Billing Documentation & Compliance Flashcards
7 cards from real AAPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Billing Documentation & Compliance flashcards as text
A physician documents a patient encounter but fails to sign the note. Under CMS guidelines, this claim is:
Answer: Considered incomplete documentation and may be denied
CMS requires that all documentation be authenticated (signed and dated) by the ordering/treating provider to support medical necessity.
Which federal law primarily governs the privacy and security of patient health information used in billing?
Answer: HIPAA
HIPAA's Privacy and Security Rules regulate how protected health information (PHI) may be used and disclosed, including for billing purposes.
A biller notices a claim was submitted with a date of service that predates the physician's licensure. This is an example of:
Answer: Fraudulent billing
Submitting a claim for services rendered before a provider was licensed to perform them constitutes fraudulent billing.
The OIG Work Plan is most useful to billers because it:
Answer: Identifies areas the OIG intends to audit for compliance issues
The OIG Work Plan outlines the OIG's planned audit and review activities, helping practices identify high-risk billing areas to monitor.
Under the False Claims Act, qui tam provisions allow:
Answer: Private individuals to file lawsuits on behalf of the government and share in any recovery
Qui tam provisions of the False Claims Act allow whistleblowers (relators) to sue on the government's behalf and receive a portion of recovered funds.
When a payer requests medical records to support a claim, the biller should send:
Answer: Documentation that directly supports the billed services and diagnosis
Billers should submit only the relevant documentation that supports the specific services billed, as requested by the payer.
A compliance program's internal audit function is designed to:
Answer: Proactively identify and correct billing errors before they become systemic problems
Internal audits allow an organization to identify patterns of billing errors and implement corrective action before government audits occur.