"An Organization identifies a potential issue when reviewing personal services and
management contracts. Which of the following should the compliance professional consider in
analyzing the issue?
a. Deficit Reduction Act (DRA)
b. Conditions of Participation (CoP)
c. IRS tax-exempt guidelines
d. Anti-Kickback (AKS) Safe Harbors - CORRECT ANSWER d. Anti-Kickback (AKS) Safe
Harbors"
"A hotline caller states the coding department was instructed to code based on LCD
requirements regardless of medical record information. Which of the following should be the
compliance professional's FIRST action?
a. direct the coding supervisor to follow the applicable policy
b. incorporate the coding issue into next year's risk assessment
c. design a review to find facts and circumstances related to the compliant
d. engage outside counsel to protect the underlying facts from discovery - CORRECT
ANSWER c. design a review to find facts and circumstances related to the compliant"
"A compliance professional identified an issue with medical necessity. The compliance
professional should collaborate with the:
a. case manager
b. billing clerk
c. documentation specialist
d. patient account representative - CORRECT ANSWER a. case manager"
"When non-compliance is substantiated, disciplinary action should be administered
a. within 30 days
b. if intent is proven
c. in a consistent manner
d. after completion of corrective action - CORRECT ANSWER c. in a consistent manner"
"Incentive programs based on employee performance may be tied to increases in
a. the case mix index
b. CPT/DRG codes
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,c. patient referrals
d. patient satisfaction - CORRECT ANSWER d. patient satisfaction"
"A preliminary investigation identified payments to physicians for medical directorship without
written contracts. Which of the following should be the compliance professional's NEXT step?
a. determine if Medicare payments were received
b. initiate a voluntary disclosure
c. provide education to contracting office
d. refund payments to the contractors - CORRECT ANSWER a. determine if Medicare
payments were received"
"In an investigation, the MOST important responsibility of the compliance professional is to
a. personally conduct all investigations
b. assure independence in investigations
c. set the scope and sample size related to investigations
d. remain within the budget for investigations - CORRECT ANSWER c. set the scope and
sample size related to investigations"
"Training is scheduled for employees to learn about cost reporting risks. This type of training is
an example of
a. online training
b. general training
c. focused training
d. orientation training - CORRECT ANSWER c. focused training"
"Which of the following are MOST relevant in evaluating the effectiveness of a compliance
training program?
1. percent of target audience that has attended
2. whether the training is computer-based or classroom-based
3. whether training adequately addresses areas of concern
4. improvement shown in pre- and post-training quizzes
A. 1, 2, 3 only
B. 1, 2, 4 only
C. 1, 3, 4 only
D. 2, 3, 4 only - CORRECT ANSWER C. 1, 3, 4 only"
"Quitam actions enable any person to bring forth an action to the
a. employer, based upon original knowledge
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, b. employer, based upon public information
c. government, based upon public knowledge
d. government, based upon original information - CORRECT ANSWER d. government, based
upon original information"
"An individual's understanding of the compliance aspects of their job can be BEST enhanced by
including compliance in
a. annual evaluations
b. exit interviews
c. HR benefit material
d. audit committee meetings - CORRECT ANSWER a. annual evaluations"
"Which of the following agencies indicate a self-evaluation after discovery of potentially
fraudulent acts?
a. CMS
b. OIG
c. OCR
d. OSHA - CORRECT ANSWER b. OIG"
"Reporting systems should be:
a. marketed to contractors
b. outsourced to a vendor
c. operated by management
d. publicized to all employees - CORRECT ANSWER d. publicized to all employees"
"An employee reports a potential problem with the attending physician's presence for surgery.
Which of the following is the compliance professional's BEST action?
a. investigate the issue
b. approach the surgeon
c. notify the OIG
d. request copies of the records - CORRECT ANSWER a. investigate the issue"
"Coinsurance and deductibles can be waived
a. for any federal payors
b. during the admission process
c. following payment to the third party
d. if there is proven financial hardship - CORRECT ANSWER d. if there is proven financial
hardship"
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