CDC Compliance, Ethics, & Legal Considerations 3 — Questions and Answers
Question 1: 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?
- Autonomy
- Nonmaleficence
- Beneficence (Correct answer)
- Justice
Correct answer: Beneficence
Beneficence requires dental professionals to promote the patient's welfare above their own financial interests.
Question 2: A dental office's Notice of Privacy Practices (NPP) must be provided to new patients:
- Within 30 days of the first treatment visit
- No later than the date of the first service delivery (Correct answer)
- Only if the patient requests it in writing
- Annually, regardless of whether care was received
Correct 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.
Question 3: A dental practice that accepts Medicare or Medicaid is considered a:
- Business Associate
- Covered Entity (Correct answer)
- Hybrid Entity
- Qualified Healthcare Intermediary
Correct 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.
Question 4: Which OIG compliance program element involves conducting internal reviews to detect potential coding and billing errors before they become external audits?
- Effective lines of communication
- Written policies and procedures
- Internal monitoring and auditing (Correct answer)
- Enforcement of disciplinary standards
Correct 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.
Question 5: A patient's estranged spouse calls the dental office requesting information about the patient's upcoming procedure. Under HIPAA, the office should:
- Release the information because spouses are legal next-of-kin
- Release the minimum necessary information as a professional courtesy
- Decline to confirm or deny the patient is even a client without patient authorization (Correct answer)
- Ask the spouse to send a written request and then release the records
Correct 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.
Question 6: Which coding scenario most clearly represents 'phantom billing'?
- Billing a comprehensive exam when only a periodic exam was performed
- Submitting a claim for a root canal that was never started or completed (Correct answer)
- Billing two procedures separately that should be bundled
- Applying an incorrect tooth number to an otherwise correct claim
Correct 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.
Question 7: A dental practice's billing vendor who accesses PHI to process claims is classified under HIPAA as a:
- Covered Entity
- Hybrid Entity
- Business Associate (Correct answer)
- Trading Partner
Correct 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.
CDC Compliance, Ethics, & Legal Considerations 3
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?