Healthcare Financial Regulations and Compliance: A Comprehensive Guide for Healthcare Professionals

Question 1

Which of the following is NOT a requirement under HIPAA's Privacy Rule?

Accepted Answer

Maintaining only electronic records

Answer

Obtaining patient authorization for use and disclosure of PHI

Answer

Establishing policies and procedures to safeguard PHI

Answer

Appointing a Privacy Officer

Question 2

Medicare Part A covers which of the following expenses?

Accepted Answer

Hospitalizations

Answer

Skilled nursing facility care

Answer

Outpatient prescription drugs

Answer

Routine dental care

Question 3

Which regulatory agency is responsible for enforcing HIPAA?

Accepted Answer

Office for Civil Rights (OCR)

Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

Federal Trade Commission (FTC)

Answer

Food and Drug Administration (FDA)

Question 4

In Medicare, which reimbursement system is mainly used to calculate payments for hospital services?

Accepted Answer

Diagnosis-Related Groups (DRGs)

Answer

Resource-Based Relative Value Scale (RBRVS)

Answer

Per Diem

Answer

Chargemaster

Question 5

Key Component of HIPAA Compliance

Which of the following is a core aspect of ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA)?

Accepted Answer

Protecting patient privacy and safeguarding their confidential information

Answer

Ensuring the accuracy and completeness of medical records

Answer

Billing patients accurately and in accordance with regulations

Answer

Submitting claims electronically to expedite the reimbursement process

Question 6

Purpose of Medicare PPS

What is the primary objective of the Medicare Prospective Payment System (PPS)?

Accepted Answer

To reimburse hospitals a predetermined fixed amount for each Medicare patient they treat

Answer

To compensate physicians a fee for each service provided to Medicare patients

Answer

To subsidize hospitals that provide care to low-income or uninsured individuals

Answer

To regulate the pricing of prescription drugs dispensed to Medicare beneficiaries

Question 7

Non-Key Eligibility Principle for Medicaid

Which of the following factors is not a primary determinant of eligibility for Medicaid coverage?

Accepted Answer

Citizenship status or legal residency within the United States

Answer

Income level in relation to federal poverty guidelines

Answer

Age, with specific eligibility criteria for children, seniors, and disabled individuals

Answer

Disability status, including physical, mental, or developmental impairments

Question 8

OIG's Role in Healthcare Compliance

What is the primary responsibility of the Office of the Inspector General (OIG) in the context of healthcare compliance?

Accepted Answer

Investigating instances of fraud, abuse, and misconduct within healthcare programs

Answer

Establishing standards and guidelines for accounting practices in healthcare organizations

Answer

Approving new healthcare technologies and innovations for use in patient care

Answer

Providing guidance and support on HIPAA compliance-related matters

Question 9

Medicare Part B covers which of the following services?

Accepted Answer

Physician visits

Answer

Hospitalization

Answer

Prescription medications

Answer

Long-term nursing home stays

Question 10

Medicaid is a joint federal-state program that provides health insurance primarily to:

Accepted Answer

Individuals and families with limited income

Answer

Seniors aged 65 and older

Answer

Military veterans

Answer

Individuals with disabilities

Question 11

Which of the following consequences is NOT typically associated with non-compliance with healthcare financial regulations?

Accepted Answer

Improved organizational reputation

Answer

Financial penalties

Answer

Imprisonment of responsible individuals

Answer

Suspension or revocation of licenses

Question 12

The Stark Law primarily prohibits:

Accepted Answer

Physicians from referring patients to healthcare entities in which they have a financial interest

Answer

Hospitals from billing for services provided by physicians with whom they have a financial relationship

Answer

Health insurers from denying coverage for medically necessary services

Answer

Patients from choosing their preferred healthcare providers

Question 13

The Anti-Kickback Statute makes it illegal to:

Accepted Answer

Provide or receive payment in exchange for patient referrals

Answer

Waive co-payments or deductibles for patients

Answer

Offer discounts on services to attract new patients

Answer

Provide free samples to healthcare professionals

Question 14

Which primary objective of the Health Insurance Portability and Accountability Act (HIPAA) is to safeguard sensitive patient health information?

Accepted Answer

Protect patient privacy

Answer

Reduce healthcare costs

Answer

Standardize billing practices

Answer

Improve healthcare quality

Question 15

What is the core function of the Centers for Medicare & Medicaid Services (CMS) in healthcare finance?

Accepted Answer

Regulate Medicare and Medicaid programs

Answer

Negotiate drug prices

Answer

Fund healthcare research

Answer

Set healthcare quality standards

Question 16

What is the primary purpose of the False Claims Act in the context of healthcare finance?

Accepted Answer

Penalize healthcare providers for fraudulent claims

Answer

Protect patients from unethical billing

Answer

Prevent excessive healthcare service use

Answer

Establish standardized billing codes

Question 17

What is the specific aim of the Stark Law in healthcare finance?

Accepted Answer

Prohibiting self-referrals for specific healthcare services

Answer

Establishing medical procedure billing codes

Answer

Limiting physician compensation

Answer

Safeguarding patient privacy

Question 18

Which act protects the privacy of patients' individually identifiable health information?

Accepted Answer

Health Insurance Portability and Accountability Act (HIPAA)

Answer

Patient Protection and Affordable Care Act

Answer

Medicare Act

Answer

Medicaid Act

Question 19

What is the primary purpose of the Medicare Fee-for-Service (FFS) program?

Accepted Answer

To reimburse healthcare providers for the cost of providing services to patients

Answer

To provide coverage for low-income individuals

Answer

To promote population health and prevent chronic diseases

Answer

To regulate the quality of healthcare services

Question 20

Which organization is responsible for running Medicaid programs in each state?

Accepted Answer

State Medicaid agencies

Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

Social Security Administration (SSA)

Answer

Department of Health and Human Services (HHS)

Question 21

What is the key objective of risk management in healthcare finance?

Accepted Answer

To prevent or minimize financial losses

Answer

To enhance patient outcomes

Answer

To increase revenue streams

Answer

To ensure compliance with regulations

Question 22

Which component is NOT a part of an internal control system in healthcare finance?

Accepted Answer

Budgeting

Answer

Control environment

Answer

Risk assessment

Answer

Control activities

Question 23

What is the primary distinction between cost accounting and financial accounting in healthcare?

Accepted Answer

Cost accounting uses internal data for decision-making, whereas financial accounting reports to external stakeholders.

Answer

Financial accounting uses internal data for decision-making, while cost accounting reports to external stakeholders.

Answer

They are fundamentally the same.

Answer

Cost accounting emphasizes future costs, and financial accounting focuses on historical costs.