RHIT Domain 5 – Compliance Practice Test

These questions are part of the practice quiz. Start practicing

• What aspect of a facility’s operations should incident reports serve?
• In a compliance program, what is one essential method to protect whistleblowers?
• How is the confidentiality of an incident report affected when it is documented in the health record?
• What type of disclosure is calling out patient names in a physician's office considered?
• Why is it important for compliance team members to be involved in EHR implementation?
• What is the first step in any quality improvement process?
• Which of the following is an example of unethical documentation in healthcare?
• Which resource should a facility compliance officer consult for reviews and audits in health programs?
• What is considered unsecured PHI?
• What is required when HHS identifies a healthcare facility as committing fraud?
• In the context of compliance, what is essential for an effective audit process?
• What is the purpose of the Coding Compliance Program?
• Every healthcare organization's risk management plan should include all of the following components EXCEPT:
• What is a primary responsibility of the Medicare Integrity Program?
• If a patient notices an unfamiliar item on their explanation of benefits, what should they do?
• What is the principal tool used by risk managers for incident documentation?
• Which step of risk analysis focuses on identifying information assets that need protection?
• Coding policies should include which important element?
• Which action can enhance compliance with EHR documentation standards?
• What term is used to describe billing for services not rendered?
• What is the fine for a hospital that unbundled laboratory charges resulting in an overpayment of $75 on each of 175 claims?
• Healthcare abuse often results from which type of practices?
• What document indicates that a patient’s protected health information was involved in a data breach?
• What type of plan should be developed in response to findings from operational audits in clinical documentation improvement?
• What is the term for a notice that suspends the destruction of paper or electronic records?
• When a patient's information is shared improperly with others, what is this an example of?
• Which category of information is considered to require special attention due to its sensitivity?
• Which report is primarily used by risk managers to document potentially compensable events?
• What is the recommended best practice for protecting information in text messages sent within healthcare?
• What action should an HIM director recommend if transcribed reports are changed by the author after transcription?
• The process of compliance aims to prevent which of the following?
• What type of agreement may be imposed by the OIG when fraud is detected?
• What must be demonstrated in healthcare communication to mitigate the risk of misinformation when sending orders?
• What action is referred to when a healthcare professional removes medication from the usual stream for personal use?
• Which of the following is NOT a requirement under the Breach Notification Rule?
• What term describes the removal of medication from its usual preparation and administration for unauthorized use?
• According to the Fair and Accurate Credit Transactions Act (FACTA), which of the following is NOT considered a red flag category?
• Which statement is true regarding drug diversion in healthcare settings?
• What action should be taken if a patient’s record is found to be delinquent?
• Which program do Quality Improvement Organizations (QIOs) conduct audits on for payment error prevention?
• What security mechanism would best minimize unauthorized viewing of a computer screen at a healthcare facility?
• Corporate compliance programs became common after the adoption of which legislation?
• What control should have been in place to minimize a security breach when a laboratory employee forgot his password?
• What process ensures the quality and safety of healthcare for patients and employees through ongoing surveillance and prevention of infections?
• What should an HIM director do if they find nurses are improperly using copy and paste in EHR documentation?
• What term describes the notification system when a user looks up a patient with the same last name?
• In performance improvement, what is meant by the “structure of a system determines its performance” principle?
• The National Patient Safety Goals require healthcare organizations to examine care processes for potential errors. Which of the following is one of those processes?
• Which measure is NOT typically used to track clinical documentation improvement (CDI) programs?
• What mechanism does the OIG use to oversee compliance activities in organizations?
• What should the data collection process in healthcare organizations be based on?
• Which entity is responsible for establishing compliance with health regulations in healthcare facilities?
• In a healthcare setting, what does PHI stand for?
• Which of these is considered a primary responsibility of health information management professionals?
• In compliance practices, what is essential for maintaining ethical healthcare standards?
• What is an example of a reviewable sentinel event?
• In a medical identity theft protection program, what should the HIM professional NOT do?
• During an audit, identifying weaknesses in clinical documentation can lead to what kind of plan?
• Which of the following would constitute deceptive coding practice?
• Which of the following is a way to demonstrate compliance with OIG guidelines?
• What is the purpose of maintaining detailed query documentation in healthcare?
• What are the key factors involved in risk determination?
• How many identifiers must be removed for data to be considered deidentified under the Safe Harbor Method?
