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Fundamentals of Law for Health Informatics and Information Management

Second Edition

Check Your Understanding

Chapter Answers


Check Your Understanding 1.1

1. A hybrid record is refers to record that is totally electronic. False

2. An electronic health record can be managed across more than one healthcare organization. True

3. Confidentiality refers to the right to be left alone. False

4. HITECH widens the scope of privacy and security protections under HIPAA. True

5. Privileged communication is a legal concept designed to protect the communication between two parties. True

Check Your Understanding 1.2

1. Ownership of a health record generated by a doctor on a patient belongs to the patient. False

2. A custodian of records is responsible for certifying that a record is what it purports to be. True

3. When a patient refuses treatment he or she is exercising the ethical principle of beneficence. False

4. In a malpractice case, a professional code of ethics may be used as a benchmark for what should be acceptable practice by a healthcare professional. True

5. The ethical principle of nonmaleficence refers to making sure rules are fairly and consistently applied to all. False


Check Your Understanding 2.1

1. Private law defines rights and duties between individuals and the government. False

2. Statutes are enacted by legislative bodies. True

3. Administrative law is created by court decisions. False

4. Persuasive authority occurs when a court looks to another court’s decision for guidance, even if it is not required to do so. True

5. Under the theory of stare decisis, a higher court must look to the decision of a lower court. False

Check Your Understanding 2.2

1. Jurisdiction is a territory of legal control. True

2. The U.S. Congress is a bicameral model. True

3. Federally, ultimate executive branch power rests with the President. True

4. Under the theory of separation of powers, each branch of government is given expanded powers. False

5. Judicial disputes may arise from constitutional challenges to existing laws. True

Check Your Understanding 2.3

1. Appellate courts hear appeals on final judgments of trial court decisions. True

2. An opinion is the written argument of one of the parties in a lawsuit. False

3. Courts of limited jurisdiction hear cases pertaining to a particular subject matter. True

4. Diversity jurisdiction enables parties from different states to engage in a lawsuit in federal court. True

5. In mediation, a third party makes a final decision about a dispute between parties. False


Check Your Understanding 3.1

1. Procedural law encompasses a court’s rules that guide a lawsuit. True

2. Class action lawsuits proceed for groups of consumers. True

3. A cross-claim is a claim by a defendant against a plaintiff. False

4. Joinder involves bringing an outsider into a lawsuit as a codefendant. True

5. Notification of a lawsuit occurs through service. True

Check Your Understanding 3.2

1. Discovery allows parties in a lawsuit to use strategies to obtain information held by other parties. True

2. Admissibility refers to evidence that parties can obtain during the pretrial period. False

3. A deposition does not occur under oath. False

4. Authentication is verification of a record’s validity. True

5. An independent mental examination may not be requested as a type of discovery. False

Check Your Understanding 3.3

1. A subpoena is another name for a court order. False

2. In most cases, a subpoena for health records must be accompanied by patient authorization. True

3. Written objections to subpoenas may be made in a motion to quash. True

4. A subpoena duces tecum primarily seeks an individual’s testimony. False

5. Material should always remain in a health record that has been subpoenaed, even if that material was not requested in the subpoena. False

Check Your Understanding 3.4

1. Cases are rarely settled before they reach trial. False

2. Judicial search warrants are more likely to be used to obtain health records in criminal cases than in civil cases. True

3. A pro se plaintiff is one who represents himself during litigation. True

4. An expert witness is called to testify based on her own observations of the situation that prompted the lawsuit. False

5. A bench trial is a trial without a jury. True

Check Your Understanding 3.5

1. In civil cases, the burden of proof is “beyond a reasonable doubt.” False

2. Noneconomic compensatory damages have been targeted as a cause of rising professional malpractice insurance premiums. True

3. The legal system does not allow photocopies of health records to be admitted into evidence. False

4. The party that appeals a lower court’s decision is the appellee. False

5. Garnishment is a court-ordered collection of money damages that is awarded to the plaintiff through a set-aside of the defendant’s wages. True


