CPC Compliance and Regulatory Guidelines 3

Question 1

Which OIG tool allows healthcare organizations to self-disclose potential fraud and abuse violations to avoid larger penalties?

Accepted Answer

Self-Disclosure Protocol (SDP)

Answer

The OIG's Self-Disclosure Protocol allows providers to voluntarily disclose potential violations, typically resulting in lower multipliers and penalties than if discovered through audit.

Question 2

Stark Law (Physician Self-Referral Law) primarily prohibits physicians from referring Medicare patients for designated health services to entities where:

Accepted Answer

The physician or immediate family member has a financial relationship, unless an exception applies

Answer

Stark Law bars self-referrals to entities with which the physician has a direct or indirect financial relationship, with specific statutory exceptions.

Question 3

Which element is NOT one of the seven core components of an effective compliance program per OIG guidance?

Accepted Answer

Mandatory profit-sharing with compliance staff

Answer

The seven OIG compliance program elements do not include profit-sharing; they focus on policies, oversight, training, auditing, communication, enforcement, and response to detected issues.

Question 4

When a coder assigns separate CPT codes for services that should be reported with a single comprehensive code, this practice is called:

Accepted Answer

Unbundling

Answer

Unbundling is the improper practice of billing component services separately when a single comprehensive code should be used, inflating reimbursement.

Question 5

A provider who is listed on the OIG Exclusion List is prohibited from:

Accepted Answer

Participating in federal healthcare programs including Medicare and Medicaid

Answer

Excluded individuals and entities are barred from participating in Medicare, Medicaid, and all other federal healthcare programs, and hiring them can result in significant penalties.

(CPC) Certified Professional Coder Practice Test

(CPC) Certified Professional Coder Practice Test

CPC Compliance and Regulatory Guidelines 3