Compliance & Regulatory Knowledge Flashcards
7 cards from real CMC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Compliance & Regulatory Knowledge flashcards as text
Which type of corporate integrity agreement (CIA) is typically imposed on a provider after an OIG settlement involving fraudulent billing?
Answer: A negotiated agreement requiring enhanced compliance measures for 3-5 years
A CIA is a negotiated agreement between OIG and a provider typically lasting 3-5 years, requiring specific compliance measures such as audits, training, and reporting as a condition of continued program participation.
The Anti-Kickback Statute (AKS) contains 'safe harbors' that protect certain arrangements. Which of the following qualifies as a safe harbor?
Answer: Discounts that are properly disclosed and reflected in submitted costs
The AKS discount safe harbor protects properly disclosed price reductions where the discounted price is accurately reported to the payer, ensuring no hidden kickback.
A coder notices that the attending physician documented 'acute respiratory failure with hypoxia' but the claim was submitted with only J96.01 (Acute respiratory failure with hypoxia). Under ICD-10-CM guidelines, what additional coding consideration applies?
Answer: The underlying cause of respiratory failure should also be coded when known
ICD-10-CM guidelines instruct coders to also code the underlying condition causing acute respiratory failure when it is documented and known.
Medicare's Recovery Audit Contractor (RAC) program is authorized to look back how many years from the date of service when auditing claims?
Answer: 3 years
RAC contractors are authorized to review Medicare claims up to 3 years from the date the claim was paid, aligning with Medicare's standard reopening period.
Which entity is responsible for publishing and updating the ICD-10-CM coding guidelines used in the United States?
Answer: The four cooperating parties: CMS, NCHS, AHA, and AHIMA
ICD-10-CM guidelines are maintained by four cooperating parties: CMS, NCHS (CDC), the American Hospital Association, and AHIMA.
A physician practice receives a subpoena from the Department of Justice requesting medical records related to a billing investigation. What is the MOST appropriate immediate action?
Answer: Notify legal counsel immediately and preserve all relevant records
Upon receiving a government subpoena, the practice must immediately notify legal counsel and implement a litigation hold to preserve all potentially relevant records.
Under the Health Care Fraud and Abuse Control (HCFAC) program, which agencies jointly administer the program?
Answer: HHS and the Department of Justice
HCFAC is jointly administered by HHS and the Department of Justice, coordinating federal, state, and local law enforcement to combat healthcare fraud and abuse.