The flashcards below were created by user victoria.ligons on FreezingBlue Flashcards.

  1. Know the components of a compliance plan?
    • The seven components are as follows:
    • 1.Monitor compliance by conducting periodic audits.
    • 2.Implement compliance and practice standards by developing written standards and procedures.
    • 3.Designate a compliance officer or contact to monitor compliance efforts and enforce practices standards.
    • 4.Conduct appropriate training and education on practice standards and procedures.
    • 5.Respond appropriately to detected violations by investigating allegations and disclosing incidents to appropriate government entities.
    • 6. Develop open lines of communication, such as discussion at staff meetings regarding how to avoid erroneous or fraudulent conduct, and community bulletin boards, to keep employees updated regarding compliance activities. 
    • 7. Enforce disciplinary standards by adhering to well- publicized guidelines.
  2. What is HCFA's new name?
    The Health Care Financing Administration, adopted a new name (CMS)
  3. Know the top 14 reported hot line issues?
    • 1.Billing and Coding
    • 2.Conflict ofInterest 
    • 3.Fraud
    • 4.Health Violation 
    • 5.Human Resources
    • 6.Medical Staff
    • 7.Patient Care
    • 8.Policy Violation
    • 9.Prejudice
    • 10.Sexual Harassment
    • 11.Substance Abuse
    • 12.Theft
    • 13.Time/Attendance
    • 14.Workplace Violation
  4. What provides exclusions of health care providers?
    Mandatory Exclusion, Permanently Excluded, and a Permissive Exclusion.
  5. What type of cap do the incentive reward program has?
    The cap on the reward is $1,000 or 10% of the recovered funds, whichever is less.
  6. Know the exclusions from Medicare?
    Physicians guilty of fraud and abuse can be excluded from participation in the Medicare and Medicaid program.
  7. Know the administrative remedies?
    • Administrative remedies may be enforced to correct abuse practices within a medical practice. Such as remedies include the following:
    • 1.Education
    • 2.Recovery of overpayment
    • 3.Withheld payments
  8. Who can authorize an autopsy?
    • -The deceased patient before death with spousal consent
    • -Written authority by the deceased
    • -The spouse of the deceased 
    • -Any adult children of the deceased 
    • -Any adult grandchildren of the deceased
    • -the parents of the deceased
    • -the brothers or sisters of the deceased
    • -the nephews or nieces of the deceased
    • -the grandparents of the deceased
    • -the uncles or aunts of the deceased
    • -the adult cousins of the deceased
    • -the adult stepchildren of the deceased
    • -A relative who is next of kin of a previously deceased spouse
    • -Any other relative or friend with written authorization from the deceased
  9. What year did antitrust laws begin to affect health care?
  10. What area is not an antitrust concern?
    Areas of concern for health care include price fixing, limiting new entrants into the area, preferred provide arrangements, exclusive contracts, and so on.
  11. Know the various types of consent?
    Express Consent, Implied Consent, Informed Consent,  Consent of a Mentally Ill Patient, Consent of a Minor, and Lack of Consent
  12. What can result in malpractice?
    • Following are seven ways to prevent malpractice:
    • 1.Maintain accurate medical records
    • 2.Have a risk management plan
    • 3.Provide patient services based on standards of care
    • 4.Maintain good rapport with patients
    • 5.Have prescriptions renewal policies in place
    • 6.Show respect for patients and their families
    • 7.Strive for good treatment outcomes
  13. Know the various forms of negligence?
    Malfeasance, Misfeasance, Nonfeasance, Malpractice,Criminal Negligence
  14. What circumstances would confidentiality must be maintained?
    • A patients medical information may be released under the following circumstances:
    • 1. The patient files a lawsuit for personal injuries
    • 2. Consent has been obtained
    • 3.The court orders it
    • 4.A third party has requested it.
  15. Know the degree of negligence?
    Ordinary Negligence, Gross Negligence
  16. Know the parts of a subpoena
    • 1. A reference number
    • 2.The names of the plaintiff and defendant
    • 3.The date, time , ad place to appear
    • 4.The name, address, and telephone number of the opposing attorney
    • 5.The documents requested, if the subpoena is for records
  17. Who could serve a subpoena?
    • 1. Attorney
    • 2.Sheriff
    • 3.Process Server
    • 4.Court clerk
  18. The act that provides for over time worked?
    Fair Labor Standards Act of 1938.
  19. Know the 50/50 rule?
    Executive Order 11246. This order, which is also know as the 50/50 rule , requires that all businesses having federal contracts of more than $50,000 and employing more than 50 people develop affirmative action programs.
  20. What act protect the handicapped?
    Vocational Rehabilitation Act of 1973
  21. What act protects employees from benefits discrimination?
    The Older workers Benefit Protection Act of 1990.
  22. What E&M Code that OIG does focus on?
    • -99214: established patient office visit level four
    • -99233:subsequent hospital visit level three
    • -99244: outpatient consultation level four
    • -99245: outpatient consultation level five
    • -99254:inpatient consultation level four
    • -99255:inpatient consultation level five
  23. What is the name of omitting certain codes on asuper bill  called?
    Code Steering: can be an issue if all levels of E&M Codes are not listed on the super bill or patient encounter form.
  24. What are the reasons that most people sue the doctors?
    • 1. Maintain accurate medical records.
    • 2.Have a risk management plan.
    • 3.Provide patient services based on standards of care.
    • 4.Maintain good rapport with patients
    • 5.Have prescription renewal policies in place
    • 6.Show respect for patients and their families
    • 7.Strive for good treatment outcomes
  25. What year did the self-determination act come into effect?
  26. Know what issues is an ethical dilemma?
    • 1. End-of-Life decisions
    • 2.Organ donations
    • 3.Confidentiality
    • 4.HIV detection and notification
    • 5. Mapping of genomes
    • 6. Beginning-of-life technologies
    • 7.Disclosure of medical errors
    • 8.Ethics and the pharmaceutical industry
Card Set
Show Answers