The Joint Commission (JC) requires the Factors that Affect Learning must be assessed for a
hospital or hospital owned physician practice as well as other health care facilities. When as-
sessing this element what does this include?
A. The patient's ability to read, method of learning and understanding.
B. Any language or physical disabilities.
C. Cultural beliefs.
D. All the above - ANSWER D. All the above
Report copies and printouts, films, scans, and other radio logic service image records must
be retained for how long according to Federal Regulations?
A. 10 years
B. 7 years
C. 5 years
D. 3 years - ANSWER C. 5 years
At which point should a provider repay over payments reported by self-disclosure to the of-
fice of Inspector General?
A. Make the payment to your carrier immediately.
1
,B. Make the payment at the conclusion of the OIG injury.
C. Make the payment to the carrier prior to the self disclosure.
D. Make the payment to the OIG with a self disclosure report. - ANSWER B. Make the
payment at the conclusion of the OIG injury
Which of the following may be considered essential element (s) of an operative report and
will allow for accurate coding?
A. The approach
B. The type of anesthesia required
C. The location and severity of wounds repaired
D. All of the above - ANSWER D. All of the above
Which of the following is NOT a covered entity under HIPPA?
A. Physician
B. Health Plan
C. Health Care Consultant
D. Physician Assistant - ANSWER C. Health Care Consultant
When referring to the authentication of a medical record entry, what does this entail?
A. Legible signature of author and date signed
B. A physician's order for ancillary services
C. An original document filed in the record
2
,D. The patient's personal information - ANSWER A. Legible signature of author and date
signed
What is the time limit mandated by CMS for adding a late entry to the medical record?
A. One Week
B. One Month
C. One Year
D. No time limit - ANSWER D. No time limit
When should a ABN be signed?
A. Prior to performing a statutorily excluded procedure for a Medicare beneficiary.
B. Prior to performing a procedure that may be denied due to medical necessity for a Medi-
care beneficiary.
C. Prior to submitting a claim to Medicaid for a non- service.
D. After performing a procedure and finding it is denied. - ANSWER B. Prior to performing
a procedure that may be denied due to medical necessity for a Medicare beneficiary.
Under a Corporate Integrity Agreement (CIA), how many claims must be randomly selected
to review to determine the financial error rate?
A. 15
B. 50
C. 75
D. 100 - ANSWER B. 50
3
, When using LCDs and CMS program Guidance as a resource for an audit, what should the
auditor keep in mind?
A. QICs are bound by NCDs, LMRPs, and CMS Program guidance, but ALJs and MACs are not.
B. Local carriers and QICs are bound by LCDs and LMRPs
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs
are not bound by them.
D. Local Carriers, QICs, ALJs, and MACs are all bound by NCDs and CMS program guidance. -
ANSWER C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs,
and MACs are not bound by them.
When reporting the claims review findings under a CIA audit, the Independent Review Or-
ganization (IRO) must provide:
A. A detailed analysis listing the patient files reviewed and findings and previous audit disclo-
sures for all services
B. A detailed report with a narrative explanation of finding and supporting rationale ap-
proved by the providers attorney.
C. A detailed report with an analysis and narrative explanation with findings and supporting
rationale regarding the claim review, including the results of the discovery or full sample.
D. A list of data reviewed and findings in a narrative form - ANSWER C. A detailed report
with an analysis and narrative explanation with findings and supporting rationale regarding
the claim review, including the results of the discovery or full sample.
4
hospital or hospital owned physician practice as well as other health care facilities. When as-
sessing this element what does this include?
A. The patient's ability to read, method of learning and understanding.
B. Any language or physical disabilities.
C. Cultural beliefs.
D. All the above - ANSWER D. All the above
Report copies and printouts, films, scans, and other radio logic service image records must
be retained for how long according to Federal Regulations?
A. 10 years
B. 7 years
C. 5 years
D. 3 years - ANSWER C. 5 years
At which point should a provider repay over payments reported by self-disclosure to the of-
fice of Inspector General?
A. Make the payment to your carrier immediately.
1
,B. Make the payment at the conclusion of the OIG injury.
C. Make the payment to the carrier prior to the self disclosure.
D. Make the payment to the OIG with a self disclosure report. - ANSWER B. Make the
payment at the conclusion of the OIG injury
Which of the following may be considered essential element (s) of an operative report and
will allow for accurate coding?
A. The approach
B. The type of anesthesia required
C. The location and severity of wounds repaired
D. All of the above - ANSWER D. All of the above
Which of the following is NOT a covered entity under HIPPA?
A. Physician
B. Health Plan
C. Health Care Consultant
D. Physician Assistant - ANSWER C. Health Care Consultant
When referring to the authentication of a medical record entry, what does this entail?
A. Legible signature of author and date signed
B. A physician's order for ancillary services
C. An original document filed in the record
2
,D. The patient's personal information - ANSWER A. Legible signature of author and date
signed
What is the time limit mandated by CMS for adding a late entry to the medical record?
A. One Week
B. One Month
C. One Year
D. No time limit - ANSWER D. No time limit
When should a ABN be signed?
A. Prior to performing a statutorily excluded procedure for a Medicare beneficiary.
B. Prior to performing a procedure that may be denied due to medical necessity for a Medi-
care beneficiary.
C. Prior to submitting a claim to Medicaid for a non- service.
D. After performing a procedure and finding it is denied. - ANSWER B. Prior to performing
a procedure that may be denied due to medical necessity for a Medicare beneficiary.
Under a Corporate Integrity Agreement (CIA), how many claims must be randomly selected
to review to determine the financial error rate?
A. 15
B. 50
C. 75
D. 100 - ANSWER B. 50
3
, When using LCDs and CMS program Guidance as a resource for an audit, what should the
auditor keep in mind?
A. QICs are bound by NCDs, LMRPs, and CMS Program guidance, but ALJs and MACs are not.
B. Local carriers and QICs are bound by LCDs and LMRPs
C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs, and MACs
are not bound by them.
D. Local Carriers, QICs, ALJs, and MACs are all bound by NCDs and CMS program guidance. -
ANSWER C. Local carries follow LCDs, LMRPs, and CMS program guidance, but QICs, ALJs,
and MACs are not bound by them.
When reporting the claims review findings under a CIA audit, the Independent Review Or-
ganization (IRO) must provide:
A. A detailed analysis listing the patient files reviewed and findings and previous audit disclo-
sures for all services
B. A detailed report with a narrative explanation of finding and supporting rationale ap-
proved by the providers attorney.
C. A detailed report with an analysis and narrative explanation with findings and supporting
rationale regarding the claim review, including the results of the discovery or full sample.
D. A list of data reviewed and findings in a narrative form - ANSWER C. A detailed report
with an analysis and narrative explanation with findings and supporting rationale regarding
the claim review, including the results of the discovery or full sample.
4
