CPC Compliance and Regulatory Rules 4

Question 1

Which federal program allows private citizens (whistleblowers) to file lawsuits on behalf of the government and receive a portion of recovered funds?

Accepted Answer

Qui Tam provisions of the False Claims Act

Answer

The False Claims Act's qui tam provisions allow private individuals (relators) to file suit on the government's behalf and receive 15-30% of recovered funds.

Question 2

A hospital provides free transportation services to Medicare patients to encourage them to use the hospital's services. This arrangement most likely violates:

Accepted Answer

Anti-Kickback Statute

Answer

Offering free services to induce patient referrals to a Medicare-covered entity likely violates the Anti-Kickback Statute.

Question 3

Which of the following best describes 'medical necessity' in the context of Medicare billing compliance?

Accepted Answer

Services that are reasonable and necessary for diagnosis or treatment of illness or injury

Answer

Medicare defines medical necessity as services or items that are reasonable and necessary for the diagnosis or treatment of illness, injury, or to improve functioning.

Question 4

A Corporate Integrity Agreement (CIA) is typically entered into between a healthcare provider and which federal agency?

Accepted Answer

Office of Inspector General (OIG) of HHS

Answer

CIAs are agreements between the OIG of HHS and healthcare providers as an alternative to exclusion from federal healthcare programs.

Question 5

What is 'excluded provider' status in the context of Medicare and Medicaid compliance?

Accepted Answer

A provider barred from participation in federal healthcare programs

Answer

An excluded provider has been prohibited by the OIG from participating in Medicare, Medicaid, and other federal healthcare programs.

CPC - Certified Professional Coder Practice Test

CPC - Certified Professional Coder Practice Test

CPC Compliance and Regulatory Rules 4