Check Your Understanding 4.1

1. Health information is important as evidence in many types of civil and criminal cases. True

2. In state court, a state’s rules of evidence will determine whether a piece of information is discoverable. True

3. Electronically stored information is now obtained more frequently through discovery than it was in the past. Electronic discovery includes computer forensics. True

4. E-mail can generally not be sought as part of the electronic discovery process. False

Check Your Understanding 4.2

1. The Federal Rules of Civil Procedure were amended in 2006 to address the discovery of electronic data. True

2. Under the Federal Rules of Civil Procedure, court-imposed sanctions are not permitted if a party fails to provide electronically stored information lost as the result of a good-faith operation. True

3. In general, documents must be produced in response to a subpoena as they are kept in the usual course of business. True

4. A hybrid record is a fully electronic record. False

5. A legal hold requires the preservation of both paper and electronic records. True

Check Your Understanding 4.3

1. Spoliation is the accidental destruction of evidence. False

2. Organizations with electronic information should develop guidelines to identify where information may be hidden or not readily apparent. True

3. Relevant evidence will always be admitted into evidence. False

4. Circumstantial evidence requires reasoning to prove a fact. True

5. Testimonial and documentary evidence may be combined during a trial. True

Check Your Understanding 4.4

1. The best evidence rule prohibits the use of a duplicate record in lieu of the original. False

2. Much documentation in the health record is hearsay. True

3. The business records exception often enables health records to be admitted as evidence. True

4. The physician-patient privilege is used to encourage full disclosure of relevant information by patients to their physicians. True

5. It is the physician who holds the physician-patient privilege. False

Check Your Understanding 4.5

1. Incident reports are created for patient treatment purposes and should be a part of the health record. False

2. State law may protect incident reports from being admitted into evidence. True

3. Peer review involves activities undertaken to ensure the provision of quality care. True

4. Plaintiffs commonly attempt to discover and admit peer review records into evidence during negligence cases against health care providers. True

5. The physician-patient privilege may be waived when a party claims damages by the physician and puts his physical or mental condition at issue. True


Check Your Understanding 5.1

1. A tort is a civil wrong. True

2. Battery is an intentional tort that involves nonconsensual contact with the plaintiff. True

3. Assault is an intentional tort that involves nonconsensual contact with the plaintiff. False

4. The law provides exceptions to false imprisonment liability where involuntarily hospitalized patients pose harm to themselves or others. True

5. Intentional infliction of emotional distress is a tort that results in extreme emotional distress to the plaintiff. True

Check Your Understanding 5.2

1. Negligence is the second most common basis for medical malpractice lawsuits, following intentional torts. False

2. The standard of care is what an individual is expected to do or not do in a particular situation. True

3. Misfeasance is the failure to act per one’s duty and according to ordinary prudence. False

4. The two types of causation are actual and proximate. True

5. Punitive damages punish the wrongdoer for tortious conduct that was committed. True

Check Your Understanding 5.3

1. Per the doctrine of res ipsa loquitur, an inference or presumption of the defendant’s negligence is permitted. True

2. Contributory negligence completely bars recovery by a plaintiff whose conduct contributed to the plaintiff’s injury. True

3. Assumption of the risk is a viable defense by physicians in most medical malpractice cases. False

4. Per the theory of corporate negligence, a hospital is liable for the torts of its employees. False

5. Per the theory of respondeat superior, a hospital is liable in its own right to the patients it serves. False

Check Your Understanding 5.4

1. The doctrine of strict liability is most common in products liability cases. True

2. Libel is written defamation. True

3. Fiduciary duty is the obligation to act in the best interest of another party. True

4. To successfully claim breach of confidentiality, a plaintiff must establish that the defendant had a duty not to disclose the information. True

