What does the acronym PHI stand for?
a. Patient Healthcare Information
b. Patient History of Illness
c. Protected Health Information
d. Protected
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c. Protected Health Information
A new radiology company opens in town. The manager calls your practice and offers to pay $20 for every Medicare patient you send to them for radiology services. What does this offer violate?
a. Stark Laws
b. HIPAA
c. Anti-Kickback law
d. Qui Tam
c. Anti-Kickback law
Which of the following is NOT a component of the Preferred Provider Organizations (PPO) payer model?
a. Offer a discounted fee schedule
b. Operate within networks
c. Require the enrollee to maintain a PCP
d. Utilization of preferred providers
c. Require the enrollee to maintain a PCP
In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission?
a. An office receives a court order.
b. An office receives requests for medical records for a Medicare audit.
c. An office receives a call from a patient's husband asking for information about his wife's recent office visit.
d. An office releases patient information to the Coroner's office upon the death of a patient.
c. An office receives a call from a patient's husband asking for information about his wife's recent office visit.
Which of the following is not a covered entity in the Privacy Rule?
a. Commercial insurance company
b. A healthcare consulting firm
c. A Pediatric practice
d. A billing service
b. A healthcare consulting firm
What types of entities do conditions of participation (CoP) apply to for health plans?
I. Hospitals
II. Clinics
III. Transplant centers
IV. Psychiatric hospitals
a. I, II, III
b. I, III, IV
c. II, III, IV
d. I, II, III, IV
d. I, II, III, IV
When a practice sends an electronic claim to a commercial health plan for payment, what is this considered?
a. A code set
b. A transaction
c. A data set
d. Minimum necessary
b. A transaction
According to the Privacy Rule, what must a Business Associate and covered entity have in order to do business?
a. A mutually exclusive agreement describing the services that will be rendered by the business associate
b. A notice of privacy
c. A background check of both parties to ensure full disclosure
d. A contract with specific safeguards on the individually identifiable health information used or disclosed by the business associate
d. A contract with specific safeguards on the individually identifiable health information used or disclosed by the business associate
A records request is received from a health plan for three dates of service in a chart months apart. What should the biller do?
a. Copy the entire chart and send it to make sure that the health plan has everything they need and will not request more records.
b. Copy everything from the first date through the third date, even if it is not included to cover the timeframe the health plan is looking at for the request.
c. Copy each date of service and black out all identifying information in the copies before sending to the health plan.
d. Copy each date of service individually and send to the health plan.
d. Copy each date of service individually and send to the health plan
A hospital records transporter is moving medical records from the hospital to an off-site building. During the transport, a chart falls from the box on to the street. It is discovered when the transporter arrives at the off-site building and the number of charts is not correct. What type of violation is this?
a. A breach
b. A minimum necessary violation
c. A disclosure violation
d. Fraud
a. A breach
Which of the following situations allow the release of PHI without authorization from the patient?
a. Request for life insurance
b. Workers' compensation
c. Physician's office to release to a family member
d. Request from family member
b. Workers' compensation
What were the eight standard transactions for electronic data interchange adopted under?
a. The Truth in Lending Act
b. HIPAA
c. The Social Security Act
d. Anti-Kickback Statute
b. HIPAA
A private practice hires a consultant to come in and audit some medical records. Under the Privacy Rule, what is this consultant considered?
a. An employee
b. A business associate
c. A covered entity
d. A clearinghouse
b. A business associate
HIPAA mandated what entity to adopt national standards for electronic transactions and code sets?
a. CMS
b. Congress
c. HHS
d. AMA
c. HHS [Show Less]