CPC Compliance and Regulatory Rules 2

Question 1

Which federal law establishes the Anti-Kickback Statute (AKS) that prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for federal healthcare programs?

Accepted Answer

Social Security Act Section 1128B

Answer

The Anti-Kickback Statute is codified at 42 U.S.C. § 1320a-7b(b), which is Section 1128B of the Social Security Act.

Question 2

A medical practice bills Medicare for a service using a CPT code that represents a higher level of service than what was actually performed. This is an example of:

Accepted Answer

Upcoding

Answer

Upcoding occurs when a provider bills for a higher-level or more expensive service than was actually rendered.

Question 3

Under the OIG Compliance Program Guidance, which element is considered the foundation of an effective compliance program?

Accepted Answer

Designation of a compliance officer

Answer

The OIG identifies the designation of a compliance officer as the foundational element because this person oversees all other compliance activities.

Question 4

Which statute imposes civil monetary penalties on any person who knowingly presents a false or fraudulent claim to a federal health care program?

Accepted Answer

False Claims Act

Answer

The False Claims Act (31 U.S.C. § 3729) imposes civil liability for submitting false or fraudulent claims to the federal government.

Question 5

A coder assigns separate CPT codes for each component of a procedure that should be reported with a single comprehensive code. This practice is known as:

Accepted Answer

Unbundling

Answer

Unbundling is the practice of billing separately for services that should be reported together under one comprehensive CPT code.

CPC - Certified Professional Coder Practice Test

CPC - Certified Professional Coder Practice Test

CPC Compliance and Regulatory Rules 2