5. Good Samaritan statutes encourage good-faith emergency assistance by providing immunity if ordinary negligence is committed by those who assist in medical emergencies. True

Check Your Understanding 5.5

1. A statute of limitations places time limits on certain claims. True

2. A tolled statute of limitations is one that has been delayed or suspended. True

3. Wrongful acts committed in the healthcare environment can lead only to civil liability. False

4. Diminishing returns on insurers’ investments is believed to be a contributing factor to the medical malpractice insurance crisis. True

5. Collateral source payments are payments received by plaintiffs from sources other than the defendant. True


Check Your Understanding 6.1

1. The owners of a corporation are generally shielded from personal liability for the debts of the corporation, although the corporation itself can sue and be sued. True

2. “Piercing the corporate veil” enables the owners of a corporation to be shielded from liability for wrongdoing committed through the corporation. False

3. Fiduciary duty includes the duty of loyalty and the duty of responsibility. True

4. A not-for-profit corporation is prohibited from making money. False

5. A healthcare organization may not form as a partnership. False

Check Your Understanding 6.2

1. A “hold harmless” clause may provide for compensation by one individual to another. True

2. A breach of contract judgment always requires monetary compensation. False

3. An acceptance of an offer reflects a meeting of the minds regarding the contract terms. True

4. To be valid, a contract must be in writing. False

5. Mistake of fact is a potential defense for nonperformance of a contract. True

Check Your Understanding 6.3

1. Antitrust violations are generally governed by individual state laws. False

2. All restraints of trade are per se antitrust violations. False

3. Medical staff credentialing can lead to antitrust concerns. True

4. There are nine safety zones in health care that the federal government will generally not challenge as antitrust violations. True

5. The Sherman Act is the oldest of the three major federal antitrust statutes. False

Check Your Understanding 6.4

1. Economic credentialing is the granting of medical staff privileges based on quality of care indicators. False

2. Antitrust claims are only valid if they relate to an entire group of individuals who have been denied privileges at a healthcare organization. False

3. A group boycott is a per se antitrust violation. True

4. Courts uphold all non-compete agreements in order to protect the livelihood of organizations that an employee or contractor leaves for other opportunities. False

5. The number of procedures performed by a provider may be linked to clinical performance and quality issues when determining medical staff privileges. True


Check Your Understanding 7.1

1. A person must give permission to receive medical treatment through express consent. True

2. Informed consent should include alternatives to the proposed treatment or procedure. True

3. The law permits a presumption of consent during emergency situations. True

4. The Genetic Information Nondiscrimination Act (GINA) applies to any entity that has the potential to make a decision about a person based on that person’s genetic information. False

5. Compound authorizations combine informed consent with authorization for the use and disclosure of a research subject’s health information. True

Check Your Understanding 7.2

1. Unless it is designated as durable, a power of attorney is only effective when the principal has capacity. True

2. A durable power of attorney for healthcare decisions expresses an individual’s wishes to limit treatment measures when specific health-related diagnoses or conditions exist and the individual cannot communicate on his own behalf. False

3. The Patient Self-Determination Act requires hospitals that are Medicare providers to document in the health record whether an individual has an advance directive. True

4. The Uniform Anatomical Gift Act permits an anatomical gift by any person designated to make decisions about a decedent’s remains. True

5. The technical process for executing a living will is standardized nationally. False

Check Your Understanding 7.3

1. A competent adult’s right to refuse consent to medical treatment applies even when the treatment is lifesaving. True

2. In right-to-die cases, courts will balance an individual’s right to self-determination against the interest of the state. True

3. The Uniform Health-Care Decisions Act suggests that in the absence of a surrogate, a spouse be the first person to make healthcare decisions on behalf of an individual who has lost mental capacity. True

4. An emancipated minor is one who has not been afforded legal status as an adult. False

5. State laws generally allow minors to seek medical treatment for sexually transmitted diseases without parental consent. True

