Compliance 101 Exam Questions and
All Correct Answers.
Anti-kickback statute - Answer Prohibits the solicitation, receiving, offering or paying of any
renumeration directly or indirectly in cash or in kind in exchange.
Stark Law - Answer Prohibits a physician from making referrals of Medicare and Medicaid
patients for the furnishing of certain designated health services with which the physician has a
financial relationship.
Statistical sampling - Answer The practice of making statements regarding the characteristics
of a large population based on a reasonably thorough review of a representative sample.
Three C's of communication - Answer Clear
Concise
Creative
Why was HIPAA created? - Answer To reduce the administrative costs of healthcare.
RAT-STATS - Answer Governments statistical rules
Deficit reduction act - Answer Whistle blowing on fraud and abuse as well as increasing
attention on the federal quality of care issues
Statute of limitations under the false claims act - Answer Either six years after the violation is
committed or three years after the date when the facts of the action are noted but no more
than ten years after the violation was committed
Attorney client privilege - Answer A legally accepted policy that communication between a
client and attorney is confidential in the course of the professional relationship and that such
communication cannot be disclosed without the consent of the client. it's purpose is to
encourage full and frank communication between attorneys and their clients.
Work product - Answer Protection of certain documents from disclosure during the course of
discovery
Corporate integrity agreement - Answer Negotiated settlement between a healthcare
provider and the government in which the provider accepts no liability but must agree to
implement a strict plan of government supervised corrective action.
, Compliance program - Answer Preserve and enhance a company's reputation
Strengthen the relationship of trust with their employees
Fulfill its legal duty to government and private payers
Help to defend against a fraud investigation
Training of employees and contractors - monitors and disciplines those who violate
Provides procedures to promptly correct misconduct
Mitigate any sanction imposed by the
What are three measures of effectiveness of your compliance program? - Answer Structure,
process and outcome
PDCA Appraoach - Answer Tried and true quality management technique (Plan, Do, Check,
Act)
HIPAA - founded and definition - Answer 1996 - healthcare information portability and
accountability act
Documentation and billing irregularities - Answer The lions share of fraud and abuse offenses
Difference between privacy and confidentiality - Answer Security regulations only apply to
PHI maintained in an electronic medium and the privacy rule applies to all PHI held by a covered
entity
Healthcare Clearinghouse - Answer An org that sends HIPAA standard transactions
Business assocuate - Answer Person or organization that performs r assists in the
performance of a function or activity the use or disclosure of individually identifiable health
information on behalf of a covered entity or provides services such as legal, actuarial,
accounting, consulting, data aggregation, management administration, Accreditation or
financial services to or for a covered entity.
Covered entity - Answer Health care provider or insurance company
Designated record set - Answer The amount of PHI that can be used or disclosed in a
particular circumstance
All Correct Answers.
Anti-kickback statute - Answer Prohibits the solicitation, receiving, offering or paying of any
renumeration directly or indirectly in cash or in kind in exchange.
Stark Law - Answer Prohibits a physician from making referrals of Medicare and Medicaid
patients for the furnishing of certain designated health services with which the physician has a
financial relationship.
Statistical sampling - Answer The practice of making statements regarding the characteristics
of a large population based on a reasonably thorough review of a representative sample.
Three C's of communication - Answer Clear
Concise
Creative
Why was HIPAA created? - Answer To reduce the administrative costs of healthcare.
RAT-STATS - Answer Governments statistical rules
Deficit reduction act - Answer Whistle blowing on fraud and abuse as well as increasing
attention on the federal quality of care issues
Statute of limitations under the false claims act - Answer Either six years after the violation is
committed or three years after the date when the facts of the action are noted but no more
than ten years after the violation was committed
Attorney client privilege - Answer A legally accepted policy that communication between a
client and attorney is confidential in the course of the professional relationship and that such
communication cannot be disclosed without the consent of the client. it's purpose is to
encourage full and frank communication between attorneys and their clients.
Work product - Answer Protection of certain documents from disclosure during the course of
discovery
Corporate integrity agreement - Answer Negotiated settlement between a healthcare
provider and the government in which the provider accepts no liability but must agree to
implement a strict plan of government supervised corrective action.
, Compliance program - Answer Preserve and enhance a company's reputation
Strengthen the relationship of trust with their employees
Fulfill its legal duty to government and private payers
Help to defend against a fraud investigation
Training of employees and contractors - monitors and disciplines those who violate
Provides procedures to promptly correct misconduct
Mitigate any sanction imposed by the
What are three measures of effectiveness of your compliance program? - Answer Structure,
process and outcome
PDCA Appraoach - Answer Tried and true quality management technique (Plan, Do, Check,
Act)
HIPAA - founded and definition - Answer 1996 - healthcare information portability and
accountability act
Documentation and billing irregularities - Answer The lions share of fraud and abuse offenses
Difference between privacy and confidentiality - Answer Security regulations only apply to
PHI maintained in an electronic medium and the privacy rule applies to all PHI held by a covered
entity
Healthcare Clearinghouse - Answer An org that sends HIPAA standard transactions
Business assocuate - Answer Person or organization that performs r assists in the
performance of a function or activity the use or disclosure of individually identifiable health
information on behalf of a covered entity or provides services such as legal, actuarial,
accounting, consulting, data aggregation, management administration, Accreditation or
financial services to or for a covered entity.
Covered entity - Answer Health care provider or insurance company
Designated record set - Answer The amount of PHI that can be used or disclosed in a
particular circumstance
