Compliance and Documentation Flashcards
7 cards from real COBGC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Compliance and Documentation flashcards as text
Which OIG compliance guidance element focuses on training and education of staff on fraud and abuse laws?
Answer: Training and education programs
The OIG's Seven Elements of an Effective Compliance Program include training and education to ensure all relevant staff understand applicable laws and billing requirements.
A physician documents 'patient is G3P2' in an obstetric note. What does 'P2' represent?
Answer: Two prior term deliveries
In standard obstetric terminology, 'P' (para) refers to the number of deliveries at or beyond 20 weeks gestation, not the number of pregnancies or live births.
Under the Stark Law, a gynecologist who refers patients for in-office laboratory services in which she has a financial interest must meet which condition to avoid a violation?
Answer: The arrangement must qualify under an applicable Stark Law exception
The Stark Law (42 U.S.C. § 1395nn) prohibits self-referrals unless the arrangement strictly meets a statutory or regulatory exception.
Which documentation element is required to support billing for a cervical colposcopy with biopsy in a GYN office?
Answer: Clinical indication, procedure description including colposcopic findings, biopsy site(s), and specimen disposition
Complete procedural documentation must include the reason for the procedure, technique used, intraoperative findings, biopsy sites, and where specimens were sent to support the code billed.
A patient's prenatal record is subpoenaed for a legal proceeding. The OB practice should:
Answer: Consult legal counsel and follow applicable state law before releasing records
A subpoena alone may not constitute sufficient legal authority under HIPAA; the practice should obtain legal guidance to determine whether a court order, authorization, or protective order is required.
Which term describes the practice of billing for a higher-level E/M service than what the documentation supports?
Answer: Upcoding
Upcoding means billing a code that reflects a higher level of service or complexity than is documented or medically necessary, which is a form of healthcare fraud.
An OB/GYN practice's compliance officer receives an anonymous hotline complaint about potential billing fraud. The compliance-appropriate response is to:
Answer: Investigate the complaint promptly and document findings
Compliance programs must have a process to promptly investigate all complaints, including anonymous ones, and document the investigation and its outcome.