Check Your Understanding 7.4

1. Battery is the usual basis of a claim for which an individual did not give consent for a procedure that was performed. True

2. The basis for a lack of informed consent claim is generally negligence. True

3. A treating provider should delegate the informed consent process to another person. False

4. General consent allows healthcare providers to provide routine noninvasive services. True

5. Both written and oral consent should be documented in an individual’s health record. True


Check Your Understanding 8.1

1. Health records using a combination of paper and electronic formats are hybrid records. True

2. The most important purpose of the health records is to provide proof of services for reimbursement. False

3. The health record is not permitted to serve as an organization’s business record. False

4. There are both federal and state versions of the Uniform Photographic Copies of Business and Public Records as Evidence Act. True

5. The custodian of the legal health record is responsible for collecting, protecting, and archiving the record. True

Check Your Understanding 8.2

1. “Patient appears to be anxious” is an example of good documentation in the health record. False

2. Charting for a block of time is recommended because it saves time. False

3. Medical staff bylaws must state the categories of personnel who are authorized to accept physician orders. True

4. Professional conclusions of individual practitioners should be documented in the health record so that they agree with one another. False

5. A jury may be permitted to infer provider negligence based on missing or incomplete information in the health record. True

Check Your Understanding 8.3

1. Authentication refers to the ability to verify the source of an entry in the health record. True

2. Author initials are prohibited as an authentication mechanism in the health record. False

3. Metadata provides information about an entry’s content, including date and time of creation. True

4. A countersignature signifies review and evaluation of the actions and documentation of another provider. True

5. Auto-authentication is favored by the Joint Commission because it is an efficient authentication tool. False

Check Your Understanding 8.4

1. A Joint Commission-accredited organization may use any abbreviation in health record documentation as long as it is explained in a facility-wide key or legend. False

2. Illegibility has been reduced through the presence of EHRs. True

3. Incorrect information in the health record should be obliterated so that it cannot be confused with the updated, corrected information that is placed in the record. False

4. A late entry in the health record should not be identified as such because it may lead to negligence liability. False

5. Version management is how an organization handles numerous versions that may exist of a document. True

Check Your Understanding 8.5

1. A computer system’s print function provides additional challenges for organizations with EHRs. True

2. A patient’s personal health record is a business record. False

3. A master patient index is a directory of patient-identifying information. True

4. Statutes of limitations may not be considered when establishing a health record retention schedule. False

5. When establishing a health record retention schedule, an organization must retain all records for the same period of time. False

Check Your Understanding 8.6

1. Health record disposition includes transferring records from paper to an optical imaging system. True

2. When a physician closes a practice, all health records should be destroyed immediately to protect the privacy of patient information. False

3. Data in a health record needs to be kept forever. False

4. Degaussing a hard drive involves neutralizing it with a magnetic field as a method to erase patient information. True

5. When an e-mail message is deleted, it is eliminated from an organization’s electronic system. False


Check Your Understanding 9.1

1. The Privacy Rule resides in the administrative simplification provision of Title II of HIPAA. True

2. The HITECH Act of the ARRA of 2009 made significant changes to the HIPAA Privacy Rule. True

3. The FOIA was enacted to address the privacy of health information. False

4. Drug and alcohol abuse treatment records have received protection under federal law. True

5. The Conditions of Participation regulate only providers who receive funds from the Medicare and Medicaid programs. True

Check Your Understanding 9.2

1. A CE needs only consider its employees when evaluating HIPAA compliance within the organization. False

2. The HITECH Act has strengthened BA requirements regarding compliance with the Privacy Rule. True

3. In part, information must be individually identifiable to meet the definition of PHI. True

4. Deidentified information receives Privacy Rule protection. False

5. A BA is anyone who might have access to a CE’s PHI. False

Check Your Understanding 9.3

1. Under the Privacy Rule, a personal representative must be treated the same as the individual regarding the use and disclosure of the individual’s PHI. True

