CDC Regulatory Compliance & Risk Management 2

Question 1

Under HIPAA's Minimum Necessary Standard, a dental consultant reviewing a claim should request:

Accepted Answer

Only the information reasonably necessary to accomplish the review purpose

Answer

HIPAA's Minimum Necessary Standard requires covered entities to limit PHI requests to what is reasonably needed for the specific purpose.

Question 2

A dental plan's internal audit reveals a pattern of upcoding by a network provider. Under the False Claims Act, which party bears primary liability if the plan knowingly paid those claims?

Accepted Answer

Both the provider and the plan may face liability if the plan knowingly paid false claims

Answer

The FCA can reach any entity that knowingly presents or causes to present a false claim, including payers that knowingly pay them.

Question 3

Which federal regulation governs the coordination of benefits (COB) when a patient is covered by both a group dental plan and Medicare?

Accepted Answer

Medicare Secondary Payer (MSP) rules

Answer

Medicare Secondary Payer rules establish which payer is primary when Medicare and an employer group health plan both cover a patient.

Question 4

A dental consultant identifies that a practice is billing crown preps and final crowns on the same tooth on the same date of service. This is an example of:

Accepted Answer

Unbundling of a global procedure

Answer

Billing separately for components that are part of a single comprehensive procedure constitutes unbundling, which is a form of fraudulent billing.

Question 5

The Stark Law (physician self-referral law) as applied to dentistry primarily concerns:

Accepted Answer

Dental referrals tied to designated health services under Medicare/Medicaid with financial relationships

Answer

Stark Law prohibits physician (and applicable provider) self-referrals for designated health services when a financial relationship exists, with relevance to dental services covered under Medicare/Medicaid.

(CDC) Certified Dental Consultant Practice Test

(CDC) Certified Dental Consultant Practice Test

CDC Regulatory Compliance & Risk Management 2