Healthcare Compliance and Risk Management Exam Practice Tests
Course Introduction
This course provides an in-depth exploration of regulatory requirements, ethical considerations, and best practices in healthcare compliance and risk management. Students will examine relevant laws such as HIPAA, the Affordable Care Act, and the False Claims Act, while analyzing the roles of compliance officers in maintaining organizational integrity. The course emphasizes the identification, assessment, and mitigation of operational and financial risks, equipping learners with strategies to implement compliance programs, conduct audits, and foster a culture of accountability. Through case studies and real-world scenarios, students develop practical skills to navigate the complexities of regulatory environments and ensure patient safety within healthcare organizations.
Recommended Textbook
Legal and Ethical Aspects of Health Information Management 3rd Edition by
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30 Chapters
838 Verified Questions
838 Flashcards
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Page 2
Dana C. McWay
Chapter 1: Workings of the American Legal System
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58 Verified Questions
58 Flashcards
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Sample Questions
Q1) Zoning, building, or public safety ordinances are examples of laws passed at:
A)a local level
B)an executive level
C)congressional hearings
D)the state legislature
Answer: A
Q2) Legislative proposals are called:
A)amendments
B)bills
C)ordinances
D)torts
Answer: B
Q3) Stare decisis is Latin for:
A)a matter [already] judged.
B)let the master answer.
C)to let the decision stand.
D)utmost good faith.
Answer: C
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Chapter 1: Workings of the American Legal System: Part A
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Sample Questions
Q1) Which source of law is considered the fundamental law of a nation or state?
A)administrative regulations
B)constitution
C)judicial decisions
D)statutes
Answer: B
Q2) Which is associated with the First Amendment of the US Constitution.
A)Establishes rules for indictment by grand jury and eminent domain, protects right to due process, and prohibits self-incrimination and double jeopardy
B)Limits the powers of the federal government to those delegated to it by the US Constitution
C)Prohibits unreasonable searches and seizures and sets out requirements for search warrants based on probable cause
D)Protects freedom of religion, speech, and the press, as well as the right to assemble and petition the government
Answer: D
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Chapter 2: Court Systems and Legal Procedures
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37 Flashcards
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Sample Questions
Q1) Which is a letter sent by an adversary in a court case that explains the need to preserve electronic evidence?
A)legal hold
B)notice of preservation
C)subpoena duces tecum
D)temporary court order
Answer: B
Q2) When parties to a dispute come together to present evidence in court, the formal setting with authority to adjudicate claims or disputes is called a bench or jury _____.
A)appellate proceeding
B)hearing
C)trial
D)warrant
Answer: C
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Page 5
Chapter 2: Court Systems and Legal Procedures: Part A
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Q1) Diversity jurisdiction is a form of subject-matter jurisdiction whereby US district courts (e.g., trial courts of general jurisdiction in the federal judiciary) have the power to hear a _____ case where the parties are "diverse" in citizenship, indicating that they are citizens of different states or non-U.S.citizens.
A)civil
B)contract
C)criminal
D)customs
Q2) The answer to a complaint that is made by the defendant is called the _____.
A)appeal
B)decision
C)interrogatory
D)written response
Q3) The person being sued is called the _____.
A)court clerk
B)defendant
C)judge
D)plaintiff
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6
Chapter 3: Judicial Process of Health Information
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Sample Questions
Q1) Which is associated with a deposition?
A)inspection of business documents and health records
B)production of business documents and health records
C)testimony given under oath outside the courtroom
D)written questions presented to a party or parties
Q2) Healthcare records are considered hearsay evidence because _____.
A)entries are not made under oath at the time they were documented
B)providers who documented in the record cannot be called as witnesses
C)there is a potential for tampering of healthcare records by the provider
D)they are business records and, therefore, not admissible into a court of law
Q3) Which occurs when the court directs a person or organization to appear to explain why the court should not take a proposed action?
A)court order
B)show cause order
C)subpoena
D)subpoena testificandum
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Chapter 3: Judicial Process of Health Information: Part A
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Q1) Rules of evidence cover what is considered both pertinent and proper for use by a jury and a judge in reaching a decision, and such evidence is considered _____.
A)admissible
B)hearsay
C)spoliation
D)worthy
Q2) Which legal use of health care information directly impacts patient care?
A)Billing for care provided to a patient
B)Confirmation of blood alcohol level
C)Establishing standards of care
D)Evidence in civil actions
Q3) Which is an approved method used to challenge the validity of a subpoena duces tecum?
