C807 Healthcare Compliance
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Free C807 Healthcare Compliance Questions
Benchmarking is a control tool designed to improve quality. Benchmarking...
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provides a comparison of one's own activities with results of another department or organization
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must be performed by external agencies comparing data with external organizations
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tells you exactly what is wrong and how to fix it
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is a mandatory aspect of any QA plan
Explanation
Explanation:
Benchmarking is a quality improvement tool that involves comparing one’s own processes, outcomes, or performance indicators against those of another department, organization, or recognized best performer. This comparison helps identify performance gaps and opportunities for improvement but does not prescribe specific corrective actions. Instead, it provides a framework for organizations to analyze successful practices elsewhere and adapt them to their own operations. Benchmarking can be done internally or externally and serves as a voluntary, strategic tool rather than a mandatory requirement.
Correct Answer:
provides a comparison of one's own activities with results of another department or organization
What is the primary purpose of risk determination in a healthcare organization?
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To identify all potential threats without prioritization
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To quantify threats and prioritize risks for resource allocation
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To eliminate all risks associated with patient care
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To ensure compliance with all regulatory requirements
Explanation
Explanation
Risk determination in a healthcare organization focuses on quantifying identified risks and assessing their potential impact and likelihood of occurrence. The goal is to prioritize which risks pose the greatest threat to patient safety, financial stability, or regulatory compliance so that resources can be effectively allocated for mitigation. This process helps healthcare leaders make informed decisions about prevention, control, and response strategies rather than attempting to eliminate all risks, which is often impossible in a healthcare environment.
Correct Answer
To quantify threats and prioritize risks for resource allocation
Explain why the OIG recommends auditing a minimum of 5 medical records per federal payer. What is the significance of this number in ensuring compliance?
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It ensures a comprehensive review of billing practices
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It is the average number of claims submitted.
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It is a requirement under HIPAA.
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It helps to reduce administrative costs.
Explanation
Explanation
The OIG recommends auditing at least 5 medical records per federal payer to establish a representative sample for identifying potential compliance issues and billing errors. Reviewing a minimum number of records helps detect patterns of incorrect coding, insufficient documentation, or improper billing practices without reviewing the entire patient population. This approach balances efficiency with thoroughness, allowing organizations to proactively address risks, implement corrective actions, and demonstrate due diligence in compliance monitoring.
Correct Answer
It ensures a comprehensive review of billing practices
Benchmarking allows an organization to:
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Compare themselves to another organization
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Compare similar services to similar services
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Compare on Joint Commission hospitals with one another
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Only used when there is no time to fully execute a SWOT analysis
Explanation
Explanation:
Benchmarking enables organizations to measure their performance by comparing similar services, processes, or outcomes to those of other high-performing entities. This comparison helps identify gaps, set improvement targets, and adopt best practices that enhance efficiency and quality. The process focuses on learning from similar departments or organizations that perform exceptionally well in the same service areas. It is not limited to Joint Commission-accredited hospitals nor is it a substitute for a SWOT analysis, which serves a different strategic purpose.
Correct Answer:
Compare similar services to similar services
What is the primary characteristic of a near miss in a healthcare setting?
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A near miss is an event that results in a serious adverse outcome for the patient.
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A near miss is an occurrence that has the potential to lead to a serious adverse event but does not result in harm.
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A near miss is a type of sentinel event that is reviewed by The Joint Commission.
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A near miss is an event that is always documented in patient records
Explanation
Explanation
A near miss in healthcare is an event that could have caused harm to a patient but did not, either by chance or because it was intercepted before reaching the patient. These events are important to track and analyze because they provide valuable information on system vulnerabilities and potential risks. By identifying and addressing near misses, healthcare organizations can prevent future adverse events and improve overall patient safety. Near misses differ from sentinel events because they do not result in actual harm.
Correct Answer
A near miss is an occurrence that has the potential to lead to a serious adverse event but does not result in harm.
