Healthcare Compliance and Legal Issues Study Guide
Questions
Course Introduction
Healthcare Compliance and Legal Issues explores the complex legal and regulatory framework governing healthcare organizations and professionals. Students will gain an understanding of federal and state laws, accreditation requirements, and ethical standards that impact patient care, privacy, billing, and organizational practices. The course emphasizes risk management, the development and implementation of compliance programs, and the identification and prevention of fraud and abuse. Through case studies and real-world scenarios, students will learn to navigate the legal challenges in healthcare settings, promoting best practices and organizational integrity.
Recommended Textbook
Health Information Management of a Strategic Resource 5th Edition by Mervat Abdelhak
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18 Chapters
1158 Verified Questions
1158 Flashcards
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Page 2
Chapter 1: Health Care Systems
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83 Flashcards
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Sample Questions
Q1) A patient who is using natural herbs for pain management is practicing what type of health care?
A) Acute care
B) Preventive medicine
C) Tertiary care
D) Alternative medicine
Answer: D
Q2) _______________________ are electronic marketplaces through which individuals can shop for health insurance.
A) Patient Protection and Affordable Care Act (PPACA)
B) Blue Cross Blue Shield
C) Medicaid
D) Health Insurance Exchanges
E) Accountable Care Organizations
Answer: D
Q3) Physicians responsible for federally funded patients in a certified health care facility are referred to as ______________________________ physicians.
Answer: participating
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Chapter 2: The Health Informatics and Information
Management Profession
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50 Flashcards
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Sample Questions
Q1) In the 1920s, the patient record was a source of needed information for board certification by the American College of Surgeons.
A)True
B)False
Answer: True
Q2) The emphasis of health care organization accreditation is on the provision of cost-effective health care.
A)True
B)False
Answer: False
Q3) What is the basis for initial certification as a health information practitioner?
A) Formal education
B) Examination
C) Work experience.
D) Both a and b
Answer: D
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Page 4
Chapter 3: Health Information Infrastructure and Systems
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42 Flashcards
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Sample Questions
Q1) The Nationwide Health Information Network's goal is to share clinical information securely.
A)True
B)False
Answer: True
Q2) Describes anatomy and diagnoses.
A)HL7
B)DICOM
C)NCPDP
D)IEEE 1073
E)CHI
F)RxNorm
G)SNOMED
H)ASTM 1384
I)LOINC
J)HIPAA transactions
Answer: G
Q3) List two benefits of using health information technology applications.
Answer: Improved quality of care, better patient access, improved patient satisfaction, increased system efficiencies
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Chapter 4: Health Data Concepts and Information
Governance
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121 Verified Questions
121 Flashcards
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Sample Questions
Q1) History of current illness: This is a 62-year-old male who has complained of fever and congestion for the past 4 days and now enters for tests to rule out possible viral pneumonia.
12. 404.90 (ICD-9-CM code field)
A)Text/categorical
B)Narrative/textual
C)Logic
D)Quantitative
Q2) The U.S. Census Bureau plays an active role in sponsoring, developing, and approving data sets in health care.
A)True
B)False
Q3) Third-party payers use primary data for health care reimbursement.
A)True
B)False
Q4) When reference is made to health care data having integrity, it means that the data are complete and accurate.
A)True
B)False
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Chapter 5: Data Access and Retention
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Sample Questions
Q1) Referring to the information above, did Mr. Rocky States' visit to emergency services result in admission?
Q2) Batch requesting of patient records is not a feasible transaction in an automated record tracking system.
A)True
B)False
Q3) Referring to the information above, in which terminal digit section of the permanent file would you find Mr. States' clinic record?
Q4) In a paper and hybrid health record environment, preparation for disaster recovery includes
A) Training staff in locating and when and how to use sprinkler shutoff valves.
B) Training staff on how and when to use fire extinguishers.
C) Locating and researching restoration specialists.
D) All of the above.
Q5) When a health care facility is sold, all records should be destroyed as soon as possible.
A)True
B)False
Q6) Name one component of a quality proposal for acquisitions approval.
7
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Chapter 6: Electronic Health Record Systems
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Sample Questions
Q1) Which is a communication system?
A) Electronic mail
B) Expert
C) Point-of-care
D) Encoder
Q2) Which data type is a discharge summary?
A) Text
B) Image
C) Numerical
D) None of the above
Q3) A repository of selected electronic information from several transaction systems such as clinical laboratory and dietary is called a(n) ____________________.
Q4) A medical device data system (MDDS) is able to transfer, store, or display medical device data.
