Compliance, Ethics, & Legal Considerations Flashcards
7 cards from real CDC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Compliance, Ethics, & Legal Considerations flashcards as text
Under the ADA Code of Professional Conduct, which principle requires a dentist to act in the patient's best interest even when it may not benefit the dentist financially?
Answer: Beneficence
Beneficence requires dental professionals to promote the patient's welfare above their own financial interests.
A dental office's Notice of Privacy Practices (NPP) must be provided to new patients:
Answer: No later than the date of the first service delivery
HIPAA requires covered entities to provide the NPP no later than the date of the first service delivery to the individual.
A dental practice that accepts Medicare or Medicaid is considered a:
Answer: Covered Entity
Under HIPAA, healthcare providers that transmit health information electronically in connection with covered transactions — including those billing Medicare or Medicaid — are covered entities.
Which OIG compliance program element involves conducting internal reviews to detect potential coding and billing errors before they become external audits?
Answer: Internal monitoring and auditing
The OIG's seven elements of an effective compliance program include internal monitoring and auditing as a proactive measure to identify and correct compliance problems.
A patient's estranged spouse calls the dental office requesting information about the patient's upcoming procedure. Under HIPAA, the office should:
Answer: Decline to confirm or deny the patient is even a client without patient authorization
Without patient authorization or a legal basis for disclosure, the office must not release PHI to unauthorized individuals, including family members who are not listed as personal representatives.
Which coding scenario most clearly represents 'phantom billing'?
Answer: Submitting a claim for a root canal that was never started or completed
Phantom billing is billing for services that were never provided at all, which is outright fraud against the payer.
A dental practice's billing vendor who accesses PHI to process claims is classified under HIPAA as a:
Answer: Business Associate
A vendor that performs functions involving the use or disclosure of PHI on behalf of a covered entity is a Business Associate and must sign a Business Associate Agreement.