Certified Medical Coding Specialist Regulatory Frameworks & Compliance 5

Question 1

Which federal statute makes it illegal to knowingly and willfully offer, pay, solicit, or receive anything of value to induce or reward referrals of items or services covered by federal healthcare programs?

Accepted Answer

Anti-Kickback Statute (42 USC 1320a-7b(b))

Answer

The Anti-Kickback Statute is a criminal statute that prohibits offering, paying, soliciting, or receiving remuneration to induce or reward federal healthcare program referrals.

Question 2

A compliance officer discovers that a coder has been miscoding diagnoses to meet LCD requirements. What is the FIRST required action under a robust compliance program?

Accepted Answer

Investigate the scope of the problem internally

Answer

A compliance program requires a thorough internal investigation to determine the scope, root cause, and whether it was systemic before corrective actions are taken.

Question 3

Which of the following is NOT one of the OIG's seven elements of an effective compliance program?

Accepted Answer

Mandatory participation in government audits

Answer

Mandatory audit participation is not one of the seven OIG compliance elements; the seven elements focus on internal program structure, education, and self-governance.

Question 4

A physician refers a patient to a physical therapy clinic in which the physician has a direct financial interest. Which law is MOST likely violated?

Accepted Answer

Stark Law (Physician Self-Referral Law)

Answer

Stark Law prohibits physician self-referrals for designated health services (including physical therapy) to entities in which the physician has a financial relationship, absent an exception.

Question 5

Under the HIPAA Security Rule, what type of safeguard includes workforce training, security policies, and contingency planning?

Accepted Answer

Administrative safeguards

Answer

Administrative safeguards under the HIPAA Security Rule encompass policies, procedures, workforce management, and contingency planning to protect ePHI.

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Practice Test

Certified Medical Coding Specialist Regulatory Frameworks & Compliance 5