A)Business record exception
B)Litigation hold
C)Motion to quash
D)Show cause order
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Chapter 4: Principles of Liability
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Sample Questions
Q1) Expert testimony is used in a malpractice case to _____.
A)defend the provider of health care
B)determine if a claim should be filed
C)establish a breach in the standard of care
D)estimate the damages due the plaintiff
Q2) Publishing something in the newspaper that leads other to ridicule a person or diminish esteem and respect for that person is called _____.
A)assault
B)battery
C)libel
D)slander
Q3) Res ipsa loquitur is translated as _____.
A)let the patient beware
B)let the physician decide
C)the patient is always right
D)the thing speaks for itself
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Chapter 4: Principles of Liability: Part A
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Sample Questions
Q1) Tarasoff v.Regents of University of California held that:
A)A psychotherapist had a duty to warn a person that his patient was making threats to harm a third person.
B)The hospital had a duty to require that patients be examined by members of the hospital staff who were skilled in the treatment required.
C)The hospital did not apply its own credentialing rules and, therefore, did not follow its own standard of care in determining the qualifications of physicians practicing at the facility.
D)When a physician withdraws from the contractual relationship with a patient, he must provide the patient with reasonable notice to obtain a new physician or alternative treatment.
Q2) Res ipsa loquitur is Latin for:
A)a matter [already] judged.
B)let the superior [or master] respond.
C)the thing speaks for itself.
D)things done.
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Chapter 5: Ethical Standards
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Sample Questions
Q1) When comparing ethics with etiquette, laws, morals, and values, ethics are based on
A)Legislation
B)Philosophy
C)Religion
D)Society
Q2) Under distributive justice, the willingness to comply with instruction or medical advice is best described as _____.
A)Compliance
B)Cooperation
C)Effort
D)Obedience
Q3) The concept of habitual truthfulness and honesty is called _____.
A)Argument
B)Fidelity
C)Justification
D)Veracity
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11
Chapter 5: Ethical Standards: Part A
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Q1) Nonmalficence is defined as _____.
A)including the qualities of kindness, mercy, and charity
B)needing someone to decide for an individual who cannot decide for himself
C)recognizing that ethical choices may result in adverse outcomes
D)the prohibition against doing harm and an obligation to maximize the good
Q2) Values are _____.
A)based on religious teachings and personal choices and help us know right from wrong
B)concepts that provide meaning to an individual's life and are used to help make decisions
C)decisions an individual makes based on internal conscience and can include personal sacrifice
D)social codes of customs and rituals we use to interact with each other in special circumstances
Q3) A command derived from a principle that does not allow exceptions is called
A)a categorical imperative
B)confidentiality and privacy
C)distributive justice
D)the ends justifies the means
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Page 12
Chapter 6: Ethical Decisions and Challenges
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Sample Questions
Q1) Which would create an ethical concern?
A)Altering statistics to meet accreditation requirements.
B)Documenting late entries as such in a patient's record.
C)Revealing conflicts of interests to hospital administration
D)Televising press conferences at the health care facility.
Q2) A written list of a profession's values and standards of conduct would best be described as the _____.
A)Bylaws
B)Code of ethics
C)Rules and regulations
D)Statutes
Q3) Insurance companies may cause an ethical dilemma by requiring _____.
A)adherence with Medicare coding practices
B)limitations of inpatient hospitalization stays
C)primary care referrals to a healthcare specialist
D)use and distribution of just formulary medications
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Chapter 6: Ethical Decisions and Challenges: Part A
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Q1) Which is established within an organization or profession to evaluate current guidelines and establish new guidelines?
A)covered entity
B)ethics committee
C)patient representative
D)statutory provision
Q2) Managers serve as a(n) _____ when ethically supervising their employees.
A)coach or teacher
B)life support
C)role model
D)negotiator
Q3) Encouraging staff to engage in ethical behavior through supervisory actions is different from role modeling, which _____.
A)feels great to the employees and manager
B)impacts the performance of the employees
C)is passive and does not require interaction
D)requires interaction and is considered active
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Chapter 7: Bioethical Issues
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Sample Questions
Q1) Roe vs.Wade decided that:
A)Abortion may only be performed when the patient was subject to rape or incest
B)Miscarriages that result in abortion are not be permitted in the third trimester
C)Restricting abortion impaired a woman's personal liberty and right to privacy
D)The embryo is entitled to legal protection regardless of the mother's condition
Q2) The study of ethical issues resulting from technologic and scientific advances is called _____.
