Professional Standards & Competencies Flashcards
7 cards from real Certified Medical Coding Specialist practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Professional Standards & Competencies flashcards as text
The 'minimum necessary' standard under HIPAA requires covered entities to:
Answer: Disclose only the PHI needed to accomplish the intended purpose
The minimum necessary standard limits PHI disclosure to only what is required to fulfill the specific purpose.
Which act established voluntary compliance programs as a key strategy for healthcare fraud prevention?
Answer: OIG Compliance Program Guidance
The OIG Compliance Program Guidance promotes voluntary compliance programs as a proactive fraud-prevention strategy.
When a patient has two diagnoses that are equally responsible for admission, the coder should:
Answer: Query the physician to designate the principal diagnosis
When two conditions equally meet the definition of principal diagnosis, the physician must designate which to sequence first.
A Notice of Privacy Practices (NPP) must be provided to patients:
Answer: At the first service delivery and upon request thereafter
HIPAA requires covered entities to provide the NPP at the first point of service and make it available upon subsequent request.
Which of the following is an example of a business associate under HIPAA?
Answer: A medical transcription company that processes patient records
A medical transcription company that performs services involving PHI on behalf of a covered entity is a business associate.
Coding from a superbill alone without reviewing the medical record is problematic because:
Answer: Superbills may not capture all conditions or correct specificity
Superbills are summary tools that may omit detail needed for accurate, complete coding from the full medical record.
The False Claims Act imposes liability on individuals who knowingly submit:
Answer: False or fraudulent claims for payment to the federal government
The False Claims Act penalizes the knowing submission of false or fraudulent claims to federal healthcare programs.