2. By definition, a DRS includes billing records. True

3. A hospital employee’s pre-employment physical examination is in his personnel file in Human Resources; this report is PHI. False

4. A university with a medical center is a hybrid entity under the Privacy Rule. True

5. Some of the Privacy Rule’s requirements are relaxed or removed where PHI is needed for purposes of TPO. True

Check Your Understanding 9.4

1. The HIPAA consent explains an individual’s rights and the CE’s legal duties with respect to PHI. False

2. Per the HIPAA Privacy Rule, patient authorization is required for the use or disclosure of PHI unless it meets an exception whereby authorization is not required. True

3. Although an individual must verbally agree to be included in a facility directory, written authorization is not required. True

4. One of the 12 public interest and benefit exceptions to the authorization requirements is disclosure to organ procurement agencies. True

5. Incidental disclosures do not require an individual’s written authorization. True

Check Your Understanding 9.5

1. Under no circumstance should health records from other facilities be made a part of an organization’s DRS. False

2. The minimum necessary principle applies to disclosures made for TPO purposes. False

3. An individual has the right of access to her psychotherapy notes. False

4. Per HITECH, an accounting of disclosures will be required in the future for TPO disclosures made by covered entities with EHRs. True

5. Complaints about alleged Privacy Rule violations must be submitted to the covered entity. False

Check Your Understanding 9.6

1. The threshold for required media notification in the event of a privacy breach is 300 affected individuals. False

2. All activities that meet the HIPAA definition of marketing must receive prior written authorization from the individual. False

3. The breach notification requirement is new under HITECH. True

4. Fundraising activities that target individuals based on diagnosis require prior authorization. True

5. A conditioned authorization may be allowed by ARRA in certain situations. True

Check Your Understanding 9.7

1. The Privacy Rule provides a floor, or minimum, of privacy requirements. True

2. Breach notification is one type of mitigation under the Privacy Rule. True

3. In order to simplify processes, individuals may be required to waive their rights under the Privacy Rule to obtain treatment or benefits eligibility. False

4. Under HITECH, state attorneys general may bring civil actions in federal district court on behalf of residents believed to have been negatively affected by a HIPAA violation. True

5. Enforcement of the Privacy Rule will continue to operate exclusively on a complaint-based system. False


Check Your Understanding 10.1

1. The Security Rule requires CEs to ensure the integrity and legality of patient information. False

2. The goal of the Security Rule is to ensure that patient information is protected from unauthorized access, alteration, deletion, and transmission. True

3. CMS is the enforcement agency for the Security Rule. False

4. CEs can decide to comply with only the Privacy Rule and don’t have to comply with the Security Rule. False

5. Only healthcare providers are required to comply with the Security Rule. False

Check Your Understanding 10.2

1. The Security Rule contains provision that CEs can ignore. False

2. The Security Rule is completely technical and requires computer programmers to address. False

3. The Security Rule contains both required and addressable standards. True

4. The Security Rule contains encryption specifications that all CEs must comply. False

5. The Conditions of Participation restrict payment to providers who are not compliant with the Security Rule. False


Check Your Understanding 11.1

1. Internal security breaches are far more common than external breaches. True

2. The Medical identity theft and Assumption Deterrence Act of 1998 make it a federal crime to commit an act of medical identity theft. True

3. Medical identity theft includes the use of a patient’s financial information to purchase goods or services even if they are not medical in nature. False

4. Healthcare organizations are excluded from the definition of “creditor” under FACTA. False

5. Red flags are used to help a healthcare provider detect medical identity theft. True

Check Your Understanding 11.2

1. CBAC is less stringent than RBAC. False

2. Biometric identifiers signify something that the user knows. False

3. An audit trail is a record that shows when a particular user accessed a computer system. True

4. Employee nondisclosure agreements are particularly important for employees who work in remote locations or telecommute. True

