Domain 4- Compliance Exam Q&A 100%
Guaranteed Success | Rated A+
In a joint effort of the Department of Health Services (DHHS), Office of
Inspector General (OIG), Centers for Medicare and Medicaid Services
(CMS), and Administration of Aging (AOA), which program was released in
1995 to target fraud and abuse among healthcare providers?
a) Operation Restore Trust
b) Medicare Integrity Program
c) Tax Equity and Fiscal Responsibility Act (TEFRA)
d) Medicare and Medicaid Patient and Program Act - ✔✔a
All of the following should be part of the core areas of a coding compliance
plan EXCEPT:
a) Physician query process
b) Correct use of encoder software
c) Coding diagnoses supported by medical documentation
d) Tracking length of stay - ✔✔d
Common forms of fraud and abuse include all of the following EXCEPT:
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, a) upcoding
b) unbundling or "exploding" charges
c) Refiling claims after denials
d) Billing for services not furnished to patients - ✔✔c
What is the primary use of the case-mix index?
a) Benchmark of emergency room levels
b) Defines how a hospital compares to peers and whether the facility is at
risk
c) Audit of APCS and the comparison to same-size hospitals
d) A tool for the coding manager to compare coder productivity - ✔✔b
A(n) ____ is considered the most innocent of improper payments because
there is no intent to falsely receive a payment from the payer:
a) fraud
b) abuse
c) mistake
d) error claim - ✔✔c
To combat fraud and abuse in coding, one strategy is to:
a) use computer assisted coding (CAC0
b) Unbundle codes
c) use best practices to write a query to clarify documentation
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
Guaranteed Success | Rated A+
In a joint effort of the Department of Health Services (DHHS), Office of
Inspector General (OIG), Centers for Medicare and Medicaid Services
(CMS), and Administration of Aging (AOA), which program was released in
1995 to target fraud and abuse among healthcare providers?
a) Operation Restore Trust
b) Medicare Integrity Program
c) Tax Equity and Fiscal Responsibility Act (TEFRA)
d) Medicare and Medicaid Patient and Program Act - ✔✔a
All of the following should be part of the core areas of a coding compliance
plan EXCEPT:
a) Physician query process
b) Correct use of encoder software
c) Coding diagnoses supported by medical documentation
d) Tracking length of stay - ✔✔d
Common forms of fraud and abuse include all of the following EXCEPT:
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, a) upcoding
b) unbundling or "exploding" charges
c) Refiling claims after denials
d) Billing for services not furnished to patients - ✔✔c
What is the primary use of the case-mix index?
a) Benchmark of emergency room levels
b) Defines how a hospital compares to peers and whether the facility is at
risk
c) Audit of APCS and the comparison to same-size hospitals
d) A tool for the coding manager to compare coder productivity - ✔✔b
A(n) ____ is considered the most innocent of improper payments because
there is no intent to falsely receive a payment from the payer:
a) fraud
b) abuse
c) mistake
d) error claim - ✔✔c
To combat fraud and abuse in coding, one strategy is to:
a) use computer assisted coding (CAC0
b) Unbundle codes
c) use best practices to write a query to clarify documentation
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
