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[Show more]True or False: 
The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). 
True 
 
ref. ACA section 6102 
 
 
 
According to HHS-OIG - what are three important reasons for proper documentation in...
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Add to cartTrue or False: 
The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). 
True 
 
ref. ACA section 6102 
 
 
 
According to HHS-OIG - what are three important reasons for proper documentation in...
Chapter 8 Federal Sentencing Guidelines (FSG) correct answersGuidelines and policy in this section apply to sentencing in federal criminal prosecution when the convicted defendant is an organization 
 
FSG- 4 factors that increase ultimate punishment of an organization correct answers1.Involvement i...
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Add to cartChapter 8 Federal Sentencing Guidelines (FSG) correct answersGuidelines and policy in this section apply to sentencing in federal criminal prosecution when the convicted defendant is an organization 
 
FSG- 4 factors that increase ultimate punishment of an organization correct answers1.Involvement i...
HIPAA became law 
1996 
 
 
 
What is the purpose of HIPAA? 
• To make health insurance portable under ERISA; 
• To move health care onto a nationally standardized electronic billing platform; and 
• To prevent fraud, waste and abuse 
 
 
 
Intent 
purpose of this subtitle to improve the Medic...
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Add to cartHIPAA became law 
1996 
 
 
 
What is the purpose of HIPAA? 
• To make health insurance portable under ERISA; 
• To move health care onto a nationally standardized electronic billing platform; and 
• To prevent fraud, waste and abuse 
 
 
 
Intent 
purpose of this subtitle to improve the Medic...
What is the purpose of HIPAA? correct answers• Protect PHI from unauthorized disclosure/use; 
• Prevent fraud, waste and abuse (via Administrative Simplification); 
• Make health insurance portable under ERISA; 
• Move health care onto a nationally standardized electronic billing platform 
 ...
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Add to cartWhat is the purpose of HIPAA? correct answers• Protect PHI from unauthorized disclosure/use; 
• Prevent fraud, waste and abuse (via Administrative Simplification); 
• Make health insurance portable under ERISA; 
• Move health care onto a nationally standardized electronic billing platform 
 ...
At which level of the Medicare Part A or B appeals process is the appeal reconsidered by a qualified independent contractor? 
a. first level appeal 
b. second level appeal 
c. third level appeal 
d. fourth level appeal correct answersb. second level appeal 
 
There are five levels of appeal. 
First ...
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Add to cartAt which level of the Medicare Part A or B appeals process is the appeal reconsidered by a qualified independent contractor? 
a. first level appeal 
b. second level appeal 
c. third level appeal 
d. fourth level appeal correct answersb. second level appeal 
 
There are five levels of appeal. 
First ...
A compliance professional has been working with a department director to implement a new policy regarding timely completion of medical records. Which of the following should be completed by the department manager to promote compliance with the new policy? 
a. Statistically valid sampling audit 
b. M...
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Add to cartA compliance professional has been working with a department director to implement a new policy regarding timely completion of medical records. Which of the following should be completed by the department manager to promote compliance with the new policy? 
a. Statistically valid sampling audit 
b. M...
Federal Sentencing Guidelines - Culpability Score Aggravating Factors correct answers1. upper-level employee participates, condones, or ignores offense 
2. repeat offense 
3. hinder investigation 
4. awareness and tolerance of violation is pervasive 
 
Federal Sentencing Guidelines - Culpability Sco...
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Add to cartFederal Sentencing Guidelines - Culpability Score Aggravating Factors correct answers1. upper-level employee participates, condones, or ignores offense 
2. repeat offense 
3. hinder investigation 
4. awareness and tolerance of violation is pervasive 
 
Federal Sentencing Guidelines - Culpability Sco...
Education & training: When designing curriculum for the audit learner correct answersUnderstand whether the concepts or ideas will be in concert or in conflict with the learner. 
 
If State law is more/less strict than HIPAA correct answersThe more strict law governs 
 
HIPAA stands for correct answ...
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Add to cartEducation & training: When designing curriculum for the audit learner correct answersUnderstand whether the concepts or ideas will be in concert or in conflict with the learner. 
 
If State law is more/less strict than HIPAA correct answersThe more strict law governs 
 
HIPAA stands for correct answ...
Organizations receiving more than $5 million in Medicaid funds must provide education on the False Claims Act (FCA) in accordance with the: 
a. Stark Laws 
b. Deficit Reduction Act (DRA) 
c. Anti-Kickback (AKS) Law 
d. Sherman Antitrust Law correct answersb. Deficit Reduction Act (DRA) 
 
An Organiz...
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Add to cartOrganizations receiving more than $5 million in Medicaid funds must provide education on the False Claims Act (FCA) in accordance with the: 
a. Stark Laws 
b. Deficit Reduction Act (DRA) 
c. Anti-Kickback (AKS) Law 
d. Sherman Antitrust Law correct answersb. Deficit Reduction Act (DRA) 
 
An Organiz...
Affordable Care Act correct answersAllowed more hospital construction bc it allowed hospitals to more confidently predict their finances. More infrastructure, tech and finance influence construction also. 
 
FGI: Guidelines (2014 Edition 2) correct answersFACILITY GUIDELINES INSTITUTE: Guidelines fo...
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Add to cartAffordable Care Act correct answersAllowed more hospital construction bc it allowed hospitals to more confidently predict their finances. More infrastructure, tech and finance influence construction also. 
 
