CPC Compliance, Regulatory & Legal Guidelines 3

Question 1

Which of the following best defines 'unbundling' in the context of medical coding compliance?

Accepted Answer

Reporting components of a procedure separately when a comprehensive code exists

Answer

Unbundling occurs when individual component codes are billed separately instead of using the single comprehensive code that covers all the components.

Question 2

A provider submits claims for 'incident-to' services performed by a medical assistant without physician presence. This is most likely:

Accepted Answer

A violation of incident-to billing requirements

Answer

Incident-to billing requires the supervising physician to be present in the office suite and immediately available, not merely to co-sign documentation.

Question 3

The OIG Work Plan is best used by compliance officers to:

Accepted Answer

Identify areas the OIG plans to review, helping prioritize internal audits

Answer

The OIG Work Plan outlines focus areas for upcoming investigations, allowing providers to proactively audit those areas internally.

Question 4

Which regulation requires Medicare participating providers to inform patients of their right to receive an Advance Beneficiary Notice (ABN)?

Accepted Answer

Medicare Claims Processing Manual

Answer

The Medicare Claims Processing Manual contains the requirements for issuing ABNs when a service may not be covered because it is considered not medically necessary.

Question 5

An auditor finds that a coder has been assigning diagnosis codes from the patient's problem list without verifying that the physician addressed those conditions during the current encounter. This violates which coding guideline?

Accepted Answer

The guideline that conditions must be documented, evaluated, treated, or managed at the encounter to be coded

Answer

ICD-10-CM guidelines state that additional diagnoses may be coded only if they are documented, evaluated, treated, managed, or affect patient care during the encounter.

(CPC) Certified Professional Coder Practice Test

(CPC) Certified Professional Coder Practice Test

CPC Compliance, Regulatory & Legal Guidelines 3