Healthcare Compliance and Regulations
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Course Introduction
Healthcare Compliance and Regulations provides a comprehensive overview of the legal, regulatory, and ethical frameworks governing the healthcare industry. The course examines key topics such as patient privacy (including HIPAA), fraud and abuse laws, accreditation standards, risk management practices, and the roles of governing agencies like the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG). Students will learn to identify compliance challenges, implement effective organizational policies, and navigate complex procedural requirements to protect patient rights and ensure institutional accountability. This foundational knowledge prepares students to support legal and ethical practices in diverse healthcare settings.
Recommended Textbook
Health Information Management of a Strategic Resource 5th Edition by Mervat
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Abdelhak
Chapter 1: Health Care Systems
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Q1) An epidemic of viral infection in the United States would most likely be reported and tracked by the
A) Centers for Medicare and Medicaid Services.
B) Agency for Health Care Research and Quality.
C) Centers for Disease Control and Prevention.
D) Health Resources and Services Administration.
Answer: C
Q2) Which Department of Health and Human Services agency was established by Omnibus Budget Reconciliation Act in 1989 for supporting scientific research?
A) Centers for Disease Control and Prevention
B) Social Security Administration
C) Agency for Health Care Research and Quality
D) Health Resources and Services Administration
Answer: C
Q3) Medicaid reimbursement for health care services is administered by state government.
A)True
B)False
Answer: True
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Page 3
Chapter 2: The Health Informatics and Information
Management Profession
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Q1) Interpret the effect of the Tax Equity and Fiscal Responsibility Act of 1983 on the health information profession.
Answer: The Tax Equity and Fiscal Responsibility Act of 1983 brought the prospective payment system to Medicare/Medicaid patient hospitalization. Payment was based on a system of diagnosis-related groups, and assignment to a particular group was determined by the assignment of an International Classification of Diseases, 9th edition (ICD-9)diagnostic code. Prospective pricing linked clinical information to the billing process, thereby making the patient's record the resource that documented and supported the assigned codes. For the first time, health information management (HIM)professionals had a direct influence on the dollars that flowed into health care institutions. HIM professionals began to be viewed as active participants in planning, finances, and information networking by virtue of the importance of the patient data that were their primary responsibility.
Q2) Before the mid-1990s, the accreditation of allied health education programs was a cooperative effort with the American Medication Association.
A)True
B)False
Answer: True
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Page 4
Chapter 3: Health Information Infrastructure and Systems
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Sample Questions
Q1) List three reasons why office-based providers of health care are likely to adopt electronic health record systems.
Answer: The ability to download data directly into billing systems, federal incentives to use electronic systems for clinical records and prescribing medications, ability to track patients who need routine specialized examinations and send reminders, ability to have legible records, ability to monitor for quality of care practices, ability to transfer data/records digitally, and more
Q2) Retrieves and transfers radiology images and diagnostic information.
A)HL7
B)DICOM
C)NCPDP
D)IEEE 1073
E)CHI
F)RxNorm
G)SNOMED
H)ASTM 1384
I)LOINC
J)HIPAA transactions
Answer: B
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Page 5
Chapter 4: Health Data Concepts and Information
Governance
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Sample Questions
Q1) Referring to the information below, which is the data element?
Coding Scheme
Sex
1 = female
2 = male
Q2) A password can be a word or a series of letters, numbers, and symbols.
A)True
B)False
Q3) Has the surgeon been notified of the spike in temperature? (Yes/No)
A)Text/categorical
B)Narrative/textual
C)Logic
D)Quantitative
Q4) Each of the following are general formats of the primary patient record EXCEPT
A) Integrated.
B) Patient-oriented.
C) Problem-oriented.
D) Source-oriented.
Page 6
Q5) Describe three principles of computer view design.
Q6) The abbreviation ANSI represents the
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Chapter 5: Data Access and Retention
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Sample Questions
Q1) 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.
Q2) One advantage to storing health records is to contract with a commercial storage company for both storage, retrieval, and filing.
A)True
B)False
Q3) When a health care facility is sold, all records should be destroyed as soon as possible.
A)True B)False
Q4) Referring to the information above, when was Mr. Rocky States last treated as an outpatient?
Q5) Use of an automated record tracking system replaces the master patient index. A)True B)False
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Chapter 6: Electronic Health Record Systems
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Sample Questions
Q1) Which data type is a discharge summary?
