CMC Compliance & Regulatory Knowledge 3

Question 1

Under the Stark Law, which of the following financial relationships between a physician and a hospital would be EXEMPT from the prohibition on referrals?

Accepted Answer

A physician employed by the hospital at fair market value compensation

Answer

The Stark Law's bona fide employment exception permits physician-hospital employment arrangements when compensation is at fair market value and not contingent on referrals.

Question 2

The National Correct Coding Initiative (NCCI) edits are designed to prevent which type of billing abuse?

Accepted Answer

Unbundling procedures that should be billed together

Answer

NCCI edits identify pairs of CPT codes that should not be billed together because one code's work is included in the other, preventing unbundling.

Question 3

A provider knowingly submits claims using a deceased physician's NPI number. This action most directly violates which law?

Accepted Answer

The False Claims Act

Answer

Knowingly submitting false or fraudulent claims to a federal healthcare program violates the False Claims Act and can result in treble damages and per-claim penalties.

Question 4

Which CMS program uses Risk Adjustment Data Validation (RADV) audits to ensure coding accuracy?

Accepted Answer

Medicare Advantage (Part C)

Answer

CMS conducts RADV audits for Medicare Advantage plans to verify that submitted diagnosis codes are supported by medical record documentation and accurate risk scores.

Question 5

What is the statute of limitations for the government to bring a False Claims Act lawsuit if the violation was NOT known to the government?

Accepted Answer

6 years from the date of the violation

Answer

Under the FCA, the government has 6 years from the violation date, or 3 years from when it knew (or should have known), whichever is later, up to 10 years maximum.

(CMC) Certified Medical Coder Practice Test

(CMC) Certified Medical Coder Practice Test

CMC Compliance & Regulatory Knowledge 3