AAPC Billing Documentation & Compliance 2

Question 1

A physician documents a patient encounter but fails to sign the note. Under CMS guidelines, this claim is:

Accepted Answer

Considered incomplete documentation and may be denied

Answer

CMS requires that all documentation be authenticated (signed and dated) by the ordering/treating provider to support medical necessity.

Question 2

Which federal law primarily governs the privacy and security of patient health information used in billing?

Accepted Answer

HIPAA

Answer

HIPAA's Privacy and Security Rules regulate how protected health information (PHI) may be used and disclosed, including for billing purposes.

Question 3

A biller notices a claim was submitted with a date of service that predates the physician's licensure. This is an example of:

Accepted Answer

Fraudulent billing

Answer

Submitting a claim for services rendered before a provider was licensed to perform them constitutes fraudulent billing.

Question 4

The OIG Work Plan is most useful to billers because it:

Accepted Answer

Identifies areas the OIG intends to audit for compliance issues

Answer

The OIG Work Plan outlines the OIG's planned audit and review activities, helping practices identify high-risk billing areas to monitor.

Question 5

Under the False Claims Act, qui tam provisions allow:

Accepted Answer

Private individuals to file lawsuits on behalf of the government and share in any recovery

Answer

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.

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

AAPC Billing Documentation & Compliance 2