CPC Compliance and Regulatory Guidelines 2

Question 1

Which federal law established the False Claims Act, allowing the government to sue individuals or companies that defraud federal programs?

Accepted Answer

False Claims Act of 1863

Answer

HIPAA

Answer

Stark Law

Answer

Anti-Kickback Statute

Question 2

Under HIPAA, which type of information is classified as Protected Health Information (PHI)?

Accepted Answer

A patient's name combined with their diagnosis

Answer

De-identified patient statistics used for research

Answer

Aggregate data from which no individual can be identified

Answer

Anonymous survey responses about treatment outcomes

Question 3

A coder bills a complex office visit when documentation only supports a straightforward visit to increase reimbursement. This is an example of:

Accepted Answer

Upcoding

Answer

Unbundling

Answer

Downcoding

Answer

Fragmentation

Question 4

Which CMS program requires providers to report quality measures and can affect Medicare reimbursement rates?

Accepted Answer

Merit-based Incentive Payment System (MIPS)

Answer

HIPAA Security Rule

Answer

False Claims Act

Answer

Stark Law Phase III

Question 5

What is the primary purpose of an Advance Beneficiary Notice (ABN)?

Accepted Answer

To inform Medicare patients of services that may not be covered so they can decide whether to receive them

Answer

To authorize a physician to provide emergency care

Answer

To obtain consent for sharing PHI with third parties

Answer

To document medical necessity for inpatient admissions

Question 6

Which of the following best describes the 'qui tam' provision of the False Claims Act?

Accepted Answer

It allows private citizens (whistleblowers) to file suits on behalf of the government and share in recovered funds

Answer

It requires all healthcare providers to report known fraud to OIG

Answer

It mandates annual compliance training for all hospital staff

Answer

It establishes penalties for duplicate billing

Question 7

A hospital's compliance program discovers a billing error that resulted in overpayment from Medicare. Under the 60-day rule, what must the provider do?

Accepted Answer

Report and return the overpayment within 60 days of identification

Answer

Correct the error internally without notifying CMS

Answer

Apply the overpayment as a credit toward future claims

Answer

Wait until the annual audit cycle to address the overpayment