5. Employee training programs are not necessary to protect the security of PHI. False

Check Your Understanding 11.3

1. Data encryption ensures that data transferred from one location on a network to another is secure from eavesdropping or data interception. True

2. An organization’s firewall limits external Internet users from accessing portions of the healthcare network, but it does not limit internal users from accessing portions of the Internet. True

3. Facsimile machines provide a highly secure method of communication. False

4. E-mail related to patient care should be kept separate from the patient medical record. False

5. Disaster recovery and contingency plans related to ePHI are nice to have but not necessary. False


Check Your Understanding 12.1

1. Ownership of a health record has traditionally been granted to the patient. False

2. A competent adult may wish to appoint another person to be his or her personal representative. True

3. A minor who is emancipated must still have his or her parents authorize for disclosure of health information. False

4. A noncustodial parent has the right to access the healthcare information of their minor children subject to other mitigating circumstances related to the minor’s rights to access. True

5. Attorneys have automatic access to patient information because they are an officer of the court. False

Check Your Understanding 12.2

1. HIPAA does not distinguish highly sensitive health information from other types of health information. False

2. Privilege statutes legally protect confidential communications between provider and patient related to diagnosis and treatment from disclosure during civil and some criminal misdemeanor litigation. True

3. The duty to warn obligation enables a physician to disclose information to a third party who may be the victim of harm perpetrated by a patient. True

4. For a substance alcohol and drug abuse program to be in compliance with the Privacy Rule the authorization of disclosure of information should include specific elements required by the Privacy Rule. True

5. Health records of HIV/AIDS patients should be clearly marked as such. False

Check Your Understanding 12.3

1. Title I of GINA allows for health plans to use genetic for insurance premium-setting decisions. False

2. Title II of GINA focus on employment and put restrictions on employers for using genetic information to make employment decisions. True

3. Most states deem adoption records as confidential and only allow release of such records with a court order. True

4. An adoptee’s birth record is restricted in order to protect the biological parent(s) unless both parties have agreed to have their identities disclosed in a mutual consent registry. True

5. Courts will decide if an adoptee may access the health information of his or her biological parents for health risk purposes. True

Check Your Understanding 12.4

1. In absence of a legal executor or administrator of an estate a surviving spouse or other descendent my access the health records of the deceased patient. True

2. The Freedom of Information Act along with open records laws including public records or sunshine laws requires that federal or state entities make information generated in the normal course of business including health information public and subject to access by whoever requests the information. False

3. An employer is entitled to information about an employee’s medical work fitness but not to a diagnosis or other specific health details. True

4. The Patriot Act of 2001 and the Homeland Security Act of 2002 allow unauthorized access to PHI upon request in order to protect the country. True

5. The Electronic Record Express initiative sponsored by the Social Security Administration to process disability claims does not require patient authorization for release of PHI. False

Check Your Understanding 12.5

1. Documents not considered part of the legal health record for example like correspondence, incident reports, and information about other family members should be released as part of the LHR. False

2. Proof of a requester’s relationship to a patient must be verified before health information is released to the requester. True

3. A request for any and all information on a patient should be honored without question as long as the authorization form is signed by the patient. False

4. Health organizations and providers may charge a reasonable fee as set by state law for copying health records in response to a request for patient information. True

5. HIPAA requires that for the purpose of accounting of disclosures only PHI that has been released electronically or in writing must be accounted for. False


Check Your Understanding 13.1

1. State required reporting laws are an exception to the doctrine of preemption. True

2. When information is released to meet state required reporting laws, the release does not have to be included in the facility’s accounting of disclosures. False

3. Central registries are covered by and must adhere to the requirements of HIPAA. False

4. Abuse of the elderly is limited to financial exploitation of an elder person’s assets. False

5. Physical abuse is usually the only type of maltreatment that must be reported under child abuse reporting laws. False

Check Your Understanding 13.2

1. The attending physician usually has responsibility for filing the death certificate. False

2. Reporting of notifiable diseases without the patient’s authorization is allowed under the public interest and benefit exception under HIPAA. True

