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The Fundamentals of Hospice Compliance: What Is It and What Are the Implications for the Future? An Overview for Hospice Clinicians, Part 1

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doi: 10.1097/NHH.0b013e3182464ab0
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The Fundamentals of Hospice Compliance: What Is It and What Are the Implications for the Future? An Overview for Hospice Clinicians, Part 1

TEST INSTRUCTIONS

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CE TEST QUESTIONS

GENERAL PURPOSE:

To provide registered professional nurses with the latest information on the current Medicare compliance climate and its implication for hospice providers, exploring the government's focus on voluntary and soon-to-be-mandatory compliance programs in particular.

LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to:

  1. Summarize the history of the government's efforts to eliminate fraud and abuse by Medicare and Medicaid providers.
  2. Outline the elements of compliance as presented here.
  3. Plan the appropriate interventions for compliance at an individual hospice.
  1. Which federal agency recently announced that it is using the same type of predictive modeling technology used in the private sector for identifying credit card fraud to analyze pre-paid claims?
    1. Centers for Medicare and Medicaid Services
    2. Council of Inspectors General on Integrity and Efficiency
    3. Office of Inspector General
    4. Medicaid Fraud Control Units
  2. In 2010, how much did the government recover through its healthcare fraud prevention and enforcement efforts?
    1. $1 billion
    2. $2 billion
    3. $3 billion
    4. $4 billion
  3. Which government agency recently launched its first-ever most wanted fugitives list to focus public attention on individuals who steal from federal healthcare programs?
    1. Centers for Medicare and Medicaid Services
    2. Council of Inspectors General on Integrity and Efficiency
    3. Office of Inspector General
    4. Medicaid Fraud Control Units
  4. In 2009, the Office of Inspector General determined that what percentage of the claims for Medicare hospice care for nursing facility residents didnotmeet Medicare coverage requirements?
    1. 56%
    2. 63%
    3. 74%
    4. 82%
  5. The total annual expenditures in the Medicare, Medicaid, and the Children's Health Insurance Programs represent what percentage of the total federal budget?
    1. 11%
    2. 19%
    3. 27%
    4. 35%
  6. In the Medicare Program Integrity Manual System, billing services that are not covered or are not correctly coded is the definition of
    1. fraud.
    2. waste.
    3. abuse.
    4. misrepresentation.
  7. In the Medicare Program Integrity Manual System, the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to himself or herself or some other person, is the definition of
    1. fraud.
    2. waste.
    3. abuse.
    4. misrepresentation.
  8. Hospice specific guidance lists 28 distinct compliance risk areas with additional emphasis on 5 specific areas, 1 of which is
    1. levels of care.
    2. overlapping services.
    3. hospice incentives.
    4. underutilization.
  9. Compliance programs for providers that bill federal programs will become mandatory under which of the following pieces of legislation?
    1. Stark Law
    2. Patient Protection and Affordable Care Act
    3. State False Claims Act
    4. Health Insurance Portability and Accountability Act
  10. The action described as, “Think through how people should behave and how care should be provided and write it down,” relates to which of the following of the seven compliance elements?
    1. Implementing written policies, procedures, and standards of conduct
    2. Conducting effective training and education
    3. Developing effective lines of communication
    4. Enforcing standards through well-publicized disciplinary guidelines
  11. Which of the following forms the foundation of a hospice's compliance structure?
    1. Its governing body
    2. Its performance standards
    3. Its standards of conduct
    4. Its communication style
  12. Which of the following are the procedures and practices that take into account the hospice's specific risks and vulnerabilities?
    1. Disciplinary guidelines
    2. Written compliance policies
    3. Standards of conduct
    4. Internal auditing policies
  13. The primary role of the compliance committee is to
    1. mediate compliance concerns.
    2. maintain and build the trust of employees.
    3. provide advice and assistance to the compliance officer.
    4. be open and accessible to all staff.
  14. An organization's culture is driven by its
    1. mission.
    2. vision.
    3. resources.
    4. leadership.
  15. The action described as “prioritize compliance risk areas, determine how to monitor them, make a schedule and stick to it” relates to which of the following of the seven compliance elements?
    1. Developing corrective action
    2. Conducting internal monitoring and auditing
    3. Developing effective lines of communication
    4. Responding promptly to detected offenses
  16. A strategy recommended by the author for handling compliance issues is to
    1. revise the compliance policies.
    2. refer the issues to human resources.
    3. consult a healthcare attorney.
    4. conduct in-depth auditing.
  17. The new expectation for hospices is that the responsibility for compliance belongs to
    1. the compliance officer.
    2. the compliance committee.
    3. the hospice administrators.
    4. everyone at every layer of the organization.
  18. Hospices that have made the commitment to developing and maintaining a comprehensive, coordinated compliance structure have realized an important additional benefit, which is
    1. increased appreciation from patients and families.
    2. less intimidation of staff by unrealistic policies.
    3. a move toward more electronic processes.
    4. higher quality and more consistent patient care.
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