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CHC |Practice |Test |questions |with |answers
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 |ANSWERS |✔✔b. |second |level | appeal There |are |five |levels |of |appeal. First |level |entails |a |redetermination |of |claim; |second |level |involves | reconsideration |by |a |qualified |independent |contractor; |third |level | includes |a |hearing |overseen |by |admin |law |judge; |fourth |level |is |a | review |of |Medicare |Review |Council; |and |fifth |level |is |a |judicial | review |in |federal |court. If |an |at-risk |patient |is |left |unattended |and |has |an |adverse | response |to |medication, |this |is |known |as: a. |sentinel |event b. |initiator c. |latent |outcome d. |slip |- |CORRECT |ANSWERS |✔✔a. |sentinel |event
Sentinel |event |is |an |adverse |occurrence |that |is |not |in |the |normal | progression |of |a |patient's |illness. |In |this |scenario, |an |adverse |drug | event |is |considered |a |sentinel |event. |AND |whenever |a |sentinel | events |is |confirmed, |the |facility |should |perform |a |Root |Cause | Analysis |(RCA). A |Latent |Outcome |- |less |apparent |failures |of |organization |or | design |that |contributed |to |the |error/patient |harm. A |Slip |- |can |be |a |fall |or |an |everyday |risk |at |hospitals. A |behavioral |health |specialist |notices |a |particularly |high |number |of | restraint |deaths |at |a |facility. |An |analysis |of |the |root |causes |of | these |events |is |most |likely |to |indicate |problems |with: a. |Equipment b. |Staff |orientation |and |training c. |Staffing |levels d. |Alarm |systems |- |CORRECT |ANSWERS |✔✔b. |Staff |orientation |and | training Equipment, |staffing |levels, |and |alarm |system |can |also |be |culpable | in |restraint |deaths, |but |problems |with |orientation |and |training |are | much |more |likely.
When |a |hospital |official |notes |that |most |errors |are |occurring |at | the |"sharp |end" |she |means |that: a. |they |involve |surgical |tools |or |knives b. |they |occur |in |clusters c. |they |occur |during |the |interactions |between |caregivers |and | patients d. |they |are |most |likely |to |occur |during |busy |periods |- |CORRECT | ANSWERS |✔✔c. |they |occur |during |the |interactions |between | caregivers |and |patients. The |"sharp |end" |and |"blunt |end" |are |used |by |quality |management | professionals |to |describe |areas |of |practice. | "Sharp |end" |is |all |of |the |operations |that |involve |direct |contact |with | patient/client/customer. "Blunt |end" |is |all |actions |that |take |place |outside |awareness |of | patient/client/customer. The |majority |of |fraud |and |abuse |violations |relate |to |irregularities |in: a. |treatment b. |diagnosis c. |billing d. |scheduling |- |CORRECT |ANSWERS |✔✔c. |billing
Which |of |the |following |words |best |describe |the |approach |to | punishment |of |the |Federal |Sentencing |Guidelines: a. |case-specific b. |draconian c. |consistent d. |remedial |- |CORRECT |ANSWERS |✔✔a. |case-specific FSG |takes |numerous |factors |into |account |when |determining | punishment. |The |range |of |penalties |that |may |be |applied |to |a |given | violation |is |broad, |and |organizations |may |affect |the |severity |of | their |punishment |with |their |actions |subsequent |to |the |violation Which |of |the |following |groups |may |request |information |from |the | Healthcare |Integrity |and |Protection |Data |Bank? a. |professional |societies |with |formal |peer |review b. |quality |improvements |organizations c. |plaintiff's |attorneys d. |state |agencies |- |CORRECT |ANSWERS |✔✔d. |state |agencies Other |groups |may |include |federal |government, |health |plans, | healthcare |practitioners. |Researchers |are |only |allowed |to |obtain | statistical |data |form |the |data |bank.
d. |nurses |- |CORRECT |ANSWERS |✔✔c. |independent |contractors Why |does |Healthcare |Quality |Improvement |Act |provide | confidentiality |and |legal |immunity |for |health |care |peer |review | processes? a. |to |prevent |malpractice |suits b. |to |discourage |complaints |by |patients c. |to |encourage |participation |by |physicians d. |to |maintain |a |sterile |work |environment |- |CORRECT |ANSWERS | ✔✔c. |to |encourage |participation |by |physicians The |Healthcare |Quality |Improvement |Act |provides |confidentiality | and |legal |immunity |for |healthcare |Peer |Review |process |to | encourage |participation |by |physicians. Which |type |of |subpoena |calls |for |the |delivery |of |certain |documents | to |the |court? a. |subpoena |habeas |corpus b. |subpoena |ad |testificandum c. |subpoena |add |infinitum d. |subpoena |duces |tectum |- |CORRECT |ANSWERS |✔✔d. |subpoena | duces |tectum
"subpoena |ad |testificandum" |- |means |the |court |demands |specific | person |appear |and |give |testimony. The |other |options |are |not |legal |terms. Which |of |the |following |is |generally |NOT |included |in |an |Explanation | of |Benefits |(EOB): a. |date |of |service b. |insurance |code |for |service c. |doctor's |fee d. |patient's |medical |history |- |CORRECT |ANSWERS |✔✔d. |patient's | medical |history EOB |only |explains |the |elements |of |the |medical |treatment |that |are | covered |by |health |insurance |policy A |healthcare |facility's |income |statement |is |an |example |of: a. |baseline |audit b. |retrospective |audit c. |concurrent |audit d. |snapshot |audit |- |CORRECT |ANSWERS |✔✔b. |retrospective |audit Concurrent |audit |is |real-time |evaluations |of |records/policies.
CPT |category |I: |evaluation |& |management. CPT |category |II: |performance |measurement. CPT |category |III: |emerging |technology. Because |of |a |doctor's |poor |handwriting, |a |prescription |must |be | reworked |before |it |leaves |the |pharmacy. |Which |of |the |following |is | true? a. |the |doctor |should |be |reprimanded b. |the |pharmacy |should |incorporate |bar |coding c. |the |prescription |should |not |count |towards |the |pharmacy's |yield d. |the |error |should |be |reported |to |the |FDA |- |CORRECT |ANSWERS | ✔✔c. |the |prescription |should |not |count |towards |the |pharmacy's | yield The |legal |doctrine |that |assigns |responsibility |to |a |doctor |for |the | behavior |of |his |or |her |employee |is: a. |Good |Samaritan b. |Qui |Tam c. |Respondeat |superior d. |Res |ipsa |loquitor |- |CORRECT |ANSWERS |✔✔c. |Respondeat |superior Res |ipsa |loquitor |means |"the |facts |speak |for |themselves"
In |general, |how |many |steps |should |a |failure |modes |and |effects | analysis |(FMEA) |proceed |in |each |direction? a. |one b. |two c. |five d. |ten |- |CORRECT |ANSWERS |✔✔b. |two Two-part |process:
- |identification |of |errors/defects |(failure |modes).
- |consideration |of |consequences |(effect |analysis). Which |piece |of |legislation |mandates |the |companies |with |securities | listed |in |the |United |States |abide |by |generally |accepted |accounting | practices? a. |Foreign |Corrupt |Practices |Act b. |Emergency |Medical |Treatment |and |Active |Labor |Act c. |False |Claims |Act d. |Civil |Monetary |Penalties |Act |- |CORRECT |ANSWERS |✔✔a. |Foreign | Corrupt |Practices |Act Which |piece |of |legislation |made |qui |tam |lawsuits |possible? a. |Fair |Labor |Standards |Act
Upcoding |- |the |provider |may |be |using |the |same |service/procedure | code, |but |he/she |chooses |the |one |that |offers |higher |reimbursement |rate. |Usually, |upcoding |is |used |regarding |CPT |codes. |For |instance: | the |three |CPT |codes |below |are |for |the |same |service |"PT |elevation". | But |you |can |see |there |is |a |minor |differentiation, |and |the |higher | the |complexity, |the |higher |the |reimbursement. 97161: |PT |evaluation |- |low |complexity 97162: |PT |evaluation |- |moderate |complexity 97163: |PT |evaluation |- |high |complexity Example |from |Frank |a |while |back: Upcoding...you |receive | 15 |mins |of |physical |therapy |services...but | the |physician |bills |for | 30 |minutes |of |"advanced" |physical |therapy | services |In |other |words, |I |give |you |a |hamburger |but |I |bill |as |if |I | gave |you |a |steak |dinner. Which |of |the |following |would |result |in |a |healthcare |provider | receiving |a |new |NPI? a. |change |of |job |description b. |change |last |name c. |change |in |work |location d. |none |of |the |above |- |CORRECT |ANSWERS |✔✔d. |none |of |the |above
Which |of |the |following |conditions |must |be |met |for |a |patient |no | longer |be |deserving |of |service |under |EMTALA? a. |the |patient |must |have |provided |the |contact |information |of |a | person |who |can |care |for |him |or |her |upon |discharge b. |the |patient |must |be |able |to |feed |himself |without |special | equipment c. |the |patient |must |be |alert d. |the |patient |must |be |able |to |communicate |without |special | equipment |- |CORRECT |ANSWERS |✔✔c. |the |patient |must |be |alert | (patient |is |stable |or |no |longer |on |emergency |medical |condition) Which |of |the |following |is |NOT |a |possible |punishment |for |a | violation |of |the |Stark |Law? a. |denial |of |payment |for |the |services |provided b. |exclusion |from |Medicare |Program c. |Fine d. |Incarceration |- |CORRECT |ANSWERS |✔✔d. |Incarceration Stark |Law |applies |to |civil |law |only, |so |incarceration |would |not |be |a | possible |punishment |for |violation |of |stark |law. However, |stark |law |penalties |may |include: |fines, |denial |of |payment | for |services |provided, |refund |of |money |already |collected, |exclusion | from |Medicare/Medicaid |or |other |state |healthcare |program.
