CBCS - Certified Billing and Coding Specialist Regulatory Compliance and HIPAA Questions and Answers

Question 1

A billing specialist notices a pattern of a specific provider consistently using a higher-level evaluation and management (E/M) code for routine office visits, which is not supported by the medical documentation.
Under which federal law could this practice be considered fraudulent?

Accepted Answer

The False Claims Act (FCA)

Answer

The Stark Law

Answer

The Health Insurance Portability and Accountability Act (HIPAA)

Answer

The Anti-Kickback Statute (AKS)

Question 2

A business associate of a covered entity discovers a breach of unsecured protected health information (PHI) affecting 600 individuals. According to the HIPAA Breach Notification Rule, what is the business associate's primary and most immediate responsibility?

Accepted Answer

Notify the covered entity of the breach without unreasonable delay.

Answer

Notify the local media via a press release within 60 days.

Answer

Notify each of the 600 affected individuals directly by mail.

Answer

Notify the Secretary of Health and Human Services (HHS) immediately.

Question 3

Which of the following is an example of a 'technical safeguard' under the HIPAA Security Rule?

Accepted Answer

Implementing unique user IDs and password requirements for EHR access.

Answer

Developing a contingency plan for data recovery.

Answer

Positioning computer monitors to prevent public viewing of PHI.

Answer

Conducting annual security risk assessments.

Question 4

A hospital owns a diagnostic imaging center. A physician employed by the hospital routinely refers their Medicare patients to this imaging center for services. This arrangement could potentially violate which of the following laws if no exception is met?

Accepted Answer

The Stark Law

Answer

HIPAA Privacy Rule

Answer

The False Claims Act

Answer

The Breach Notification Rule

Question 5

A patient's friend calls the billing office to ask about the details of a recent bill. The billing specialist, wanting to be helpful, confirms the patient's recent surgery date and the outstanding balance. This action is a violation of which HIPAA principle?

Accepted Answer

The Minimum Necessary Standard

Answer

The Security Rule

Answer

The Breach Notification Rule

Answer

The Pre-authorization Requirement

Question 6

A covered entity must notify the Secretary of HHS of a breach of unsecured PHI. If the breach affects fewer than 500 individuals, when must this notification be provided?

Accepted Answer

No later than 60 days from the end of the calendar year in which the breach was discovered.

Answer

Within 10 business days of discovering the breach.

Answer

Immediately upon discovery, but no later than 24 hours.

Answer

Within 60 days of the discovery of the breach.

A billing specialist notices a pattern of a specific provider consistently using a higher-level evaluation and management (E/M) code for routine office visits, which is not supported by the medical documentation.Under which federal law could this practice be considered fraudulent?

A billing specialist notices a pattern of a specific provider consistently using a higher-level evaluation and management (E/M) code for routine office visits, which is not supported by the medical documentation.
Under which federal law could this practice be considered fraudulent?