Certified Medical Coding Specialist Regulatory Frameworks & Compliance 4

Question 1

The Exclusion Database maintained by the OIG lists individuals and entities that are excluded from participation in federal healthcare programs. How often should providers check this database for employees and contractors?

Accepted Answer

Monthly

Answer

OIG recommends monthly checks of the exclusion database (LEIE) to ensure employees and contractors have not become excluded after initial hire.

Question 2

Which federal agency is primarily responsible for investigating healthcare fraud and abuse under the False Claims Act?

Accepted Answer

Department of Justice (DOJ)

Answer

The Department of Justice (DOJ) has primary authority to litigate civil False Claims Act cases, often working in partnership with the OIG and FBI.

Question 3

A coder separately bills CPT code 36000 (IV catheter placement) when it is included in the procedure code for a more complex service. This is an example of:

Accepted Answer

Unbundling

Answer

Unbundling is the practice of billing separately for services that should be bundled into a single comprehensive code, violating NCCI edit policies.

Question 4

Under HIPAA's Minimum Necessary Standard, a medical coder accessing PHI should:

Accepted Answer

Access only the information needed to perform their job duties

Answer

The Minimum Necessary Standard requires covered entities to limit PHI access to the minimum needed to accomplish the intended purpose.

Question 5

Which of the following is the primary purpose of the Medicare Integrity Program (MIP)?

Accepted Answer

To identify and recover improper Medicare payments through audits and investigations

Answer

The Medicare Integrity Program authorizes CMS to enter into contracts with entities to perform audits, cost report reviews, and investigations to protect Medicare Trust Fund integrity.

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Regulatory Frameworks & Compliance 4