A) Text
B) Image
C) Numerical
D) None of the above
Q2) There have been a number of barriers to successful health information exchange. Which of the following is tied to technology?
A) Business case
B) Privacy and security
C) Lack of funding
D) Competitive disadvantage
E) All of the above
Q3) Which data type are International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) codes?
A) Text
B) Alphanumeric
C) Image
D) None of the above
Q4) Define "users" as related to health information systems.
Q5) Contrast a decision-support and an executive information system.
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Chapter 7: Classification Systems, Clinical Vocabularies and Terminology
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Q1) Systematized Nomenclature of Medicine (SNOMED) stores terms with the same meaning as synonyms.
A)True
B)False
Q2) What is the purpose of using a naming nomenclature and standard document titles in an electronic health record system?
Q3) When various analysts compare codes in ICD-10-CM to ICD-9-CM, they use software that is referred to as _________________________.
Q4) Which is descriptive of the International Classification of Diseases (ICD) coding system?
A) Glossary
B) Epistemologic nosology
C) Statistical classification
D) Nomenclature
Q5) One of the uses of coded data (i.e., ICD, CPT) is reimbursement for health care services rendered by health care providers.
A)True
B)False
Q6) Describe the purposes of coding diseases and operations.
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Chapter 8: Technology, Applications and Security
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Q1) What is one advantage of using thin-clients when upgrading a software application?
Q2) In what generation language would you find a program generator?
Q3) A virtual machine is able to be connected directly to the information warehouse.
A)True
B)False
Q4) Define an ERP.
Q5) Secure socket layer (SSL) is an example of public key/private key encryption.
A)True
B)False
Q6) A primary feature that a radio frequency identification device (RFID) tag contains that a bar code does not is that
A) An RFID tag has write-many capabilities.
B) An RFID tag can be printed on labels.
C) An RFID tag number will never be repeated.
D) An RFID tag is less expensive than a bar code.
Q7) Given the relational database model principles, what is the most effective way to store each patient's address?
Q8) List three functions that an ADT system can support.
Q9) What is the term given to the study of medical computing?
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Chapter 9: Health Information Systems: Collaboration,
Analysis, Design, Implementation, and Operations
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Q1) Collaboration in health care projects occurs only when there are formally established groups.
A)True
B)False
Q2) ERDs should be developed whether the information system is to be developed in-house or purchased from a vendor. Do you agree?
A)True
B)False
Q3) Over time, no one will know the EHR system better than its users - including the Information Systems department.
A)True
B)False
Q4) When the combined labor of users and Information Systems staff results in the successful implementation of an EHR system, most likely there was a strong collaboration during all phases of the project.
A)True
B)False
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Chapter 10: Statistics and Data Presentation
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Sample Questions
Q1) When two groups have very different means, it is best to compare their
A) Standard deviation.
B) Mean.
C) Median.
D) Coefficient of variation.
Q2) The ranking of variables according to some criterion is called _____ data.
A) Nominal
B) Ordinal
C) Discrete
D) Continuous
Q3) Which of the following should be excluded in computing the net autopsy rate?
A) Death occurring under 48 hours
B) Postoperative deaths
C) Medical examiner deaths that cannot be autopsied
D) None of the above
Q4) What is the term for the number of existing cases of a disease?
A) Incidence
B) Prevalence
C) Mortality
D) Morbidity
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Chapter 11: Research and Epidemiology
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Q1) Determines what research has been previously conducted
A)Hypothesis
B)Methodology
C)Specific aims
D)Literature review
E)Validity
F)Reliability
G)Bias
H)Prevalence
I)Incidence
Q2) Reliability assesses relevance, completeness, accuracy, and correctness.
A)True
B)False
Q3) The three major types of epidemiologic research study designs are (1) descriptive studies, (2) analytical studies, and (3) experimental studies.
A)True
B)False
Q4) In a cohort study, two groups free of disease are followed forward in time.
A)True
B)False
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Chapter 12: Performance Management and Patient Safety
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Q1) A highly reliable measure will yield a large number of random errors.
A)True
B)False
Q2) 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
Q3) Clinical practice guidelines are
A) Statements of the "right" things to do for patients with a particular diagnosis.
B) Standards for accountable care organizations.
C) Billing regulations for Medicare and Medicaid services.
D) Recommendations for providers negotiating third-party contracts.
