CPC Compliance, Regulatory & Legal Guidelines 2

Question 1

Under HIPAA, which of the following is considered a covered entity?

Accepted Answer

A health plan that pays for medical care

Answer

Health plans that pay for medical care are covered entities under HIPAA, along with healthcare providers and healthcare clearinghouses.

Question 2

Which federal act established the national do-not-pay list and requires providers to screen employees against exclusion databases?

Accepted Answer

Social Security Act Section 1128

Answer

Section 1128 of the Social Security Act grants the OIG authority to exclude individuals and entities from federal healthcare programs and maintain the exclusion database.

Question 3

A coder discovers that a physician consistently documents 'chest pain' after the fact when the actual presenting complaint was a cough. This practice is best described as:

Accepted Answer

Fraudulent documentation

Answer

Altering documentation to reflect conditions not present at the time of the encounter constitutes fraudulent documentation.

Question 4

The Physician Self-Referral Law (Stark Law) prohibits physicians from referring Medicare patients to entities where the physician has a financial relationship unless:

Accepted Answer

A specific exception applies

Answer

Stark Law violations are strict liability but specific statutory and regulatory exceptions allow certain arrangements when strict criteria are met.

Question 5

Which type of audit is conducted by an outside organization to assess a facility's compliance program objectively?

Accepted Answer

External audit

Answer

An external audit is performed by an independent third party to provide an objective evaluation of coding accuracy and compliance.

(CPC) Certified Professional Coder Practice Test

(CPC) Certified Professional Coder Practice Test

CPC Compliance, Regulatory & Legal Guidelines 2