Certified Medical Coding Specialist Professional Standards & Competencies 3 — Questions and Answers
Question 1: The 'minimum necessary' standard under HIPAA requires covered entities to:
- Share all patient records when requested by any provider
- Disclose only the PHI needed to accomplish the intended purpose (Correct answer)
- Encrypt all PHI regardless of intended use
- Obtain written consent for every internal use of PHI
Correct 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.
Question 2: Which act established voluntary compliance programs as a key strategy for healthcare fraud prevention?
- Stark Law
- False Claims Act
- Health Insurance Portability and Accountability Act
- OIG Compliance Program Guidance (Correct answer)
Correct answer: OIG Compliance Program Guidance
The OIG Compliance Program Guidance promotes voluntary compliance programs as a proactive fraud-prevention strategy.
Question 3: When a patient has two diagnoses that are equally responsible for admission, the coder should:
- Always code the more expensive diagnosis first
- Query the physician to designate the principal diagnosis (Correct answer)
- List them alphabetically
- Code only the diagnosis with the most procedures linked to it
Correct 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.
Question 4: A Notice of Privacy Practices (NPP) must be provided to patients:
- Only upon written request
- At the first service delivery and upon request thereafter (Correct answer)
- Once per calendar year regardless of visits
- Only when PHI is shared with a third party
Correct 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.
Question 5: Which of the following is an example of a business associate under HIPAA?
- A hospital's employed nurse
- A medical transcription company that processes patient records (Correct answer)
- A patient's family member acting as interpreter
- A state public health department receiving legally required disclosures
Correct 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.
Question 6: Coding from a superbill alone without reviewing the medical record is problematic because:
- Superbills are not accepted by payers
- Superbills may not capture all conditions or correct specificity (Correct answer)
- HIPAA prohibits the use of superbills for coding
- Superbills are only valid for inpatient coding
Correct 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.
Question 7: The False Claims Act imposes liability on individuals who knowingly submit:
- Duplicate claims only
- Any claims that are later denied by the payer
- False or fraudulent claims for payment to the federal government (Correct answer)
- Claims without a referring physician NPI
Correct 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.
Certified Medical Coding Specialist Professional Standards & Competencies 3
The 'minimum necessary' standard under HIPAA requires covered entities to: