ABFM Industry Regulations 2 — Questions and Answers
Question 1: Under HIPAA's Minimum Necessary Standard, when a staff member requests access to a patient's entire medical record for billing purposes, the appropriate response is to:
- Provide the full record as requested
- Provide only the information reasonably necessary to complete the billing task (Correct answer)
- Deny all access until a formal request is submitted
- Require written authorization from the patient before any disclosure
Correct answer: Provide only the information reasonably necessary to complete the billing task
The Minimum Necessary Standard requires covered entities to limit PHI disclosures to the least amount needed to accomplish the intended purpose.
Question 2: The Stark Law (Physician Self-Referral Law) primarily prohibits physicians from:
- Accepting gifts from pharmaceutical representatives
- Referring Medicare/Medicaid patients to entities with which they have a financial relationship, absent an exception (Correct answer)
- Billing for services not personally performed
- Employing nurse practitioners without supervision agreements
Correct answer: Referring Medicare/Medicaid patients to entities with which they have a financial relationship, absent an exception
The Stark Law prohibits physicians from referring patients for designated health services to entities in which they or an immediate family member have a financial interest, unless a specific exception applies.
Question 3: Which federal agency enforces the Anti-Kickback Statute in healthcare?
- Centers for Medicare & Medicaid Services (CMS)
- Office of Inspector General (OIG), Department of Health and Human Services (Correct answer)
- Drug Enforcement Administration (DEA)
- Federal Trade Commission (FTC)
Correct answer: Office of Inspector General (OIG), Department of Health and Human Services
The OIG of the Department of HHS is the primary enforcement body for the Anti-Kickback Statute and issues advisory opinions and safe harbor regulations.
Question 4: A family physician wants to offer a chronic care management (CCM) program. Under CMS regulations, CCM services require a minimum of how many minutes of clinical staff time per calendar month?
- 10 minutes
- 15 minutes
- 20 minutes (Correct answer)
- 30 minutes
Correct answer: 20 minutes
CMS requires at least 20 minutes of clinical staff time per calendar month directed by a physician to bill CPT 99490 for chronic care management.
Question 5: The No Surprises Act (effective January 2022) primarily protects patients from:
- Prescription drug price increases
- Unexpected medical bills from out-of-network providers at in-network facilities (Correct answer)
- Denial of coverage for pre-existing conditions
- Balance billing by primary care physicians
Correct answer: Unexpected medical bills from out-of-network providers at in-network facilities
The No Surprises Act protects patients from surprise bills when they receive care from out-of-network providers at in-network facilities or in emergency situations.
Question 6: Under the Controlled Substances Act, which schedule includes drugs with high abuse potential and no currently accepted medical use in the United States?
- Schedule I (Correct answer)
- Schedule II
- Schedule III
- Schedule IV
Correct answer: Schedule I
Schedule I substances have high abuse potential, no accepted medical use, and lack accepted safety for use under medical supervision (e.g., heroin, LSD).
Question 7: A physician signs a collaborative practice agreement with an advanced practice registered nurse (APRN). Which regulatory framework primarily governs the scope of this agreement?
- Federal DEA regulations
- State medical and nursing practice acts (Correct answer)
- CMS Conditions of Participation
- HIPAA Privacy Rule
Correct answer: State medical and nursing practice acts
Collaborative practice agreements between physicians and APRNs are governed primarily by state medical and nursing practice acts, which vary significantly by state.
ABFM Industry Regulations 2
Under HIPAA's Minimum Necessary Standard, when a staff member requests access to a patient's entire medical record for billing purposes, the appropriate response is to: