McGraw-Hill Specialty Board Review Pain Medicine

Salahadin Abdi, Pradeep Chopra, Howard Smith

Chapter 14 Compensation and Disability Assessment - all with Video Answers

Educators

Chapter Questions

Problem 912

A concert pianist and a vice president of a major corporation have both suffered the loss of the second finger of the dominant hand. Which of the following statements is true regarding the condition of impairment or disability caused by the injury?
(A) The concert pianist is more impaired than the vice president
(B) The concert pianist and vice president are equally disabled
(C) The concert pianist and vice president are both handicapped
(D) The concert pianist is more disabled than the vice president
(E) The concert pianist is more handicapped than the vice president

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01:50

Problem 913

Identify the true statement with regards to a physician's role in impairment and disability evaluation:
(A) Determine impairment; provide medical information to assist in disability determination
(B) Provide a disability rating which is binding on the administrative law judge for social security and disability
(C) In State Worker's Compensation Law, a physician's role is limited to determining only disability, not impairment
(D) The World Health Organization (WHO) has specifically defined the role of the physician in impairment and disability
(E) Physician's role in impairment and disability determination is independent, without input from employer and without consideration to job duties

Alexa Moschella

Numerade Educator

01:50

Problem 914

Which of the following is true statement with reference to the Americans with Disability Act (ADA)?
(A) The physician's input is not essential for determining any of the criteria under ADA
(B) Conditions that are temporary and are not considered to be impairment under the ADA include pregnancy, old age, sexual orientation, sexual addiction, smoking, or current illegal drug use
(C) To be deemed disabled for purposes of ADA protection, an individual needs to have only mild physical or mental impairment that does not limit major life activities
(D) The person may be hypothetically or perceived to be disabled to be qualified under ADA
(E) It is the physician's responsibility to identify and determine if reasonable accommodations are possible to enable the individual's performance of essential job activities in his or her employment

Alexa Moschella

Numerade Educator

Problem 915

Which of the following is true regarding causation, apportionment, and worker's compensation?
(A) Determining medical causation requires detective work and witness of the accident
(B) For purposes of the Guides to the Evaluation of Permanent Impairment, causation means an identifiable factor, such as an accident that results in a medically identifiable condition
(C) The legal standard for causation in civil litigation and in worker's compensation is uniform across the United States
(D) Apportionment analysis in worker's compensation represents assignment of all factors
(E) The role of a physician in worker's compensation system is only to provide effective medical care but not be involved in other aspects of the care

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01:50

Problem 916

Which of the following is true with regards to disability?
(A) It is a term that can be used interchangeably with the term "handicap"
(B) It is a condition that relates to the effects of a disease process or injury
(C) It is a condition that requires the use of an assistive device to perform activities of daily living
(D) It is expressed as a percentage of the body as a whole
(E) It is a condition that relates to function relative to work or other obligations

Alexa Moschella

Numerade Educator

02:16

Problem 917

The CAGE questionnaire is used in case of
(A) mental retardation
(B) bipolar disorder
(C) major depression
(D) opioid abuse
(E) alcohol abuse

Sarah Howell

Numerade Educator

Problem 918

The "rules" that, in many cases, define which physician referrals are legal and which are not, are found in the following regulations:
(A) Stark regulations
(B) Antikickback statute
(C) Stark regulations and antikickback statute
(D) Stark regulations, antikickback statute, and Omnibus Budget Reconciliation Act (OBRA) of 1993
(E) Stark regulations, Health Insurance Portability and Accountability Act (HIPAA), and Balanced Budget Act (BBA)

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Problem 919

Which of the following statements is correct?
(A) Patient may request that a provider amend a diagnosis that was submitted on a billing claim form
(B) A provider must act on a patient's request for amendment within 30 days, either deny or amend
(C) A provider does not agree with a patient's request for an amendment. The provider must make the amendment but can note disagreement in the amendment and inform the insurer
(D) Provider has to amend diagnosis in 30 days as provider may not deny the patient's requests
(E) Provider has no obligation even if the information on the claim was inaccurate