Explain how the Anti-kickback statute impacts joint ventures in healthcare. What are the potential consequences of violating this statute?
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It allows for financial incentives between providers, leading to increased services.
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It prohibits financial incentives that could lead to unnecessary services, with penalties for violations.
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It encourages collaboration among providers without restrictions.
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It only applies to pharmaceutical companies and not healthcare providers.
Explanation
Explanation
The Anti-Kickback Statute is a federal law that prohibits offering, paying, soliciting, or receiving any remuneration to induce or reward referrals for services covered by federal healthcare programs. In the context of joint ventures, this means that any financial arrangement between providers must not incentivize unnecessary services or referrals. Violating the statute can result in severe penalties, including criminal charges, civil fines, and exclusion from federal healthcare programs. This law ensures that joint ventures are structured to prioritize patient care rather than financial gain.
Correct Answer
It prohibits financial incentives that could lead to unnecessary services, with penalties for violations
Which of the following is a primary focus of the National Patient Safety Goals (NPSGs) in healthcare organizations?
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Enhancing the financial performance of healthcare facilities
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Improving the accuracy of patient identification
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Increasing the number of patients treated per day
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Streamlining administrative processes
Explanation
Explanation
The National Patient Safety Goals (NPSGs), established by The Joint Commission, are designed to improve patient safety by addressing specific areas of concern in healthcare settings. A primary focus of these goals is ensuring the accurate identification of patients to prevent errors such as administering the wrong treatment or medication to the wrong individual. Other NPSGs include improving communication among caregivers, reducing healthcare-associated infections, and preventing patient falls. The emphasis is on safety and quality of care rather than financial performance or administrative efficiency.
Correct Answer
Improving the accuracy of patient identification
Which one of the following is NOT considered an engineering control?
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Floor cleaning devices
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Needleless devices
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Safe medical devices
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Shielded needle devices
Explanation
Explanation
Engineering controls in healthcare are physical modifications or devices designed to reduce the risk of exposure to hazards, particularly bloodborne pathogens. Examples include needleless systems, safe medical devices, and shielded needles, which prevent accidental needle sticks and reduce the risk of infection. Floor cleaning devices, while important for maintaining hygiene, do not directly control exposure to occupational hazards through engineered design and therefore are not considered engineering controls.
Correct Answer
Floor cleaning devices
Why is the OIG Work Plan important to review each year by facilities?
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It outlines the facilities that are on the watch list for the OIG.
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It announces potential problem areas with claims submissions that the OIG will target for special scrutiny
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It published the fines each year for noncompliance with the OIG Compliance Program Guidance.
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Addendum B of the OIG Work Plan provides the status indicators for hospitals
Explanation
Explanation:
The Office of Inspector General (OIG) Work Plan is an essential compliance resource that outlines the agency’s priorities for audits, evaluations, and enforcement for the coming year. It identifies areas within healthcare operations—particularly billing, coding, and claims submissions—that are prone to fraud, waste, or abuse and will therefore be subject to increased scrutiny. By reviewing the Work Plan annually, healthcare facilities can proactively address these high-risk areas, ensure compliance with federal regulations, and avoid potential penalties or corrective actions.
Correct Answer:
It announces potential problem areas with claims submissions that the OIG will target for special scrutiny.
Infection control is
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An infection limited to a specific part of the body
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An object that has not been contaminated with pathogens
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A set of methods used to prevent the spread of disease
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The way in which infections occur
Explanation
Explanation
Infection control refers to the organized practices, policies, and procedures implemented in healthcare and community settings to prevent and limit the spread of infectious diseases. These methods include hand hygiene, use of personal protective equipment, sterilization, isolation protocols, and vaccination programs. Effective infection control minimizes the risk of transmission of pathogens among patients, healthcare workers, and the community, thereby protecting public health.
Correct Answer
A set of methods used to prevent the spread of disease
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