A)True
B)False
Q5) Name three key diagnostic or treatment devices that are not yet necessarily part of an organization's electronic health record system.
Q6) Write a definition of an electronic health record.
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Chapter 7: Classification Systems, Clinical Vocabularies and Terminology
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Sample Questions
Q1) This classification system classifies neoplasms: ______________________.
Q2) The Healthcare Common Procedure Coding System contains levels of codes.
A)True
B)False
Q3) Which of the following coding systems is a nomenclature?
A) ATLAS
B) ICD-0
C) RBRVS
D) SNOMED
Q4) The procedural coding system that replaces the procedures codes in International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) is
A) Read codes.
B) Current Procedural Terminology (CPT).
C) International Classification of Diseases, 10th edition, Procedure Coding System (ICD-10-PCS).
D) International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM).
Q5) List five characteristics of useful clinical terminologies.
Page 9
Q6) Write one reason why there is a need to upgrade ICD-9-CM to ICD-10-CM/PCS.
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Chapter 8: Technology, Applications and Security
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Sample Questions
Q1) A good design of a Web page will enable the user to obtain the information in the fewest possible steps.
A)True
B)False
Q2) Within a health care organization, in what department would you expect to find discussions about transmission control protocol/Internet protocol (TCP/IP)?
A) Patient accounting
B) Medical records
C) Data communication
D) Software development
Q3) List one difference between thick-client and thin-client computers.
Q4) What is one advantage of using thin-clients when upgrading a software application?
Q5) Standard query language (SQL) is designed to enable queries to databases.
A)True
B)False
Q6) What are the typical five roles defined in role-based access control (RBAC)?
Q7) List one benefit of using an interface engine instead of a point-to-point interface.
Page 10
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Chapter 9: Health Information Systems: Collaboration,
Analysis, Design, Implementation, and Operations
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72 Flashcards
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Sample Questions
Q1) In a data dictionary notation for a data element, the "label" describes which of the following?
A) The project
B) The data name
C) The data entry type
D) The data value or meaning
Q2) Which of the following is an advantage of using unstructured questions in an interview?
A) Allows for probing
B) Takes little interview time
C) Provides a limited range of responses
D) Allows for easy analysis of responses
Q3) Each of the following is considered a CBA technique EXCEPT
A) Break-even analysis.
B) Payback.
C) Discounted payback period.
D) Benefits realization.
Q4) The electronic development of systems analysis aids can be facilitated by RFPs.
A)True
B)False
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Chapter 10: Statistics and Data Presentation
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Sample Questions
Q1) Ten patients were discharged from the obstetrical service on May 4 at Rocky Mountain Hospital. The day's stay for each patient was 3, 2, 1, 1, 6, 5, 1, 2, 2, and 4. What was the median day's stay for these patients?
A) 1
B) 2
C) 3
D) 4
Q2) The ____________________ is the difference between the highest and lowest values.
Q3) What was the average length of stay for the following patients: 4, 3, 2, 5, 5,10?
A) 5.8
B) 4.8
C) 6.0
D) 7.8
Q4) ____________________ is a measure of how often data are classified in the same manner.
Q5) The number of medications a person is taking is an example of ordinal data. A)True B)False
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Chapter 11: Research and Epidemiology
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Sample Questions
Q1) Age, sex, race
A)Independent variable
B)Dependent variable
C)Institutional review board
D)Risk factors
E)Specificity
F)Confounding variables
G)Case
H)Control
I)Research question
J)Historical-prospective study
K)Recall bias
L)Interviewer bias
Q2) Healthy People 2020 is an action agenda for the twenty-first century and includes priorities and research needs relevant to health information management.
A)True
B)False
Q3) Sensitivity is the percentage of all True cases correctly identified.
A)True
B)False
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Chapter 12: Performance Management and Patient Safety
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Sample Questions
Q1) Lean thinking is more about cost containment than about customer focus.
A)True
B)False
Q2) Efforts to ensure that current research is applied in medical decision-making are termed
A) Performance measuring.
B) Evidence-based medicine.
C) Pay for performance.
D) Patient advocacy.
Q3) A second y axis is useful on a Pareto chart to plot
A) Cumulative frequency.
B) Categories of events.
C) Relative rank of categories.
D) Reverse occurrence order.
Q4) What does pay for performance mean?
A) Denial of payment when undesirable clinical outcomes occur
B) Negotiated payment for large-scale providers
C) Sliding scale payment based on severity of illness in the target population
D) Financial rewards for providers who achieve specific quality goals
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Chapter 13: Data Analytics: Reporting, Interpretation, and Use
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58 Verified Questions
58 Flashcards
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Sample Questions
Q1) One of the reasons that aggregate data analysis from varying payers is limited in accuracy is
A) Differing providers and coding systems from provider data.
