CDC Regulatory Compliance & Risk Management 3

Question 1

Under the ADA's Code of Ethics, a dental consultant who also maintains a private practice has a duty to:

Accepted Answer

Disclose conflicts of interest and recuse themselves from decisions where bias exists

Answer

The ADA Code of Ethics requires dental professionals to disclose conflicts and avoid decisions where personal interest could bias professional judgment.

Question 2

The National Association of Dental Plans (NADP) recognizes which standard as the benchmark for dental claim transaction data exchange?

Accepted Answer

HIPAA ASC X12 837D transaction set

Answer

The HIPAA-mandated ASC X12 837D electronic transaction set is the standard for submitting dental claims electronically.

Question 3

A group dental plan operating under ERISA is audited by the Department of Labor. The auditor's primary concern would be whether the plan:

Accepted Answer

Is operating in accordance with its written plan document and ERISA fiduciary standards

Answer

DOL ERISA audits focus on whether plan fiduciaries act prudently and in accordance with plan documents, not on state-level insurance requirements.

Question 4

A dental benefits consultant discovers that a plan administrator has been approving prior authorizations for a provider without clinical review. This violates which risk management principle?

Accepted Answer

Utilization management integrity and medical necessity standards

Answer

Approving prior authorizations without clinical review undermines utilization management integrity and exposes the plan to liability for medically unnecessary expenditures.

Question 5

Which best describes the dental consultant's role when a provider appeals a claim denial on the grounds that the procedure was medically necessary?

Accepted Answer

The consultant should conduct a clinical review of submitted records using evidence-based criteria

Answer

A proper appeal response requires the consultant to perform a clinical review of submitted documentation against evidence-based medical necessity criteria.

(CDC) Certified Dental Consultant Practice Test

(CDC) Certified Dental Consultant Practice Test

CDC Regulatory Compliance & Risk Management 3