CRCR CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations 5

Question 1

Under the Emergency Medical Treatment and Labor Act (EMTALA), a hospital with an emergency department must:

Accepted Answer

Provide a medical screening exam to all individuals who come to the ED regardless of ability to pay

Answer

EMTALA requires hospitals with EDs to provide a medical screening examination to anyone who presents, regardless of their ability to pay, citizenship, or insurance status.

Question 2

In healthcare compliance, 'bundling' refers to which billing scenario?

Accepted Answer

Combining multiple services into one single payment code as required by payer rules

Answer

Bundling is the correct and required practice of submitting multiple services under a single code per payer rules; 'unbundling' (splitting bundled codes) is the fraudulent practice.

Question 3

Which of the following actions would constitute a HIPAA Security Rule violation?

Accepted Answer

Allowing workforce members to share login credentials to access ePHI systems

Answer

Sharing login credentials undermines access controls and audit controls required by the HIPAA Security Rule, making it impossible to track individual access to ePHI.

Question 4

What does the term 'coordination of benefits' (COB) mean in revenue cycle compliance?

Accepted Answer

The process of determining which payer is primary and which is secondary when a patient has multiple insurance coverages

Answer

COB is the standardized process for determining the order in which multiple insurers pay claims to prevent total payment from exceeding 100% of the actual charges.

Question 5

A compliance officer discovers that a coder has been billing 99215 (highest-complexity E&M) for all established patient office visits. Which compliance risk does this BEST represent?

Accepted Answer

Upcoding

Answer

Systematically billing the highest-level E&M code regardless of documentation is upcoding — inflating codes beyond what the medical record supports.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR CRCR - Certified Revenue Cycle Representative Program Healthcare Compliance and Regulations 5