CHPC Study Group

Classic Scenario Questions

  • 1.  Classic Scenario Questions

    Posted 4 days ago
    What is helpful, as I'm continuing to talk to folks who are taking exams from other listservs...the scenario below is typical to what you will likely see on the exam.

    Scenario 1:
    A compliance officer reviews a hotline call left by an anonymous caller that Coder Cliff is purposely upcoding a particular type of patient encounter so that the organization can get paid more than it should for services provided to a Medicare patient.  The NEXT step the compliance officer should do is:
    A.  Stop all Medicare billing immediately until an investigation is conducted
    B.  Contact legal about the alleged upcoding of Medicare claims and request guidance on next steps
    C.  Arrange for a review of claims completed by Coder Cliff to assess his coding accuracy
    D.  Reassign Coder Cliff to perform coding for non-Medicare patients


    Scenario 2:
    A compliance officer receives a copy of a letter by an unknown sender.  The letter states that the organization's patient database has been breached and in the letter there is a copy of a 20 patients listed with their demographic information, banking account information, and social security numbers along with a comment that the information about the patients was obtained as part of the breach.  The letter indicates that a copy of the letter was also sent to the local newspaper to alert the newspaper that the organization has not protected its patients' information.  The BEST course of action for the compliance officer to take is to:
    A. Contact the privacy officer for the hospital and pass the letter along to the privacy officer for follow up and subsequent action
    B. Contact legal about the receipt of the letter
    C. Confirm whether the patient information listed in the letter is accurate
    D. Report the incident to the Office for Civil Rights as a breach using the online breach reporting portal
    .



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    -------------Frank "Snake Bite Leader" Ruelas--------------
    ► We don't fail unless we quit! ◄
    Bill Wong's Resource Folder: https://bit.ly/BillWong
    NEXT UP:
    Auditing and More: 7/3
    Next DCO Group Launch: 7/7

    ░ Pass the Exam Group for 2020 ░
    Melissa Singleton - Jan - CHPC
    Julie Clutter - Jan - CHPC
    Tanisha Grant - Feb - CHC
    Lisa Bibby - Jan - CHPC
    Kelly Puida - Mar - CHPC
    Christina Serrano - Mar - CHC
    Rachel Anderson - May - CHC
    Melissa Alexander - June - CHC
    Theresa Veazey - June - CHC
    Barbara Zubeck - June - CHPC
    Patricia Radatz - June - CHC
    ------------------------------
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  • 2.  RE: Classic Scenario Questions

    Posted 4 days ago

    Yes, these are exactly the types of questions that make up most of the exam content.

     

    1. A good rule of thumb, as stated by Frank many times..."always do your homework"! So for this one, I choose C ...let's first find out exactly what Coder Cliff is doing or not doing.
    2. Now, many might be tempted to apply the same rule of thumb for #2 here...BUT look at the difference in the question...#2 is asking what is the BEST next step, whereas #1 asked what was the FIRST step...Because the letter was also sent to the media already, I'm choosing B in this case. If I were to verify that the information in the letter is in fact accurate (doing the homework) without first talking with the lawyers, then that information becomes "discoverable" in a law suit and is not protected under attorney-client privilege. So for #2 I'm talking to the lawyers first, then we can check to see if the information provided is accurate.

     

    Other opinions to Compare and Contrast?

     

    Best Regards,

    Scot Lovejoy   

    Scot Lovejoy RPh. CHC CHPC

    Chief Pharmacy Officer

    Compliance Officer

    Agadia_itself (625x184) (625x184) (100x29)

    9 Campus Drive, Suite 200

    Parisippany, N.J. 07054

    (O) 973-540-8400  x227

    (C) 973-570-3803

    (F) 973-540-8440

     

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  • 3.  RE: Classic Scenario Questions

    Posted 4 days ago
    Scot reminds us of a critical or key success factor for us to apply.

    No matter what your answer...make sure to get to your answer by some method or approach that you can apply consistently.  Yes...sometimes that approach will be nothing more than a guess.  Nothing wrong with that.  Sometimes we may be able to add a bit more to our decision making process that could lead us to our choice.

    In the end...no matter how we arrived at our choice...we will never know if we answered the question correctly or not...which for some folks can be frustrating.  So people sharing their reasons and rationale is what is so important in these scenarios!

    ------------------------------
    -------------Frank "Snake Bite Leader" Ruelas--------------
    ► We don't fail unless we quit! ◄
    Bill Wong's Resource Folder: https://bit.ly/BillWong
    NEXT UP:
    Auditing and More: 7/3
    Next DCO Group Launch: 7/7

    ░ Pass the Exam Group for 2020 ░
    Melissa Singleton - Jan - CHPC
    Julie Clutter - Jan - CHPC
    Tanisha Grant - Feb - CHC
    Lisa Bibby - Jan - CHPC
    Kelly Puida - Mar - CHPC
    Christina Serrano - Mar - CHC
    Rachel Anderson - May - CHC
    Melissa Alexander - June - CHC
    Theresa Veazey - June - CHC
    Barbara Zubeck - June - CHPC
    Patricia Radatz - June - CHC
    ------------------------------

    Certification Disclaimer


  • 4.  RE: Classic Scenario Questions

    Posted 4 days ago

    Scenario 1 – Going to say C

    Scenario 2 – Going to say B, However, the answer about the Privacy Officer made me second guess.

     

    Vicky Roe, RN CHC CPMA

    Clinical Auditor

    Southeast Georgia Health System, Inc.

    2415 Parkwood Drive, Brunswick, GA 31520

    Office:  (912) 466-3264   Fax:  (912) 466-7044    Emailvroe@sghs.org

     

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  • 5.  RE: Classic Scenario Questions

    Posted 4 days ago
    Question #1 C.  You do not know that anything is happening, the allegation could be false.  You have to do your homework first.
    question #2 B (followed by A, C, D)..  Since there may be a copy at the newspaper, notify legal about it.  Then get the PO involved.​​

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    Lloyd Hemmert
    Compliance & Ethics Officer
    Hill Country MHDD Centers
    Kerrville,TX
    [lhemmert@hillcountry.org]
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  • 6.  RE: Classic Scenario Questions

    Posted 4 days ago
    Scenario 1
    This is (mostly) an internal matter and before accusing someone directly I would want some kind of verification. So I choose C, verify the accusation.

    Scenario 2
    This one has been threatened to be an external matter, especially with the alleged notification to the media. So I'm talking to our lawyer (Choice B) first to make sure the next step I take is the correct one. Of course, as soon as I put the phone down I'm doing my research to find out if the list really is our. Maybe the source of the letter sent it to the wrong company in error.

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    Carl Russell
    Compliance Analyst, CHPC
    Delta Dental of Idaho
    Boise,ID

    Anything I say is my sole opinion and not of my company.
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  • 7.  RE: Classic Scenario Questions

    Posted 4 days ago
    I am going with
    C
    B

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    Marie Wagner, CHC, CHRC
    Operations Manager, Corporate Compliance
    The Queen's Health Systems
    Honolulu, HI
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