A)Bioethics
B)Eugenics
C)Medical technology
D)Scientific method
Q3) Which patient right is associated with the issue of HIV/AIDS?
A)Confidentiality
B)Duty to treat
C)Genetic testing
D)Prenatal surgery
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Chapter 7: Bioethical Issues: Part A
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Sample Questions
Q1) Prenatal testing can cause _____.
A)defective genes
B)genetic abnormalities
C)risk to the fetus
D)the control of hereditary factors
Q2) Which is a document executed by the patient before health care is anticipated and which provides direction as to the type of medical treatment the patient does and does not want if s/he cannot make the decisions?
A)enduring power of attorney
B)equal dignity rule
C)living will
D)power of attorney
Q3) Euthanasia is the act or practice of causing death painlessly, with the aim to end suffering.Which act is associated with passive euthanasia?
A)DNR order
B)Initiating dying process
C)withdrawing treatment
D)withholding treatment
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Chapter 8: Patient Record Requirements
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Sample Questions
Q1) The destruction of records _____.
A)Can be done when requests for the production of documents legally endangers an organization
B)Is performed at the discretion of the health information manager due to storage concerns
C)May be performed in the regular course of business following a specified retention period
D)Should never be performed so that the integrity of patient care is consistently maintained
Q2) The use of physician handwritten signature stamps to authenticate health record entries _____.
A)Has been eliminated by CMS
B)Is considered acceptable by CMS
C)Proves to be a best practice standard
D)Saves time for physicians and their designees
Q3) Which is an example of personal information associated with the health record?
A)Alcohol, tobacco, and work history
B)Demographic data, such as address
C)Test results and operative reports
D)Third-party payer information
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Chapter 8: Patient Record Requirements: Part A
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Sample Questions
Q1) Which is a statutory source that governs the content requirements for health records?
A)Health Insurance Portability & Accountability Act
B)Joint Commission accreditation standards
C)Medical staff bylaws, rules and regulations
D)State codes, rules and regulations
Q2) Which permits patients to request that an amendment be made to their own health record?
A)ARRA
B)CMS CoP
C)EMTALA
D)HIPAA
Q3) When creating a facility's destruction of health records policy and procedure, the HIPAA _____ rule must be addressed.
A)accountability
B)portability
C)privacy
D)security
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Chapter 9: Confidentiality and Informed Consent
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Sample Questions
Q1) The physician-patient privilege applies to information obtained in the context of
A)Introduction of evidence at trial
B)Mental health treatment
C)Suppression of information
D)Reporting of STDs
Q2) When obtaining informed consent, which information must be part of the process?
A)Documentation that discussion occurred
B)Obtaining patient's insurance information
C)Release of liability statement from patient
D)Use of electronic health record (EHR)
Q3) Which legislation was enacted to allow patients to create advance directives while competent.
A)FOIA
B)HIPAA
C)PSDA
D)TEFRA
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Chapter 9: Confidentiality and Informed Consent: Part A
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Q1) A surgeon meets with his patient and discusses the procedure that should be performed treat her current medical condition.The patient has the right to decide to go forward with or to refuse the procedure.This is done only after the physician has explained the pros and cons about the procedure to the patient so she can make an intelligent choice.This is an example of _____,
A)express consent
B)implicit consent
C)informed consent
D)substituted consent
Q2) Clinical information or medical data provided during the patient-health care provider relationship is considered _____.
A)confidential
B)de-identified
C)redisclosed
D)statutory
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20
Chapter 10: Access to Health Information
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Sample Questions
Q1) HIPAA regulations establish a "floor" of patient rights, which means _____.
A)Facilities of multi-state hospital systems abide by state laws granting the least access
B)Multi-state hospital systems are bound by the federal HIPAA requirements only
C)States may enact legislation that provides for additional patient access to records
D)States must restrict patient access to records according to minimum HIPAA
Q2) The minimum necessary standard refers to the healthcare provider's effort to _____.
A)Invoice third-party payers for the least reasonable amount associated with care provided to the patient
B)Limit patient-specific health information released to that which is needed to accomplish the intended purpose only
C)Minimalize the risk of negligence that would result in becoming involved in a malpractice lawsuit
D)Provide the patient with the minimum amount of procedures and medications to maintain reasonable insurance costs
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21
Chapter 10: Access to Health Information: Part A
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Q1) A valid authorization to release healthcare information must include a _____, which describes the patient's right to cancel the authorization in writing, the exceptions to cancellation, and the cancellation process.