B) Lack of legal right to data for encounter information.
C) Differing coding requirement and reimbursement rules.
D) Lack of data sharing agreements and differing data elements for the longitudinal records.
Q2) CMS attempts to make the Medicare beneficiary a better informed public consumer of health care for inpatient services by providing which of the following?
A) Health Grades
B) Hospital Compare
C) Texas Medical Foundation Health Quality Institute
D) Agency for Health Care Research & Quality
Q3) Federal law requires the reporting of implant problems to the Food and Drug Administration when there is a probability a device has caused a death, serious illness, or injury.
A)True
B)False
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Chapter 14: Public Health Informatics
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Sample Questions
Q1) Adolescents (ages 13-15) need a booster of Tdap (tetanus-diphtheria-acellular pertussis)
A)True
B)False
Q2) A HIM professional in a hospital would be supporting implementation of a syndromic surveillance system when he
A) Presents the public health benefits to the Chairman of the Medical Record Committee in preparation for a scheduled monthly meeting.
B) Works with the hospital's CIO to research and develop a secure methodology to identify and transmit de-identified hospital-specific coded health care data to the public health authority.
C) Educates ER, outpatient, and hospital HIM coders about the critical nature of syndromic surveillance.
D) All of the above.
Q3) The National Electronic Disease Surveillance System (NEDSS) is a conduit for
A) Using data standards to facilitate timely, secure reporting of data.
B) Public health agencies to report disease data to the CDC.
C) Exchanging information to support the national disease surveillance system.
D) All of the above.
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Page 16
Chapter 15: Privacy and Health Law
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Sample Questions
Q1) All of the following are considered advance directives except A) Durable power of attorney.
B) Durable power of attorney for health care.
C) Living will.
D) Health care declaration.
Q2) When a nursing home patient is transferred to the hospital for surgery on a broken hip sustained in a fall, the informed consent for surgery is implied in the nursing home transfer.
A)True
B)False
Q3) In a given situation, it is determined that the Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations preempted another law. This means that the law that applies to the situation is
A) HIPAA Privacy Regulations.
B) The other law.
C) Neither HIPAA nor the other law.
D) Both HIPAA and the other law.
Q4) Health information can be admitted to a court proceeding as a business record.
A)True
B)False
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Chapter 16: Human Resource Management
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Sample Questions
Q1) What do all job evaluation approaches have in common?
Q2) The major purpose of suspension as a disciplinary measure is to punish the employee for his or her conduct.
A)True
B)False
Q3) A method of interviewing that ensures each interview presents exactly the same questions in the same order is a
A) Structured interview.
B) Stress interview.
C) Group interview.
D) Behavioral interview.
Q4) Which of the following values is NOT considered to be among the core standards for ethical behavior in health care?
A) Fairness
B) Doing good
C) Nonmaleficence
D) Generosity
Q5) What are some constraints that arise in recruitment that affect the size of the applicant pool?
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Chapter 17: Operational Management
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Sample Questions
Q1) Looking at various outside factors that influence a health care organization's future business plan is called an internal environmental analysis.
A)True
B)False
Q2) A _________________ can be used to determine alternative actions for solving a problem such as when there is an unexpected volume of requests by patients for medical records.
Q3) The color red is rarely used in offices because it can cause headaches and increase blood pressure.
A)True
B)False
Q4) The task of strategic planning in an organization would most likely be completed by A) Top management.
B) Middle managers.
C) Consultants.
D) Supervisors.
Q5) "To assure the correct patient identification number is assigned 100% of the time" is an example of a(n) ___________________.
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Chapter 18: Revenue Cycle and Financial Management
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Sample Questions
Q1) The statement of revenues and expenses and the balance sheet provide the foundation for ____________________ analysis.
Q2) During the planning process, the health information manager had no internal historical data (except for the number of physicians on the staff) available to predict the volume of outpatient clinic use it could accurately anticipate for an optical imaging service. Because of this, a ____________________ budget would not be possible for the first year of service.
Q3) What is the purpose of a budget?
Q4) In addition, the health information manager wants to monitor the accounts receivable carefully for the newly implemented system to track the (number of days) of revenue in accounts receivable. What financial statement would supply the needed information?
Q5) ___________________ to determine whether what is being expended in the newly implemented system is the same as what was planned.
Q6) Which of the following is a performance measure?
A) Operating margin ratio
B) Capitalization ratio
C) Accounts receivable turnover ratio
D) Total asset ratio
Page 20
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