FGI: Guidelines (2014 Edition 2) correct answersFACILITY GUIDELINES INSTITUTE: Guidelines fo...
Informed Consent correct answersA statement that the study involves research. Explanation of purpose of research. Expected duration of subject's participation. Procedures to be followed. Identification of experimental procedures. Reasonably foreseeable risks or discomforts. Benefits to subject or t...
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Add to cartInformed Consent correct answersA statement that the study involves research. Explanation of purpose of research. Expected duration of subject's participation. Procedures to be followed. Identification of experimental procedures. Reasonably foreseeable risks or discomforts. Benefits to subject or t...
7 elements correct answersPolicies & Procedures 
Oversight Responsibilities/Assignments 
Oversight Responsibilities/Due Care 
Education and Training 
Monitoring and Auditing 
Enforcement and Discipline 
Response and Prevention 
 
ECHO correct answersEconomic, Clinical and Humanistic Outcomes 
 
Econ...
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Add to cart7 elements correct answersPolicies & Procedures 
Oversight Responsibilities/Assignments 
Oversight Responsibilities/Due Care 
Education and Training 
Monitoring and Auditing 
Enforcement and Discipline 
Response and Prevention 
 
ECHO correct answersEconomic, Clinical and Humanistic Outcomes 
 
Econ...
True or False: 
 
The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). 
True 
 
 
 
According to HHS-OIG - what are three important reasons for proper documentation in Compliance? 
 
1.Prote...
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Add to cartTrue or False: 
 
The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). 
True 
 
 
 
According to HHS-OIG - what are three important reasons for proper documentation in Compliance? 
 
1.Prote...
A compliance program at its most basic level would be: (think of the 1st CP element) correct answersA set of internal policies and procedures that you put into place to help your organization comply with the law. 
 
Before developing a Compliance Program, FIRST, conduct a ___ _______, then, NEXT, __...
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Add to cartA compliance program at its most basic level would be: (think of the 1st CP element) correct answersA set of internal policies and procedures that you put into place to help your organization comply with the law. 
 
Before developing a Compliance Program, FIRST, conduct a ___ _______, then, NEXT, __...
A compliance professional is trying to determine if attorney client privilege should be requested. The compliance professional's policy should require attorney-client privilege to be established in which of the following situations: 
a. Violation of employee that occurred outside of the organizatio...
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Add to cartA compliance professional is trying to determine if attorney client privilege should be requested. The compliance professional's policy should require attorney-client privilege to be established in which of the following situations: 
a. Violation of employee that occurred outside of the organizatio...
A compliance professional conducts an investigation into allegations of physicians and nurses taking pictures of injuries and posting them on a social network. It is confirmed that the two physicians and a nurse have engaged in this behavior. Which of the following is the compliance professional's ...
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Add to cartA compliance professional conducts an investigation into allegations of physicians and nurses taking pictures of injuries and posting them on a social network. It is confirmed that the two physicians and a nurse have engaged in this behavior. Which of the following is the compliance professional's ...
Anti-Kickback Law correct answersProhibits the solicitation, receiving, offering, or paying of any remuneration directly or indirectly in cash or in kind in exchange. 
 
Audit - Baseline correct answersA systematic inspection of records, policies, and procedures with the goal to establish a set of b...
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Add to cartAnti-Kickback Law correct answersProhibits the solicitation, receiving, offering, or paying of any remuneration directly or indirectly in cash or in kind in exchange. 
 
Audit - Baseline correct answersA systematic inspection of records, policies, and procedures with the goal to establish a set of b...
Compliance Program correct answersfollowing rules and regulations 
 
Integrity Program correct answersvalues and doing the right thing 
 
Current Compliance activities in many organization correct answerso Equal Employment Opportunity Commission (EEOC) 
o Employee Retirement Income Security Act (ERI...
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Add to cartCompliance Program correct answersfollowing rules and regulations 
 
Integrity Program correct answersvalues and doing the right thing 
 
Current Compliance activities in many organization correct answerso Equal Employment Opportunity Commission (EEOC) 
o Employee Retirement Income Security Act (ERI...
5 most important federal fraud and abuse laws: correct answers*False Claims Act (FCA) 
*Anti - kickback Statute (AKS) 
*Physician Self-Referral Law (Stark I II III ) 
*Exclusion Authorities 
*Civil Monetary Penalties Law (CMPL) 
 
The purpose of EMTALA is to prevent: 
a. Hospitals from rejecting pat...
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Add to cart5 most important federal fraud and abuse laws: correct answers*False Claims Act (FCA) 
*Anti - kickback Statute (AKS) 
*Physician Self-Referral Law (Stark I II III ) 
*Exclusion Authorities 
*Civil Monetary Penalties Law (CMPL) 
 
The purpose of EMTALA is to prevent: 
a. Hospitals from rejecting pat...
What does paragraph 7A of the One to Four Family Residential contract grant every buyer the right to do? correct answershave the property inspected 
 
If a property is occupied solely by people over the age of 62 and qualifies as senior housing it is exempt from: correct answersthe familial status p...
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Add to cartWhat does paragraph 7A of the One to Four Family Residential contract grant every buyer the right to do? correct answershave the property inspected 
 
If a property is occupied solely by people over the age of 62 and qualifies as senior housing it is exempt from: correct answersthe familial status p...
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