RHIT Domain 5 – Compliance Practice Test

These questions are part of the practice quiz. Start practicing

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