OCC OCC Practice Management & Healthcare Systems 2 — Questions and Answers
Question 1: A physician wants to document a level 4 office visit (99214). Which elements must be present under the 2021 E/M guidelines?
- Moderate medical decision making OR 30-39 minutes total time (Correct answer)
- 4 HPI elements and 2 exam systems
- Detailed history, detailed exam, moderate MDM
- Review of 10+ systems and complete physical
Correct answer: Moderate medical decision making OR 30-39 minutes total time
Under 2021 CMS E/M guidelines, 99214 requires either moderate MDM or 30–39 minutes of total physician time; history and exam are no longer separately scored.
Question 2: Which Stark Law provision prohibits a physician from making a referral for designated health services to an entity with which the physician has a financial relationship?
- Stark Law (Physician Self-Referral Law) (Correct answer)
- Anti-Kickback Statute
- False Claims Act
- EMTALA
Correct answer: Stark Law (Physician Self-Referral Law)
The Stark Law (42 U.S.C. § 1395nn) prohibits physician self-referrals for designated health services when a financial relationship exists with the receiving entity.
Question 3: What is the primary purpose of a National Provider Identifier (NPI) number?
- Uniquely identify healthcare providers in electronic transactions (Correct answer)
- Assign billing codes to specific procedures
- Track malpractice history of providers
- Authorize prescribing of controlled substances
Correct answer: Uniquely identify healthcare providers in electronic transactions
The NPI is a unique 10-digit identification number for covered health care providers required for electronic HIPAA transactions.
Question 4: Under the Medicare Merit-based Incentive Payment System (MIPS), physicians are evaluated on which four performance categories?
- Quality, Promoting Interoperability, Improvement Activities, Cost (Correct answer)
- Quality, Cost, Patient Satisfaction, Access
- Efficiency, Safety, Timeliness, Effectiveness
- Preventive Care, Chronic Disease, Acute Care, Mental Health
Correct answer: Quality, Promoting Interoperability, Improvement Activities, Cost
MIPS evaluates eligible clinicians on Quality, Promoting Interoperability (EHR use), Improvement Activities, and Cost.
Question 5: Which type of medical malpractice insurance provides coverage only if the claim is filed while the policy is active, regardless of when the incident occurred?
- Claims-made policy (Correct answer)
- Occurrence policy
- Tail coverage
- Umbrella policy
Correct answer: Claims-made policy
A claims-made policy covers incidents only if both the event and the claim filing occur during the policy period.
Question 6: A physician practice is considering adopting an Electronic Health Record (EHR). Under the 21st Century Cures Act, what requirement is placed on EHR vendors?
- Prohibit information blocking and ensure interoperability (Correct answer)
- Store all records on federal servers
- Limit data access to attending physicians only
- Require paper backup for all electronic records
Correct answer: Prohibit information blocking and ensure interoperability
The 21st Century Cures Act prohibits information blocking practices that prevent access, exchange, or use of health information.
OCC OCC Practice Management & Healthcare Systems 2
A physician wants to document a level 4 office visit (99214).
Which elements must be present under the 2021 E/M guidelines?