PERT |lead |time |- |interval |within |which |a |proceeding |event |must |be | finished |to |allow |time |to |complete |next |step |in |process. PERT |fast |track |- |accelerating |processes |by |performing |several | activities |at |once. And |critical |path |is |the |minimum |duration |of |the |project. Which |of |the |following |is |NOT |one |of |the |prerequisites |for |the | voluntary |self-disclosure |program |administered |by |the |OIG? a. |the |disclosing |party |must |describe |the |wrongdoing |and |the | harm |that |may |have |been |caused |to |federal |programs b. |the |disclosure |may |not |be |the |result |of |investigation |or |a | pending |proceeding c. |the |disclosure |must |not |be |the |subject |of |a |bankruptcy | proceeding d. |the |disclosure |must |be |on |behalf |of |an |individual |rather |than |an | entity |- |CORRECT |ANSWERS |✔✔d. |the |disclosure |must |be |on |behalf | of |an |individual |rather |than |an |entity Which |of |the |following |is |NOT |one |of |the |categories |of |obligations | outlined |in |the |Code |of |Ethics |for |healthcare |compliance | professionals |issued |by |the |Health |Care |Compliance |Association? a. |obligations |to |the |public b. |obligations |to |the |government c. |obligations |to |the |employing |organization
d. |obligations |to |the |profession |- |CORRECT |ANSWERS |✔✔b. | obligations |to |the |government Before |conducting |a |safety |audit |in |an |emergency |department, |and | administrator |first |needs |to |obtain: a. |a |list |of |the |employees |in |that |department b. |a |map |of |the |department c. |a |written |set |of |safety |standards d. |statistics |on |adverse |events |- |CORRECT |ANSWERS |✔✔c. |a |written | set |of |safety |standards Which |of |the |following |is |NOT |covered |by |the |Stark |Law? a. |physician |services b. |physical |therapy |services c. |clinical |laboratory |services d. |occupational |therapy |services |- |CORRECT |ANSWERS |✔✔a. | physician |services Stark |Law |is |only |applicable |to |Designated |Health |Services |(DHS) The |secretary |of |which |federal |agency |oversees |the |FDA? a. |Occupational |Safety |and |Health |Administration b. |General |Services |Administration
The |practice |of |separating |claims |which |should |be |billed |together | is |known |as: a. |upcoding b. |unbundling c. |DRG |creep d. |kickback |- |CORRECT |ANSWERS |✔✔b. |unbundling A |hospital's |medication |system |is |vast, |and |various |element |of |it | fall |within |the |purview |of |several |different |departments. |One | important |step |forwards |reducing |errors |in |this |system |is |to: a. |make |each |department |responsible |for |the |system |as |a |whole b. |have |each |department |use |the |same |self-assessment |tools c. |give |a |single |person |responsibility |for |overseeing |the |entire | system d. |simplify |it |- |CORRECT |ANSWERS |✔✔c. |give |a |single |person | responsibility |for |overseeing |the |entire |system Which |type |of |audit |is |generally |recommended |for |healthcare | compliance |programs? a. |concurrent |audit b. |baseline |audit c. |retrospective |audit
d. |snapshot |audit |- |CORRECT |ANSWERS |✔✔a. |concurrent |audit In |concurrent |audit, |real-time |evaluation, |problems |are |identified | and |resolved |as |they |emerge. Which |piece |of |legislation |applies |to |claims |that |were |NOT | provided |as |requested? a. |False |Claims |Act b. |Civil |Monetary |Penalties |Law c. |Employee |Retirement |Income |Security |Act d. |Balanced |Budget |Act |of | 1997 |- |CORRECT |ANSWERS |✔✔b. |Civil | Monetary |Penalties |Law In |comprehensive |error |rate |testing |(CERT), |the |proportion |of |paid | and |denied |claims |that |are |incorrectly |handled |is |known |as: a. |fiscal |liability |rate b. |total |claims |error |rate c. |denied |claims |error |rate d. |paid |claims |error |rate |- |CORRECT |ANSWERS |✔✔d. |paid |claims | error |rate Medicare |contractors |use |this |rate |as |a |quick |gauge |of |how |claims | errors |are |affecting |Medicare |Trust |Fund.
