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
Under the Stark Law (physician self-referral law), a physician is generally prohibited from referring patients to an entity for designated health services if:
Answer: The physician or an immediate family member has a financial relationship with the entity
The Stark Law prohibits referrals to entities in which the referring physician or immediate family member has a financial relationship, unless an exception applies.
Which of the following is a key element of a compliant Notice of Privacy Practices (NPP) under HIPAA?
Answer: It must describe how PHI may be used and disclosed and patient rights regarding their information
The NPP must explain permitted uses and disclosures of PHI, patient rights (access, amendment, accounting), and the covered entity's legal duties.
A compliance officer discovers that a coder has been consistently assigning higher-severity DRGs than documentation supports. The FIRST action should be to:
Answer: Conduct a focused internal audit to determine the scope of the problem
The first step is to assess the extent of the problem through an internal audit before determining the appropriate corrective action.
The 'look-back period' under the False Claims Act statute of limitations is generally:
Answer: 6 years from the date the violation occurred, or up to 10 years in some cases
The FCA statute of limitations is 6 years from the violation, or 3 years from when the government knew or should have known, not to exceed 10 years.
When a provider voluntarily discloses overpayments through the OIG's Self-Disclosure Protocol, one benefit is:
Answer: Potentially reduced multipliers compared to a government-initiated investigation
Self-disclosure through the OIG's protocol can result in reduced settlement multipliers (as low as 1.5x) compared to those imposed in government-initiated cases.
Which of the following best describes 'concurrent care' in billing?
Answer: Services provided to the same patient by two or more physicians on the same day, each managing different conditions
Concurrent care occurs when two or more physicians each provide E/M services to the same patient on the same day, each managing distinct medical conditions.
A Business Associate Agreement (BAA) under HIPAA is required when:
Answer: A covered entity shares PHI with a vendor who performs functions on its behalf
A BAA is a contract required between a covered entity and any business associate that creates, receives, maintains, or transmits PHI on its behalf.