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

HIPAA's minimum necessary rule requires that only the PHI needed for the specific purpose—here, billing—be disclosed or accessed.

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

AHIMA and ACDIS guidelines require that queries offer all reasonable clinical options, including 'clinically undetermined,' to avoid leading the physician.

Question 3

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

Accepted Answer

The False Claims Act

Answer

The False Claims Act (31 U.S.C. §§ 3729–3733) imposes civil and criminal liability on individuals and entities that submit fraudulent claims to federal health programs.

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

Payers and auditors generally reject 'as above' or 'see above' as insufficient documentation because the specific findings must be recorded to support level of service coding.

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

When a physician does not provide the full antepartum care included in the global OB package, only the delivery and postpartum components actually rendered should be billed.

(COBGC) Certified Obstetrics Gynecology Coder Practice Test

(COBGC) Certified Obstetrics Gynecology Coder Practice Test

COBGC Compliance and Documentation 2