Regulatory Compliance & Legal Framework Flashcards
7 cards from real CMAS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Regulatory Compliance & Legal Framework flashcards as text
The OIG (Office of Inspector General) Compliance Program Guidance for medical practices recommends which of the following as a core element?
Answer: Designating a compliance officer and implementing written compliance policies and procedures
OIG compliance program guidance identifies seven core elements, including designating a compliance officer, implementing written standards, and establishing reporting mechanisms.
Which type of medical record release does NOT require a patient's written authorization under HIPAA?
Answer: Release for treatment, payment, and healthcare operations (TPO)
HIPAA permits disclosure of PHI for Treatment, Payment, and Healthcare Operations without patient authorization, as these are considered essential healthcare functions.
A medical practice bills Medicare for a service that was not actually performed. This constitutes:
Answer: Fraudulent billing under the False Claims Act
Billing for services not rendered is fraud under the False Claims Act and can result in criminal prosecution, civil monetary penalties, and program exclusion.
The concept of 'respondeat superior' in medical liability holds that:
Answer: An employer can be held legally responsible for the negligent acts of an employee acting within the scope of employment
Respondeat superior ('let the master answer') makes employers vicariously liable for employees' negligent actions performed within the scope of their employment.
A Notice of Privacy Practices (NPP) under HIPAA must be provided to patients:
Answer: At the patient's first service delivery and upon request thereafter
Covered entities must provide the NPP no later than the date of first service delivery and must make it available upon request at any time thereafter.
Under state medical records laws, the general minimum retention period for adult patient medical records in most U.S. states is:
Answer: 5 to 10 years from the date of service or last patient contact
Most states require adult medical records to be retained for a minimum of 5 to 10 years from the date of service, though requirements vary by state.
Which of the following is an example of 'upcoding' in medical billing?
Answer: Billing for a 99215 when documentation only supports a 99213
Upcoding occurs when a provider bills for a higher-level service than what was actually documented and performed, resulting in inflated reimbursement.