• What are safe harbors in relation to the Federal Anti-Kickback Statute?
• What category does a healthcare facility guilty of failing to comply with legislative requirements fall into if they tried but failed?
• What does unbundling in healthcare billing refer to?
• What must be included in the designated record set according to HIPAA?
• What data source is appropriate to investigate complaints about turnaround times for ROI requests?
• Which coder at the Community Hospital requires additional assistance to meet the coding standard?
• What does compliance in a healthcare organization primarily promote?
• What is the impact of improper handling of overpayments in healthcare billing?
• Which group is involved in the feedback loop between denials, management, and clinical documentation improvement (CDI) program staff?
• What type of audit is conducted by an external organization such as The Joint Commission?
• To comply with HIPAA requirements for fundraising, what must a hospital inform individuals in its notice of privacy practices?
• In healthcare compliance, what does the term 'spoliation' refer to?
• What term refers to billing for services that are not covered by insurance?
• Which of the following is a key component of a compliant clinical documentation improvement program?
• What is the goal of a clinical documentation improvement (CDI) compliance review?
• If a hospital's medical staff rules state that records should not be delinquent for more than 15 days after discharge, what can be concluded if records are delinquent for an average of 29 days?
• Which professional is responsible for ensuring compliance with healthcare regulations in a facility?
• In the context of a healthcare organization, what is 'willful neglect'?
• Which of the following practices is NOT an example of high-risk billing practices that create compliance risks?
• Which of the following is NOT a part of the Medicare Integrity Program?
• Offering $100 for each patient referral violates which statute?
• According to HIPAA regulations, what should be done with records from a previous hospital when a patient requests her health records?
• Which of the following are basic functions of healthcare risk management programs?
• What crime is committed when a pharmacist submits Medicaid claims for reimbursement on brand name drugs instead of dispensed generic drugs?
• A hospital employee navigated a violation on electronic documentation. What documentation practice creates a risk of violations?
• What is the minimum duration for which HIPAA requires data security policies and procedures to be maintained?
• Which department should the clinical documentation improvement (CDI) staff create a feedback loop with to avoid conflicts?
• What is an example of medical identity theft?
• Identifying risk areas is crucial in which process?
• What is the process called that addresses vulnerabilities in systems containing protected health information (PHI)?
• Which item is NOT included in the policies and procedures section of a coding compliance plan?
• What is an essential component of a compliance program related to healthcare quality improvement?
• What type of identity theft occurs when a patient uses another person's name and insurance for healthcare benefits?
• What is the first step in the expert determination model for de-identification of data?
• Which type of breach must be reported to affected individuals?
• What document is sent to providers when the Medicare Recovery Audit Contractor determines an incorrect payment?
• What is the first step when corrective action is required in the HIM department?
• Which of the following actions is an example of healthcare fraud?
• In healthcare compliance, what does the term "unbundling" refer to?
• What is the primary benefit of implementing automatic session terminations on workstations?
• What legal obligation arises from the loss of a USB drive containing patient information?
• What system assists pharmacists in checking for drug contraindications at a hospital?
• What action should healthcare facilities take to prevent sentinel events?
• Which principle of contemporary performance improvement emphasizes the importance of collecting and analyzing data?
• When it comes to electronic health records, what do subpoenas often request?
• In Medicare, which of the following is NOT a common form of fraud and abuse?
• If an HIM department disregards official coding guidelines, what might they be committing?
• What is a recommended basis for evaluating coders?
• In an acute-care setting, which documents are monitored in claims reconciliation and collections?
• What is NOT recommended by the HHS and OIG for clinical documentation compliance?
• Which resource should be reviewed annually to identify compliance focus areas?
• What is the primary goal of a healthcare risk management program?
• What is an important factor that healthcare organizations should prioritize for monitoring?
• What is a sentinel event in healthcare?
• What is the main concern of healthcare compliance in the claims processing system?
• In an internal coding audit review program, which risk area is prioritized for auditing?
• When informing individuals of a PHI breach, which of the following details is not required to be shared?
• When an RAC conducts a claim determination without human review of health records, this type of review is known as what?
• What describes a coder's misrepresentation of the patient's clinical picture intentional coding or omission of codes?
• How often should the coding staff be updated on compliance requirements?
• Which document can be considered a discoverable item in a legal proceeding?
• What term describes the overutilization or inappropriate utilization of services and misuse of resources, typically not a criminal act?
