CCC Quality Assurance & Compliance 5

Question 1

A cardiology group's compliance plan requires annual risk assessments. What is the PRIMARY goal of a billing risk assessment?

Accepted Answer

To identify areas of coding and billing vulnerability before they result in audits or penalties

Answer

A billing risk assessment proactively identifies high-risk areas in coding and billing so the practice can implement corrective measures before external auditors identify them.

Question 2

Under Stark Law (Physician Self-Referral Law), which of the following would constitute a prohibited referral in a cardiology context?

Accepted Answer

A cardiologist directing patients to a stress testing facility in which the cardiologist has an ownership interest without an applicable exception

Answer

Stark Law prohibits physician self-referrals for designated health services (including radiology) to entities in which the physician has a financial relationship, unless a specific exception applies.

Question 3

A coder is reviewing a TAVR (transcatheter aortic valve replacement) claim. The attending cardiologist and the cardiac surgeon both participated. How should this be billed?

Accepted Answer

Both physicians bill the appropriate TAVR code with modifier -62 (co-surgery)

Answer

When two surgeons of different specialties perform a procedure together as co-surgeons, each bills the procedure code with modifier -62.

Question 4

Which government program uses Recovery Audit Contractors (RACs) specifically to identify and correct improper Medicare payments?

Accepted Answer

CMS

Answer

CMS administers the RAC program under which contractors review Medicare claims on a post-payment basis to identify overpayments and underpayments.

Question 5

A cardiology practice bills for physician interpretation of a Holter monitor (CPT 93227) but the report was generated by an automated algorithm with no physician review documented. What is the compliance issue?

Accepted Answer

The claim lacks documentation of required physician interpretation and constitutes a false claim

Answer

CPT 93227 requires documented physician interpretation; automated analysis without a physician's signed interpretation does not satisfy this requirement and the claim would be unsupported.

CCC Practice Test

CCC Practice Test

CCC Quality Assurance & Compliance 5