D. Regularly - ✔✔For larger physician practices, how frequently does the OIG
recommend reporting compliance activities to the Board of Directors and CEO?
A. Monthly
B. Quarterly
C. Annually
D. Regularly
C. All employees will receive training on how to perform their jobs in compliance with the
standards of the practice and any applicable regulations. - ✔✔When conducting compliance
training within a physician practice, what is one of the goals that the practice should strive for
in this training?
A. Only new employees will receive training on how to perform their jobs in compliance
with the standards of the practice and any applicable regulations.
B. Managers of employees will receive training on how to perform their jobs in compliance
with the standards of the practice and any applicable regulations.
C. All employees will receive training on how to perform their jobs in compliance with
the standards of the practice and any applicable regulations.
D. All employees will receive training on the definition of compliance.
C. Ongoing auditing and monitoring will evaluate whether the physician practice's standards
and procedures are current and accurate and whether the compliance program is working. -
✔✔What is the goal of ongoing auditing and monitoring in a physician's practice?
,A. Ongoing auditing and monitoring will prevent fraud
B. Ongoing auditing and monitoring will enhance revenues by detecting instances of
undercoding.
C. Ongoing auditing and monitoring will evaluate whether the physician practice's standards
and procedures are current and accurate and whether the compliance program is working.
D. Ongoing auditing and monitoring will improve the quality of patient care.
C. Well-publicized disciplinary actions for retaliation - ✔✔A compliance program's plan for
communication should include a provision for non-retaliation for reporting fraudulent
conduct. Which method below helps ensure that an employee would be free from retribution?
A. A clearly defined chain of command for reporting potentially fraudulent conduct
B. Guaranteed anonymity
C. Well-publicized disciplinary actions for retaliation
D. A policy that encourages reporting directly to the OIG
A. Significant change in the number or type of claim rejections. - ✔✔What does the HHS
OIG suggest as possible warning signs that non-compliance may exist?
A. Significant change in the number or type of claim rejections.
B. Getting carrier newsletters pertaining to the types of service that your practice bills.
C. Consistent use of certain codes.
D. Receipt of carrier requests for documentation.
B. Create a response team, consisting of representatives from compliance, audit, and any other
relevant functional department. - ✔✔Having the ability to respond to issues enables a practice
to develop effective action plans to correct problems and prevent future problems from
occurring. What is one step that can be taken to establish compliance effectiveness for
responding to and/or preventing compliance issues?
, A. Create a response team, consisting of representatives from the compliance and audit
department.
B. Create a response team, consisting of representatives from compliance, audit, and any other
relevant functional department.
C. Create an investigation team, consisting of representatives from compliance, audit, and any
other relevant functional department.
D. Create a prevention team, consisting of representatives from compliance, audit, and
any other relevant functional department.
A. Yes. Performing the microscopic test on all patients when the results of the urinalysis are
negative could be considered medically unnecessary. - ✔✔A physician office laboratory is
authorized to perform urinalysis testing, including the microscopic analysis under their
Provider-Performed Microscopy Procedures (PPMP) certification. It has been the physician's
experience that many of his patients that have urinalysis testing done also requires the
microscopic exam. Because of this and to be able to provide better treatment, he has
established an office policy that for all urinalysis testing performed in his office, the lab should
also perform the microscopic test. Is this a
compliance risk?
A. Yes. Performing the microscopic test on all patients when the results of the urinalysis
are negative could be considered medically unnecessary.
B. Yes. The physician must always order the code for the urinalysis test with the microscopic
exam to avoid unbundling.
C. No. Because the physician is providing quality patient care, there is no compliance risk.
D. No. The physician is performing tests that are authorized under his CLIA certification so there
is no compliance risk.
C. Establish and maintain a process for pre- and post-submission review of claims to ensure
claims submitted for reimbursement accurately represent services provided, are supported by
sufficient documentation and are in conformity with any applicable coverage criteria for
reimbursement - ✔✔Billing companies should have written policies and procedures that reflect
and reinforce Federal and State statutes. These policies must create a mechanism for the billing
or reimbursement staff to communicate effectively and accurately with the health care
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