Q4) Failure mode and effects analysis is a useful tool for
A) Cost analysis.
B) Clinical practice management.
C) Risk analysis.
D) Lean thinking.
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Chapter 13: Data Analytics: Reporting, Interpretation, and Use
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Sample Questions
Q1) The selection of a data element should meet which of the following criteria?
A) Can be reused in a different system if it has a different definition
B) Should be obtainable in the normal work process
C) Must be unique and clearly definable
D) Should be used to make decisions important to the organization
Q2) Identify the function that is NOT common to all registries.
A) Case definition and eligibility criteria
B) Abstracting and entering specified data elements into a database
C) Staging of the disease process and periodic follow-up for ACS approval
D) Data reporting for use by agencies, the scientific community, and the public
Q3) The United Network for Organ Sharing (UNOS) has administered the contract for the nation's only Organ Procurement and Transplantation Network (OPTN) since 1986.
A)True
B)False
Q4) Registries are established for different purposes and respond to different regulating bodies.
A)True
B)False
Page 16
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Chapter 14: Public Health Informatics
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Q1) Public health focuses on what society can do to assure healthy conditions for its citizens and concentrates on populations, not individuals.
A)True
B)False
Q2) HEDIS reporting combines reference data from the CDC with HEDIS data.
A)True
B)False
Q3) If we understood more about the causes of injuries, more could be done to prevent them.
A)True
B)False
Q4) Clinical and public health practices can be harmonized when clinical EHR systems can automatically report certain data to authorized public health entities.
A)True
B)False
Q5) Assuring and supporting healthy pregnancies is considered a core public health activity.
A)True
B)False
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Chapter 15: Privacy and Health Law
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Q1) Which of the following is never considered confidential?
A) Peer review records
B) Incident reports
C) Credentialing files
D) Policies and procedures about access and disclosure of health information
Q2) The Patient Self-Determination Act requires that health care organizations inquire whether patients have advance directives.
A)True
B)False
Q3) When a health care provider divulges confidential information from a patient's record to an improper recipient without the patient's permission, a breach of confidentiality and breach of duty has occurred.
A)True
B)False
Q4) The doctrine of charitable immunity was repealed as a result of the Darling v. Charleston Community Memorial Hospital decision by the Illinois Supreme Court.
A)True
B)False
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Chapter 16: Human Resource Management
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Q1) Which of the following leadership styles identified in the Blake-Mouton Leadership Grid is most appropriate when the input of followers is critical to implementing the leader's decision AND the stakes and risks associated with the decision are high?
A) Organization man management
B) Authority obedience
C) Country club
D) Team management
Q2) When a HIM manager is using a systematic process to gather and analyze information to describe data analytic jobs, she is using
A) Strategic analysis.
B) Job evaluation.
C) Job analysis.
D) Pay structure.
Q3) HR strategies must align with
A) Organizational strategic thinking.
B) Organizational characteristics and capabilities.
C) Both organizational strategies and the external environment.
D) Organizational tactics and a strategic lens.
Q4) What do all job evaluation approaches have in common?
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Chapter 17: Operational Management
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Q1) Work sampling using random observations is effective because
A) Data are obtained with less time and expense.
B) The employee gets the manager's attention.
C) The manager can see whether work is distributed equitably.
D) It interrupts the normal work routine for shorter periods of time.
Q2) Organizing the health information department of a large ambulatory care center into teams to provide services to particular clinics is an example of which type of work organization?
A) Functional
B) Customer
C) Process
D) Project
Q3) When planning a project implementation in a small physician office, the _________________describes how the EHR system will function when fully implemented.
Q4) Improving work processes requires questioning the necessity of continuing to do all currently performed tasks.
A)True
B)False
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Chapter 18: Revenue Cycle and Financial Management
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Q1) Performance ratios use data from the statement of revenues and expenses.
A)True
B)False
Q2) The statement of revenues and expenses and the balance sheet provide the foundation for ____________________ analysis.
Q3) One of the financial statements most useful to the director of Health Information Management is the ______________________________________________________.
Q4) The current ratio is a measurement of performance for evaluating the effective use of resources to deliver a service.
A)True
B)False
Q5) Before the Capital Evaluation Committee authorizes the acquisition of the proposed imaging system, it will also examine other capital evaluation measures. All the following are capital evaluation measures except
A) Accounting rate of return.
B) Operating margin ratio.
C) Net present value.
D) Payback year.
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