3. National hospital quality measures data may only be released to the QIO or the CDAC with a signed authorization from the patient. False

4. Every hospital receiving reimbursement from Medicare for implantable cardiac defibrillators must submit data to the American College of Cardiologists National Cardiovascular Data Registry. True

5. Federal law requires that a hospital notify the designated organ procurement organization (OPO) in a timely manner regarding specified organ donors who die in the hospital or for whom death is imminent. True

Check Your Understanding 13.3

1. Information included in state registries is considered public information. False

2. Immunization registries are different from other state registries because they allow access by the individuals included in the registry or their representatives, such as parents. True

3. Transplant registries may include data about organ donors as well as organ recipients. True

4. Implant registries are frequently developed in response to highly publicized cases of harm resulting from implants to provide for easier notification of individuals affected. True

5. Statewide cancer registries are frequently required to report data to the National Center for Health Statistics. False


Check Your Understanding 14.1

1. Risk management focuses on an organization’s financial liability. True

2. Quality and risk management programs have evolved concurrently. True

3. A hospital’s strongest legal defense is the doctrine of charitable immunity. False

4. Darling vs. Charleston Community Memorial Hospital is a landmark case that extended negligence liability to hospitals. True

5. A 1999 report by the Institute of Medicine concluded that very few preventable errors lead to patient deaths in hospitals. False

Check Your Understanding 14.2

1. A review of patient complaints can assist in the risk identification process. True

2. Establishing the frequency or severity of a particular loss occurring is part of the risk treatment process. True

3. A claims management program should include the retention of all insurance policies. True

4. An incident report should be completed by an individual who investigated a situation and determined its cause. False

5. Incident reports are protected from discovery in all states. False

Check Your Understanding 14.3

1. Patient non-compliance with medical advice should not be documented in the health record because it might upset the patient. False

2. A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. True

3. All medical errors are sentinel events. False

4. Joint Commission accredited organizations are expected to complete a root cause analysis following a sentinel event. True

5. National Patient Safety Goals are optional standards that an organization may choose to meet in order to receive a special designation from the Joint Commission. False

Check Your Understanding 14.4

1. Patient-centered care is one of 10 objectives recommended by the Institute of Medicine in 2001 as central to the U.S. healthcare system. False

2. The American Hospital Association’s Patient Bill of Rights is now the Patient Care Partnership, which focuses on patient expectations, rights, and responsibilities. True

3. The Hill-Burton Act is federal legislation, passed in 1946, that provided hospitals money for construction and modernization. True

4. EMTALA was passed by Congress to combat transfer and discharge of patients, and refusal to treat, based on inability to pay. True

5. In addition to recognizing patient rights, many hospitals have adopted codes of patient responsibility. True

Check Your Understanding 14.5

1. The National Practitioner Data Bank collects malpractice and disciplinary action information on physicians. True

2. The Medicare Conditions of Participation encourage restraints in the interest of patient safety. False

3. Quality Improvement Organizations provide consultation and quality improvement resources to a wide range of providers. True

4. The Leapfrog Group consists of organizations that are responsible for purchasing healthcare coverage for employees. True

5. Pay for performance provides incentives to healthcare providers to deliver high-quality care. True


Check Your Understanding 15.1

1. Healthcare abuse relates to a false representation of fact. False

2. Billing for services never rendered is one of the most common types of healthcare fraud. True

3. Unbundling is a billing practice preferred by payers. False

4. A Corporate Integrity Agreement is a voluntary compliance program adopted by a healthcare organization. False

5. Although desirable, correct documentation in the health record is not necessary to support billing. False

Check Your Understanding 15.2

1. The False Claims Act targets anyone who knowingly submits false claims to a private insurance company. False

2. A qui tam action involves whistleblowers who file a complaint alleging fraud against the government. True

3. The False Claims Act utilizes a knowing standard, which includes acting in deliberate ignorance. True

4. The Federal Anti-Kickback Statute targets those who pay, solicit or receive payment in exchange for business that will be reimbursed by a federal healthcare program. True

