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
The principle of 'informed consent' in dental practice requires that the patient understands all of the following EXCEPT:
Answer: The dentist's personal financial incentives for recommending the treatment
Informed consent requires disclosure of treatment nature, risks, benefits, and alternatives, but does not require disclosure of the provider's personal financial incentives.
A dental coder applies code D4341 (periodontal scaling and root planing) instead of D1110 (prophylaxis) for a patient who only received a routine cleaning. This represents:
Answer: Upcoding
Substituting a higher-reimbursing periodontal code for a routine prophylaxis that was actually performed is upcoding, a fraudulent billing practice.
Under the Anti-Kickback Statute, which of the following arrangements could be LEGAL if structured properly under a safe harbor?
Answer: A dentist leasing office space to a specialist at fair market value
The Anti-Kickback Statute has a safe harbor for space and equipment rental arrangements that are set at fair market value, in writing, and not based on the volume of referrals.
Which government agency is primarily responsible for publishing the OIG Work Plan that identifies dental billing risk areas targeted for review?
Answer: Office of Inspector General (OIG) of HHS
The Office of Inspector General of the U.S. Department of Health and Human Services publishes the annual OIG Work Plan identifying compliance risk areas including dental billing.
A dental office routinely waives patient copayments without documenting financial hardship. This practice is problematic because it:
Answer: May constitute fraud against the insurer and a kickback to attract patients
Routine copayment waivers inflate the effective billed charge, misrepresent the patient's financial obligation to the insurer, and can be considered inducement to use a particular provider.
A patient revokes their previously signed HIPAA authorization for release of dental records. The revocation:
Answer: Becomes effective only if submitted in writing to the covered entity
Patients may revoke a HIPAA authorization at any time in writing; however, the revocation does not affect disclosures already made in reliance on the original authorization.
Which document establishes the legal relationship between a dental practice and a third-party vendor who handles PHI, outlining allowable uses and required safeguards?
Answer: Business Associate Agreement
A Business Associate Agreement (BAA) is the legally required contract that governs how a business associate may use and protect PHI on behalf of a covered entity.