COBGC Compliance and Documentation 4

Question 1

Which OIG compliance guidance element focuses on training and education of staff on fraud and abuse laws?

Accepted Answer

Training and education programs

Answer

Effective lines of communication

Answer

Monitoring and auditing

Answer

Response to detected offenses

Question 2

A physician documents 'patient is G3P2' in an obstetric note. What does 'P2' represent?

Accepted Answer

Two prior term deliveries

Answer

Two previous pregnancies regardless of outcome

Answer

Two prior live births

Answer

Two prior cesarean sections

Question 3

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?

Accepted Answer

The arrangement must qualify under an applicable Stark Law exception

Answer

She must disclose the referral to the patient in writing

Answer

She must obtain prior authorization from Medicare

Answer

She must charge no more than the Medicare fee schedule

Question 4

Which documentation element is required to support billing for a cervical colposcopy with biopsy in a GYN office?

Accepted Answer

Clinical indication, procedure description including colposcopic findings, biopsy site(s), and specimen disposition

Answer

Only the CPT code and patient consent form

Answer

A referral from the primary care physician

Answer

Pre-authorization number from the insurer only

Question 5

A patient's prenatal record is subpoenaed for a legal proceeding. The OB practice should:

Accepted Answer

Consult legal counsel and follow applicable state law before releasing records

Answer

Release the records immediately as subpoenas override HIPAA

Answer

Refuse all subpoenas on HIPAA grounds

Answer

Require a signed patient authorization before complying with any court order

Question 6

Which term describes the practice of billing for a higher-level E/M service than what the documentation supports?

Accepted Answer

Upcoding

Answer

Unbundling

Answer

Downcoding

Answer

Balance billing

Question 7

An OB/GYN practice's compliance officer receives an anonymous hotline complaint about potential billing fraud. The compliance-appropriate response is to:

Accepted Answer

Investigate the complaint promptly and document findings

Answer

Discard it because anonymous complaints are unreliable

Answer

Immediately self-report to the OIG without first investigating

Answer

Share the complaint with the accused physician for comment before investigation