A)ratification standard
B)reasonable notification
C)redisclosure notice
D)revocation statement
Q2) Patients have an opportunity to consent, reject, or restrict the use of their personal health information, which is done by providing a _____ to the patient
A)minimum necessity standard
B)notice of privacy practice
C)preemption doctrine
D)release of information authorization
Q3) Which gives patients the right to access their own information.
A)Federal Trade Commission
B)HIPAA privacy rule
C)Privacy Act of 1974
D)U.S.Public Health Service
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Chapter 11: Specialized Patient Records
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Q1) Which are subject to federal regulations regarding drug and alcohol treatment programs?
A)Facilities that provide general health care and substance abuse diagnosis/treatment
B)General hospitals that operate a substance abuse unit that diagnoses and treats patients
C)Mental health care organizations that provide long term care for psychiatric patients
D)Physician offices that provide family medicine care, including treatment of anxiety
Q2) Substance abuse health information is _____.
A)Included with any discovery request
B)Not released under any circumstances
C)Obtained with a court order only
D)Released via specific authorization
Q3) Medicare conditions of participation require that home health ____.
A)Patients be informed of rights prior to billing
B)Records be destroyed upon patient discharge
C)Staff maintain certain professional qualifications
D)Treatment be provided free of charge to patients
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Chapter 11: Specialized Patient Records: Part A
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Q1) Which legislation requires that the Secretary of Health and Human Services (or his staff) review psychotherapy notes to determine if additional information should be kept in them?
A)ARRA
B)GINA
C)HIPAA
D)PSDA
Q2) The majority of HIV testing is performed on a voluntary basis due to the _____.
A)ethical concept of autonomy and individual self-determination
B)handicap discrimination law, which classifies HIV and AIDS as a handicap.
C)mandatory enforcement of court-ordered testing to protect the public good.
D)provision that anonymous testing is allowed by all of the states.
Q3) Which release of information method requires compliance with HIPAA regulations?
A)court orders
B)medical emergencies
C)research activities
D)written patient authorization
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Chapter 12: Risk Management, Quality Management, and Utilization Management
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Q1) Peer Review Organizations (PROs) _____.
A)determine the amount of reimbursement for facilities
B)enact policies relative to risk management processes
C)monitor the appropriateness and quality of outcomes
D)take disciplinary actions against providers for malpractice
Q2) Which is an example of a sentinel event?
A)Expected reaction to administered medications
B)Patient who reports being aware during surgery
C)Recovery following elective open heart surgery
D)Transfer of a patient to a tertiary care facility
Q3) Medicare's inpatient prospective payment system _____.
A)Changed reimbursement per diem rates to predetermined rates
B)Defined APCs, APGs, DRGs, MS-DRGs, RBRVS, and RUGs
C)Established minimum reimbursement amounts for hospital stays
D)Provided payment to facilities in advance of inpatient admission
Q4) An incident report _____.
A)Is always discoverable as part of the official malpractice litigation process
B)May help determine patterns of healthcare activity that should be altered
C)Requires discussion with the plaintiff's legal team of malpractice attorneys
D)Should be included as a part of the patient's permanent medial record
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Chapter 12: Risk Management, Quality Management, and Utilization Management: Part A
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Sample Questions
Q1) Information about disciplinary actions is reported to the _____ by hospitals, medical societies, licensing boards, prepaid medical practices, and other health care entities.
A)Healthcare Integrity and Protection Data Bank
B)Medical Information Bureau
C)National Practitioner Data Bank
D)Quality Improvement Organizations
Q2) The development, implementation, and enforcement of facility-wide patient confidentiality policies are significant in _____.
A)decreasing risk of breach of confidentiality
B)managing adverse risk management incidents
C)retaining health records according to statutes
D)the opportunity for providing nontechnical sources
Q3) A risk manager would typically have a _____ background.
A)administration
B)billing
C)legal
D)monetary
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Chapter 13: Information Systems
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Q1) Digital imaging in the context of maintaining PHI refers to _____.
A)Electronic indexing of patient records and other documents
B)Photographs taken of patients before and after surgery
C)Scanning a paper document, to be viewed over a server
D)Using fiberoptics in minimally invasive procedures
Q2) The patient's legal electronic health record is _____
A)Clearly defined by federal statues and written regulations
B)Defined by each institution with input from its legal counsel
C)Healthcare documentation imported from an R.H.I.O.
