February 2012 Compliance Education
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  1. A claim from services including a diagnosis of cancer is sent to an employer in error. The employer reports to SVA that the claim was received and this is not workers compensation. This is an example of what?
    A disclosure that is not a breach
    A disclosure that is a breach
    An incidental disclosure
    An error that is unrelated to HIPAA


  1. A patient called because he received his credit card receipt along with the receipt for another patient. What is the best choice for the next steps?
    Apologize to the caller and move to the next patient call without further action
    Only file a compliance report
    Ask the patient to shred the other patient's receipt, resend the receipt and file a compliance report
    Resend the receipt to the other patient, apologize to the caller


  1. SVA receives a denial for a client stating that a provider is not credentialed with a payer and services will be denied. Which action is not appropriate?
    Checking on credentialing status for the provider
    Changing the claim to someone in the provider's group who is credentialed with the payer
    Adjusting charges if the claim is before the credentialing effective date
    Contacting the payer for further information


  1. You need to send an email with PHI to a client - patient names are included. You should
    Include Zixsecure in the subject line to make sure it encrypts
    Never send an email outside of SVA
    Hope that Zixsecure works and encrypts the email
    Not worry because the client does not like email protections


  1. You received a valid authorization for billing records from an attorney for an accident and a certain date range. You should provide
    An itemized statement for the whole date range because that is the request
    Medical records and the itemized statement for the whole date range
    Nothing because you are unsure about the request
    An itemized statement including only those dates of service relating to the accident


  1. A medical necessity denial is received from a payer and you are not a coder. You should:
    Request the medical report and review it yourself
    Apply a modifier and resubmit the claim
    Have a coder review the report and the diagnosis
    Write off the charges because the payer denies everything anyway


  1. You receive instructions from a client to adjust off a patient due balance. The client seems to have many patient adjustments. Which action is not appropriate?
    Let your supervisor know about the adjustments
    Keep writing off the charges - the client knows best
    Ask the client if there is a financial hardship
    Documenting the reason for the adjustment in patient notes


  1. An email arrives in your inbox with an unknown name, an attachment and a subject that does not make sense. The best choice is to:
    Forward it to IT for review without opening it
    Open it because you are curious
    Forward it to a friend
    Delete it because it does not pose any harm


  1. During your daily tasks, you have an account to work that belongs to a co-worker. You should:
    Let the co-worker know that you were in the account
    Email your supervisor or compliance manager that you were in the account for work purposes
    Make sure you read everything in the account in case your co-worker needs support
    Exit the account and forget about the charge


  1. What is the difference between a power of attorney and an executor when it comes to releasing patient information under HIPAA?
    They have equal authority
    An executor has more control than a power of attorney
    A person needs to be both to have authority
    A power of attorney is for a living patient and an executor is for a deceased patient





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