CDIP Healthcare Compliance and Ethics 2

Question 1

Under the False Claims Act, what is the term for a private individual who files a lawsuit on behalf of the government alleging healthcare fraud?

Accepted Answer

Relator

Answer

A relator (also called a whistleblower) files a qui tam lawsuit under the False Claims Act on behalf of the government.

Question 2

Which federal statute prohibits healthcare providers from referring patients to entities in which they have a financial relationship, unless an exception applies?

Accepted Answer

Stark Law

Answer

The Stark Law (Physician Self-Referral Law) prohibits physicians from referring Medicare/Medicaid patients to entities where they or an immediate family member have a financial interest.

Question 3

A CDI specialist notices a physician consistently documents 'pneumonia' without specifying the type. What is the MOST appropriate first step?

Accepted Answer

Submit a physician query requesting clarification of the pneumonia type

Answer

A compliant physician query requesting clarification of the pneumonia type is the appropriate first step to improve documentation specificity.

Question 4

Which element is REQUIRED for a physician query to be considered compliant according to AHIMA guidelines?

Accepted Answer

The query must be clear, concise, and not leading

Answer

AHIMA guidelines require physician queries to be clear, concise, and non-leading to avoid influencing documentation inappropriately.

Question 5

What does the term 'upcoding' refer to in the context of healthcare billing compliance?

Accepted Answer

Billing for a more complex or higher-reimbursement service than was actually provided

Answer

Upcoding is a fraudulent practice of billing for a higher-level or more expensive service than was actually rendered.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP Healthcare Compliance and Ethics 2