COBGC Compliance and Documentation 2

Question 1

Under HIPAA, which minimum necessary standard applies when a billing staff member requests a patient's OB record for claim submission?

Accepted Answer

Only the information reasonably necessary to accomplish the billing purpose should be disclosed

Answer

The full medical record must always be provided

Answer

Any PHI may be shared freely within the practice

Answer

Minimum necessary does not apply to treatment team members

Question 2

A gynecology coder queries a physician about an unspecified diagnosis code. Which element is required for a compliant physician query?

Accepted Answer

The query must present all clinically reasonable options including 'clinically undetermined'

Answer

The coder must suggest the preferred diagnosis to the physician

Answer

Queries are only allowed before the claim is submitted

Answer

The physician must respond within 24 hours or the code is dropped

Question 3

Which federal law establishes criminal penalties for knowingly submitting false claims to Medicare or Medicaid?

Accepted Answer

The False Claims Act

Answer

HIPAA

Answer

The Anti-Kickback Statute

Answer

EMTALA

Question 4

In OB/GYN documentation, the phrase 'as above' used to describe a physical examination finding is considered:

Accepted Answer

Incomplete documentation that may not support the code billed

Answer

Acceptable shorthand that meets documentation requirements

Answer

A valid cross-reference as long as it refers to the same encounter

Answer

Sufficient if co-signed by the supervising physician

Question 5

A practice bills a global OB package but the patient's prenatal care was provided by a different physician group. How should this be handled?

Accepted Answer

Bill only the delivery and postpartum services actually provided by the billing physician

Answer

Bill the global package anyway to maximize reimbursement

Answer

Append modifier -22 to the global package code

Answer

Use an unlisted procedure code for the partial global

Question 6

Which document serves as the primary compliance roadmap outlining an OB/GYN practice's commitment to ethical billing and coding standards?

Accepted Answer

The compliance plan

Answer

The superbill

Answer

The charge master

Answer

The fee schedule

Question 7

A coder notices that a physician consistently documents a comprehensive history and exam for straightforward OB follow-up visits. This pattern most likely warrants:

Accepted Answer

An internal audit and potential education on medical necessity and upcoding risk

Answer

No action—physicians always document the highest level for safety

Answer

Immediate report to the OIG hotline

Answer

Downcoding all claims retroactively