5. Under the CMP law, a hospital may be excluded from the Medicare program if its wrongdoing caused harm to an HHS program. True

Check Your Understanding 15.3

1. The Stark Law prohibits physicians from ordering certain health services for Medicare patients from entities in which the physician or immediate family member has a financial relationship. True

2. A purpose of antitrust laws is to discourage marketplace competition. False

3. In its definition of “referral,” the Stark Law excludes a request by a radiologist for diagnostic radiology services. True

4. State healthcare fraud and abuse laws apply to all payers. True

5. The Deficit Reduction Act of 2005 made compliance programs voluntary rather than mandatory. False

Check Your Understanding 15.4

1. Fraudulent billings practices are a major compliance risk area for healthcare organizations. True

2. A claim that is resubmitted based on a patient complaint is not a false claim because it was not initiated by the healthcare provider. False

3. Sending a duplicate claim each month to a payer until it is paid is an acceptable billing practice. False

4. CPT codes that should not be billed together are listed in Medicare’s Correct Coding Initiative. True

5. Medicare deems all services to be medically necessary if they are ordered by a patient’s attending physician. False

Check Your Understanding 15.5

1. A corporate code of conduct expresses an organization’s commitment to ethical behavior. True

2. A corporate compliance officer position is ideally suited to a clerical staff person. False

3. Federal Sentencing Guidelines encourage organizations to have fraud prevention and detection programs in place. True

4. Anonymous reporting of compliance violations should be prohibited because it inhibits open communication. False

5. The mission of the Office of the Inspector General for the U.S. Department of Health and Human Services (HHS) is to protect the integrity of HHS programs, and the health and welfare of those programs’ beneficiaries. True


Check Your Understanding 16.1

1. The medical staff has the ultimate responsibility for the quality and financial well-being of the health organization. False

2. Medical staff bylaws are considered a contract and are legally binding in most states. True

3. Joint Commission standards require that the medical staff bylaws address issues of self-governance and accountability to the governing board. True

4. Credentialing is the process of reviewing and validating qualifications of practitioners for granting medical staff membership. True

5. If a practitioner is assigned a medical staff category of “associate,” he or she can chair the medical staff executive committee. False

Check Your Understanding 16.2

1. The process for verifying the credentials of a physician who wishes to join a medical staff is referred to as primary source verification. True

2. A healthcare organization does not have a duty to share information on a practitioner upon legitimate request. False

3. The National Practitioner Data Bank enables a healthcare facility to check on the background of a practitioner to determine if the practitioner has had his or her license to practice suspended for any reason. True

4. An adverse action against a physician is not reportable to the National Practitioner Data Bank. False

5. Due process is required in the hiring and disciplinary process that affects a practitioner’s medical staff privileges or employment. True


Check Your Understanding 17.1

1. The EEOC enforces laws that protect the employer from poor job applicants. False

2. The Age Discrimination in Employment Act of 1967 protects individuals 40 years and older from being discriminated against in the employment setting. True

3. If an employee discovers he is carrying the gene that causes colon cancer his insurance company can deny him insurance. False

4. A hospital has the right to deny employment to an applicant from another country if the applicant does not speak English. False

5. Employers must handle the conditions of pregnancy and childbirth, or related medical conditions, in the same manner as they handle medical conditions afford an individual who is not pregnant. True

Check Your Understanding 17.2

1. The number of hours a child under the age of 16 is protected by law. True

2. ERISA refers to pension plans while COBRA refers to health insurance. True

3. Employees may not self-select to join a union. False

4. Labor unions exist to protect employers from demanding employees. False

5. Hospital employers must provide healthcare workers with information regarding what to do if the worker is accidently stick with a needle that has been used on a patient. True


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