• What encompasses the education and training that the health information manager should provide annually?
• National patient safety goals primarily focus on preventing what?
• What essential information should be included in a demand letter from a Recovery Audit Contractor?
• Breach notification requirements apply to which type of PHI?
• In the clinical documentation improvement (CDI) program, maintaining thorough query documentation is necessary for which purpose?
• According to compliance standards, which of the following principles should a compliance program follow?
• A Joint Commission-accredited organization must review its formulary annually to ensure what?
• What is one benefit of a coding compliance plan?
• What are events that do not affect outcomes but could lead to serious adverse events if they recur referred to as?
• What is the purpose of an external audit?
• Quality Improvement Organizations are responsible for reviewing which aspect of Medicare and Medicaid claims?
• What is the name of the report that captures details about potentially compensable events?
• Which of the following practices is an appropriate coding compliance activity?
• In a compliance program, why is it important to choose the right expert for de-identification?
• What should organizations do to address risks related to health information security?
• Which of the following is not considered healthcare fraud?
• If a coding audit reveals a coder is assigning incorrect codes for higher reimbursement, what should be the next step?
• What is the main goal of infection control in healthcare settings?
• What is one of the legal concerns associated with electronic health records (EHR)?
• Which group is usually excluded from coding compliance education participants?
• What constitutes an intentional healthcare fraud?
• Which of the following best describes a coding compliance issue?
• According to The Joint Commission, healthcare organizations must collect data for improvement on which area?
• Which of the following should be regularly audited in a monitoring program for inpatient coding compliance?
• What is considered the most constant threat to health information integrity?
• What document outlines policies and procedures for an effective compliance program?
• Which is NOT a goal of a coding compliance program?
• What is a core part of a coding compliance program?
• What is the primary goal of coding compliance programs?
• What is considered a component of internal monitoring in organizations?
• What action should be taken if the HIM department's error rate is too high?
• What is one element included in a compliance program as outlined by the OIG?
• What type of event was identified when a visitor fell and fractured his femur due to spilled water?
• If a facility submits multiple claims for the same service, resulting in excessive reimbursement, this is termed what?
• What investigational technique is used to identify factors contributing to a problem?
• What is the minimum expected number of medical records a coder should code per day?
• What is the purpose of the hotline in a compliance program?
• What is required of covered entities under the Breach Notification Rule?
• Which practice could lead healthcare providers to commit fraud unintentionally?
• What should be done with sensitive health information to comply with regulations?
• What is a core element of an effective compliance program as defined by the Federal Sentencing Guidelines?
• Which of the following is considered a breach of PHI?
• Which focus area is NOT part of claims auditing in an emergency department?
• Which aspect of healthcare documentation should be closely monitored to ensure compliance?
• What can a physician be sued for if they leave sensitive medical records in a public place?
• What is a common consequence of healthcare abuse?
• What is the number of basic elements in an effective compliance program?
• What risk is associated with copying and pasting patient documentation in electronic health records?
• A hospital employee destroyed a health record to prevent damaging evidence at trial. What legal term describes this action?
• Which of the following is an example of a reviewable sentinel event?
• Which organization issues compliance program guidance?
• How is healthcare fraud defined?
• What type of diagram is effective in analyzing cause-and-effect relationships?
• What is the primary goal of internal auditing programs for billing and coding?
• What is the best action to validate that a clinical documentation improvement (CDI) program is achieving its goals?
• In the case of Sarah who falsely claims to have passed her RHIT exam, what should Nancy and Joan do?
• Which of the following is assessed in a qualitative analysis review?
• What does the term 'upcoding' refer to in Medicare fraud?
• What action should a healthcare provider take immediately after identifying a potential compliance issue?
• What is the whistleblower provision of the False Claims Act known as?
• From an evidentiary standpoint, what should incident reports not be placed in?
• A Recovery Auditing Contractor (RAC) performs what type of review using electronic methods?
• Which role primarily focuses on mitigating risks within healthcare organizations?
• If a HIM professional refuses to release emergency room records without written authorization from the patient, is this action compliant?
• Within how many days must individual patients be notified of a data breach according to regulations?
• Which area should be targeted for audits in an internal audit review program?
• What is the reporting threshold for individual notifications in case of a data breach?
• Which question should a coding supervisor ask when evaluating potential fraud or abuse risks in coding?