CPC - Certified Professional Coder Compliance and Regulatory Rules Questions and Answers

Question 1

A primary care physician is a part-owner of a local imaging center.
The physician refers her Medicare patients who need radiology services exclusively to this facility.
Under which federal regulation is this financial arrangement most likely to be scrutinized?

Accepted Answer

The Stark Law

Answer

Emergency Medical Treatment and Active Labor Act (EMTALA)

Answer

Health Insurance Portability and Accountability Act (HIPAA)

Answer

The Anti-Kickback Statute (AKS)

Question 2

According to the Office of Inspector General (OIG), which of the following is considered one of the seven fundamental elements of an effective compliance program for a physician practice?

Accepted Answer

Conducting appropriate training and education for employees.

Answer

Outsourcing all billing and coding functions to a third-party vendor.

Answer

Purchasing the most expensive Electronic Health Record (EHR) system available.

Answer

Guaranteeing a 10% annual increase in practice revenue.

Question 3

In which of the following situations must a provider issue a mandatory Advance Beneficiary Notice of Noncoverage (ABN) to an Original Medicare beneficiary?

Accepted Answer

Prior to delivering a service that is typically covered but may not be considered medically necessary for this specific patient.

Answer

When providing a service that is statutorily excluded from Medicare, such as cosmetic surgery.

Answer

After a service has been provided and the claim has been denied by Medicare.

Answer

When the patient is enrolled in a Medicare Advantage (Part C) plan.

Question 4

A billing department audit reveals that due to a coding error, a physician's practice has received overpayments from Medicare for the past six months. What is the practice's primary legal obligation according to federal law?

Accepted Answer

To report and return the overpayment within 60 days of its identification.

Answer

To keep the funds, as the error was unintentional.

Answer

To wait until Medicare performs an audit and requests the money back.

Answer

To correct the error for future claims but take no action on past payments.

Question 5

What is the primary focus of the federal Anti-Kickback Statute (AKS)?

Accepted Answer

To prohibit offering or receiving remuneration to induce referrals for items or services covered by federal healthcare programs.

Answer

To prevent improper billing for services not rendered.

Answer

To protect the privacy and security of patient health information.

Answer

To ensure all patients receive stabilizing treatment in an emergency, regardless of ability to pay.

Question 6

Which of the following is a critical requirement for billing a service performed by a non-physician practitioner (NPP) as 'incident-to' a physician's service in an office setting?

Accepted Answer

The service must be part of an established plan of care initiated by a physician.

Answer

The service must be for a new patient to establish care.

Answer

The supervising physician must be in the same room while the NPP performs the service.

Answer

The NPP must bill the service under their own National Provider Identifier (NPI).