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Problem 920

What are the consequences of downcoding?
(A) Compliance with guidelines may not be the most important aspect
(B) It is not necessary to assure proper coding of the level of service during downcoding
(C) Medicare will eventually reimburse all your downcoding after 5 years
(D) Downcoding is the largest area of loss of revenue for the practice
(E) Medicare may not investigate downcoding
921. Which is the accurate statement about billing and compliance?
(A) A physician may mark up durable medical equipment (DME) items under the

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Problem 921

Which is the accurate statement about billing and compliance?
(A) A physician may mark up durable medical equipment (DME) items under the
physician self-referral Stark regulation in-office ancillary services exception
(B) If a practice which does not have a compliance plan discovers a billing error, it is not necessary for this practice to make a voluntary disclosure and a refund of the overpayment
(C) When a provider receives a payment from Medicare that should have gone to the patient, the provider should keep the payment
(D) Direct supervision is defined as "The physician is responsible overall, but is not necessarily present at the time of procedure"
(E) If an employee files a qui tam (whistleblower) suit against his or her employer, the employer may ask the employee to stay out of the work place and refrain from speaking to his or her co-workers until a full investigation has taken plan

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08:13

Problem 922

A local clinical laboratory provides a phlebotomist free of charge to a doctor's office. The phlebotomist takes specimens from the physician's office to the laboratory. When the phlebotomist is not busy drawing blood, the phlebotomist assists the doctor's office personnel with filing of records and other clerical duties. What aspects of this scenario, if any, implicate the antikickback laws?
(A) Provision by the clinical laboratory of a phlebotomist free of charge to the physician
(B) Performance by the phlebotomist of clerical duties in the physician's office
(C) Phlebotomist taking specimens from physician's office to the laboratory
(D) All of the above
(E) None of the above

Jeremiah Mbaria

Numerade Educator

Problem 923

What do the physician self-referral Stark rules prohibit?
(A) They prohibit physicians from referring patients to hospitals where the physicians work
(B) They prohibit physicians from referring patients for designated health services
to entities in which the physicians have financial relationships, unless an exception applies
(C) They prohibit health care providers from billing for services of patients they refer to other providers
(D) They prohibit health care providers from receiving money from their services for any referrals to physical therapy
(E) The prohibit physicians performing cases in ambulatory surgery centers with physician ownership of $50 \%$ or more

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Problem 924

Centers for Medicare and Medicaid Services (CMS) guidelines in a documentation of evaluation and management services recommend the use of the following:
(A) SOAP-subjective, objective, assessment, and plan
(B) SOAPER-subjective, objective, assessment, plan, education and return instructions
(C) SOAPIE-subjective, objective, assessment, plan, implementation, and evaluation
(D) SNOCAMP-subjective, nature of presenting problem, counseling, assessment, medical decision making, and plan
(E) Documentation involving elements, bullets, and level of care

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Problem 925

Identify true statements about current procedural technology (CPT) and International Classification of Diseases (ICD-9) codes?
(A) ICD-9 is a systematic listing of procedure or service accurately defining and assisting with simplified reporting
(B) CPT is a systematic listing and coding of procedures and services performed by physicians
(C) ICD-9 identifies each procedure or service with a five-digit code
(D) CPT provides systematic listing of disease classification and provides alphabetic index to diseases
(E) CPT and ICD-9 both provide a tabular list of diseases

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06:08

Problem 926

Which of the following factors will determine the number of drug-receptor complexes formed?
(A) Efficacy of the drug
(B) Receptor affinity for the drug
(C) Therapeutic index of the drug
(D) Half-life of the drug
(E) Rate of renal secretion

Noah Boudrie

Numerade Educator

Problem 927

In response to a call from the patient's spouse informing the physician that the patient is abusing narcotics prescribed by the physician, the physician notes in the patient's medical record that the spouse called to report such information. The spouse is concerned that her husband would be extremely upset if he knew she called with the information. In an event that the husband requests a complete copy of his records, which of the following is correct statement?
(A) The physician is permitted to withhold the information
(B) The physician must provide entire chart immediately
(C) The physician must determine with $100 \%$ certainty that, wife will be harmed, to withhold the information
(D) The physician is required to provide oral information, but withhold written information
(E) The physician may provide this information only after spouse's death