D)Information captured from one health care setting to another
Q3) E-health practices _____.
A)Are subject to the same requirements for safeguarding confidentiality of PHI
B)Have been assigned exempt status from HIPAA regulations and requirements
C)Govern only those patients who receive Medicare reimbursable services
D)May be implemented by entities subject to Medicare Conditions of Participation
Q4) An electronic health record includes _____.
A)Healthcare information that always resides off site in a computer system
B)Patient documentation created, authenticated, and retrieved manually
C)Systems that may contain links to clinical decision support systems
D)Warehoused data that is accessible by patients and third-party payers
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Chapter 13: Information Systems: Part A
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Q1) The electronic health record (EHR) is created as a result of many electronic systems, and the health information manager works in concert with the health care provider's attorney to determine what constitutes the legal health record.Which statement below supports this collaborative process?
A)All aspects of the electronic systems are considered part of the legal health record, regardless of origin.
B)Legal records include documentation of delivery of health care services and exclude electronic systems.
C)Medicolegal requests for the release of health record information are part of the legal health record.
D)Parts of electronic systems and all health care delivery documentation comprise the legal health record.
Q2) An electronic signature (or computer-generated signature code) is used to _____ entries in an electronic health record (EHR).
A)authenticate
B)invalidate
C)nullify
D)rescind
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Chapter 14: Health-Care Fraud and Abuse
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Q1) Which usually involves a qui tam action?
A)FCA claim
B)HIPAA violation
C)Negligent action
D)Stark laws
Q2) The DHHS Office of the Inspector General (OIG) is _____.
A)Authorized to conduct civil and criminal investigations of fraud associated with Medicare
B)Not allowed to guide healthcare providers on how to comply with applicable laws and regulations
C)Permitted to investigate claims of fraud and abuse and prohibited from investigating overpayments
D)Simply a figurehead office that wields little or no effect on healthcare fraud and abuse violations
Q3) Compliance programs seek to _____.
A)Enhance health information management functions in organizations
B)Maximize reimbursement from federally funded healthcare programs
C)Prevent and detect conduct that does not conform to applicable laws
D)Punish healthcare providers who engage in illegal billing practices
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Page 29
Chapter 14: Health-Care Fraud and Abuse: Part A
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Q1) Federal and state government health programs and third-party payers lose _____ of dollars annually due to intentional fraudulent actions and poor coding practices.
A)billions
B)millions
C)thousands
D)trillions
Q2) Match the law enforcement agency that fights fraud and abuse with its purpose. Its DCIS branch investigates fraud schemes committed against the military's health insurance.
A)Federal Bureau of Investigation
B)Office of Inspector General
C)State Attorney General
Q3) Match the type of facility or service with the appropriate law.
Occupational and physical therapy practices
A)Stark I
B)Stark II
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Page 30
Chapter 15: Law and Ethics in the Workplace
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Sample Questions
Q1) Which is a written list of a profession's values and standards of conduct?
A)Bylaws
B)Code of ethics
C)Policies and procedures
D)Rules and regulations
Q2) Employees who are considered at-will employees are those who _____.
A)Are protected by a contract from termination for no cause
B)Can leave an employer or be terminated at any time
C)Give a 30-day notice to vacate a position with the employer
D)Must be provided an explanation of cause if terminated
Q3) An employer is permitted to terminate an employee who _____.
A)Has been found guilty of a DUI
B)Is called to serve on jury duty
C)Requires garnishment of wages
D)Signs up to serve in the Army Reserve
Q4) A living wage law requires employers to pay _____.
A)Employees the federal minimum wage
B)Health insurance for all employees
C)More than the Federal minimum wage
D)Workers even if illegal aliens
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Chapter 15: Law and Ethics in the Workplace: Part A
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Q1) Which legislation requires employers to provide a 60-day warning period before closing facility or beginning massive layoffs?
A)ADEA
B)EOE Act
C)OSHA
D)WARN
Q2) Match the Federal legislation with its description. Requires employers to make reasonable accommodations to assist employees in performing the essential functions of the job as long as there is not a financial hardship to the employer.
A)American Disabilities Act
B)Equal Pay Act
C)Family and Medical Leave Act
D)National Labor Relations Act
E)Title VII of the Civil Rights Act of 1964
Q3) Match the appropriate term with its characteristic or definition. Individuals who perform work and work-related services.
A)Employment
B)Employers
C)Employees
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