Certified Medical Coding Specialist Regulatory Frameworks & Compliance 2

Question 1

Which federal act established the National Correct Coding Initiative (NCCI) to prevent improper coding?

Accepted Answer

The Omnibus Budget Reconciliation Act of 1993

Answer

NCCI was established under OBRA 1993 to promote correct coding and control improper coding that leads to inappropriate Medicare payments.

Question 2

A coder notices a physician consistently upcodes E/M services. Under the False Claims Act, who can file a qui tam lawsuit on behalf of the government?

Accepted Answer

Any private individual with knowledge of the fraud

Answer

The False Claims Act's qui tam provision allows any private individual (a 'whistleblower' or relator) who has knowledge of fraud against the government to file a lawsuit.

Question 3

Under HIPAA, a covered entity must provide a patient with an accounting of disclosures for the past how many years?

Accepted Answer

6 years

Answer

HIPAA requires covered entities to provide patients with an accounting of certain disclosures of PHI for the six years prior to the date of the request.

Question 4

Which CMS program uses Recovery Audit Contractors (RACs) to identify and correct improper Medicare payments?

Accepted Answer

Recovery Audit Program

Answer

The Recovery Audit Program uses RACs to identify and recover improper Medicare payments made to healthcare providers.

Question 5

A hospital submits a claim for a service that was not medically necessary. Which regulation most directly governs this violation?

Accepted Answer

Social Security Act Section 1862(a)(1)

Answer

Social Security Act Section 1862(a)(1) is the statutory basis for denying Medicare payment for services that are not reasonable and medically necessary.

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Regulatory Frameworks & Compliance 2