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Problem 928

Which of the following is a true statement applicable to a patient's request for a copy of his or her record?
(A) The physician is not required to give the patient any records that were not created or generated by the practice
(B) The provider is required to give a copy of all the records
(C) Designated record sets include only the medical records generated by the provider
(D) Medical records may be released only after patient has paid his bill in full
(E) Patient's access is limited to only certain areas of medical record

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Problem 929

What are the ramifications of the antikickback statute on your practice?
(A) It is a felony-10 years imprisonment
(B) It is a crime to offer, solicit, pay, or receive remuneration, in cash or in kind, directly or indirectly, for referrals under a federally funded health care program
(C) Civil penalties $$\$ 500,000$$ per violation
(D) "Multipurpose" rule
(E) No safe harbors

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Problem 930

The training requirements of needlestick safety include all of the following EXCEPT
(A) work hours
(B) ninety days after initial assignment
(C) at a cost to employee
(D) within 365 days after effective date of standard
(E) within 10 years of previous training

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Problem 931

Identify accurate statement in the scenario where a health care provider fails to honor a patient's written request for an itemized statement of items or services within 30 days. What penalties may the provider face from the HHS (United States Department of Health and Human Services) Office of Inspector General (OIG)?
(A) Exclusion from Medicare program
(B) Civil monetary penalty of $$\$ 5000$$
(C) Civil monetary penalty and exclusion
(D) Civil monetary penalty of $$\$ 100$$ for each unfilled request
(E) Criminal penalty with 6 -month prison time

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Problem 932

What is the true statement about global fee policy?
(A) Global fee policy describes packaging or inclusion of certain services in allowance for a surgical procedure
(B) Global fee policy describes unbundling or combining multiple services into a single charge
(C) Global package includes preoperative and postoperative services for 120 days
(D) Global package includes initial evaluation if performed on the same day
(E) Global package includes all diagnostic tests

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Problem 933

Pay for performance is being considered by Medicare and third-party payers. Identify accurate statements:
(A) Compensation incentives will not induce changes in the quality of services
(B) Outcome measures are easy to develop
(C) Compensation incentives rest on the economic field of agency theory (method of compensation induces conduct)
(D) Quality measures are already in place
(E) It is simple to finance incentives

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01:23

Problem 934

For a service to be reasonable and necessary it must be
(A) safe
(B) experimental
(C) investigational
(D) patient can afford to pay
(E) furnished only in a hospital

Lottie Adams

Numerade Educator

Problem 935

Which of the following is an accurate statement about proper billing?
(A) Bill for items or services not rendered or not provided as claimed
(B) Submit claims for equipment, medical supplies, and services that are not reasonable and necessary
(C) Double bill resulting in duplicate payment
(D) Bill for noncovered services as if covered
(E) Knowingly do not misuse provider identification numbers, which results in improper billing

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Problem 936

What are important aspects of the Needlestick Safety and Prevention Act of 2001?
(A) It has 24 areas of change
(B) Two terms were added to definitions
(C) It was enacted because of a total of more than 20 million needlesticks per year
(D) Risks of contracting disease were minimal
(E) Psychologic stress was the only issue

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Problem 937

Multiple components of proper medical record documentation do not include the following:
(A) The reason for the patient's visit
(B) The indication of services provided
(C) The location of the services
(D) Itemized billing for services
(E) Plan of action including return appointment

Emily Himsel

Numerade Educator

Problem 938

Which of the following is an accurate statement describing legitimate professional courtesy?
(A) When a physician practice waives coinsurance obligations or other out-ofpocket expenses for other physicians or family members, but only based on their referrals
(B) When a hospital or other institution waives fees for services provided to their medical staff, but not employees
(C) When an organization waives fees based on proportion of referrals
(D) When a physician practice is able to collect full fee, by increasing charges proportionately
(E) When a physician practice waives all or part of a fee for services for office staff, other physicians or family members

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Problem 939

Impairment is correctly characterized by the following definition(s):
(1) A loss, loss of use, or derangement of any body part, organ system, or organ function
(2) An alteration of an individual's capacity to meet personal, social, or occupational demands because of impairment
(3) An anatomical, physiological, or psychologic abnormality that can be shown by medically acceptable clinical and laboratory diagnostic techniques
(4) A barrier to full functional activity that may be overcome by compensating in some way for the causative impairment

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Problem 940

Identify the true statement(s) describing functional restoration:
(1) Functional restoration is a monotherapy intended to return patients to work
(2) Functional restoration includes an interdisciplinary approach with physical therapy, occupational therapy, vocational rehabilitation, psychology, nursing, and physician
(3) Indications for functional restoration include temporary disability and ability to return to work following exercise program
(4) Phases of rehabilitation and functional restoration include initial reconditioning, comprehensive phase, and follow-up phase

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01:25

Problem 941

Sedentary work is characterized by which of the following criteria?
(1) Lifting a maximum of $10 \mathrm{lb}$
(2) Carrying objects weighing up to $10 \mathrm{lb}$
(3) Requirement of occasional walking and standing, but mostly sitting
(4) Pushing and pulling of arm or leg controls

Subham Jyoti Mishra

Numerade Educator

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Problem 942

The Social Security Administration uses a number of criteria for determination of eligibility for disability benefits. The sequential evaluation for determination of benefits includes which of the following factors? (Nonexertional factors [evaluation of the applicant's cognitive capabilities] are part of the evaluation of residual functional capacity.)
(1) Age
(2) Educational background
(3) Previous work history
(4) Residual functional capacity

James Kiss

Numerade Educator

Problem 943

The following statement(s) is (are) true to describe the purposes of rehabilitation:
(1) To resolve deconditioning syndrome that developed from prolonged bed rest with loss of muscle strength, decreased flexibility, and increased stiffness
(2) To optimize outcome by restoring function and returning to activity
(3) To minimize potential or recurrence or reinjury
(4) Short periods of rest between activities help to exacerbate the deleterious effects of inactivity

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Problem 944

Identify true statement(s) to assist in your practice by specialty designation of interventional pain management:
(1) Physician profiling or comparative utilization assessment
(2) $500 \%$ increase of practice expense calculation immediately
(3) Carrier advisory committee (CAC) membership
(4) $100 \%$ increase in physician's reimbursement

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01:26

Problem 945

Which of the following statement(s) is (are) true with regards to the Controlled Substances Act of the Comprehensive Drug Abuse Prevention and Control Act of 1970?
(1) It is the legal foundation of the government's fight against the abuse of drugs and other substances
(2) It is a consolidation of numerous laws regulating the manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, anabolic steroids, and chemicals used in the illicit production of controlled substances
(3) All the substances that are regulated under existing federal law are placed into schedule I of the five schedules
(4) Schedule I is reserved for the least dangerous drugs that have the highest recognized medical use

Lottie Adams

Numerade Educator

Problem 946

What does the following HIPAA compliance administrative simplification do?
(1) Increases costs associated with administrative and claims related transactions
(2) Establishes a national uniform standards for eight electronic transactions, and claims attachments
(3) Eliminates unique provider identifiers
(4) Establishes protections for the privacy and security of individual health information

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Problem 947

What are true statements about fraud in medicine in the United States?
(1) Medicare fee for service error rate was $8 \%$ in 2004
(2) A GAO (US Government Accountability Office) audit reported that in the United States approximately $10 \%$ of every health care dollar is lost to fraud annually
(3) Estimated net improper payments of CMS for 2004 exceeded $$\$ 50$$ billion
(4) Fraud and abuse cases include $60 \%$ public and $40 \%$ private cases

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01:40

Problem 948

Which of the following statement(s) is (are) accurate?
(1) Voluntary disclosure program offers immunity to providers who come forward within 30 days of discovering an offence
(2) Providers must always repay all Medicare overpayments within 30 days
(3) Health care providers in medically underserved areas (MUAs) may automatically waive coinsurance and deductible payments
(4) Before the OIG issues a demand letter in a civil money penalty case, the government must have legally sufficient evidence for eight elements of civil monetary penalties offense

Asmita Mehta

Numerade Educator