: 221

24. What is the first thing the administrator should do after receiving notification of an external audit?

a. Pull the requested files.

b. Call a Board of Directors meeting.

c. Verify from whom the request has come.

d. Contact the facility’s attorney.

Feedback: The first thing to do, as soon as notification of an external audit is received, is to verify from whom the request has come.

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25. When going through an external audit, before receiving the auditor’s determinations, you should be certain to prepare:

a. An alibi.

b. A company check for the fines and penalties.

c. Information and documentation required for the appeals process.

d. Your résumé.

Feedback: When going through an external audit, before receiving the auditor’s determinations, you should be certain to prepare information and documentation required for the appeals process.

Page Ref: 222