CPC Compliance and Regulatory Rules 3

Question 1

Under HIPAA, which of the following is NOT considered Protected Health Information (PHI)?

Accepted Answer

De-identified health information

Answer

De-identified health information that has been properly stripped of all 18 HIPAA identifiers is not considered PHI.

Question 2

A physician self-refers a Medicare patient for physical therapy services at a physical therapy clinic in which the physician has a financial interest. This likely violates:

Accepted Answer

The Stark Law (Physician Self-Referral Law)

Answer

The Stark Law prohibits physicians from referring patients to entities providing designated health services in which the physician has a financial relationship.

Question 3

Which type of Medicare audit is conducted by Recovery Audit Contractors (RACs) to identify and correct improper payments?

Accepted Answer

Post-payment review

Answer

RAC audits are post-payment reviews that look back at claims already paid by Medicare to identify overpayments and underpayments.

Question 4

When a provider bills for services that were never rendered to the patient, this is classified as:

Accepted Answer

Phantom billing

Answer

Phantom billing (also called billing for services not rendered) is submitting claims for services that were never actually provided to the patient.

Question 5

The OIG Work Plan is published annually to indicate which areas are under scrutiny for potential fraud and abuse. Who publishes the OIG Work Plan?

Accepted Answer

Office of Inspector General (OIG) of HHS

Answer

The OIG Work Plan is published by the HHS Office of Inspector General and outlines planned audits and investigations for the coming year.

CPC - Certified Professional Coder Practice Test

CPC - Certified Professional Coder Practice Test

CPC Compliance and Regulatory Rules 3