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.CPC- Compliance and regulatory questions and development of answers
(2023) Download to score an A
What value does the OIG Work Plan have for a physician practice?
A. It provides information about Medicare coverage rules.
B. It reports on areas of billing non-compliance that require further investigation.
C. It is an annual report on the financial health of the Medicare program.
D. It sets the risk adjustment rules for the coming year.
The Office of Inspector General (OIG) publishes a monthly update to its list of
priorities to be used when auditing claims within the Medicare program. The
priorities are determined based on data on non-compliance observed during the
last year. This document provides a step-by-step plan for providers who want this
monitor their practices for non-compliance.
What is PHI?
A. Exchange between physician and health care provider
B. Private health insurance
C. Protected Health Information
D. Provider Identified Incident
c
Protected Health Information Under the Portability of Health Information and
Accountability Act (HIPAA) is any information, whether oral or recorded, in any form
form or medium created or received by a healthcare provider, care plan,
public health authority, employer, life insurer, school or university, or health care provider
clearinghouse regarding past, present or future physical or mental health
condition of an individual, the provision of health services to that individual, or
payment for these services. This is only health information at the individual level
covered; health information from groups is not.
What is NOT included in the CPT® surgical package?
A. Typical postoperative aftercare
B. One related evaluation and management service on the same date of the procedure
C. Return to the operating room the next day for a complication due to the
initial procedure
D. Evaluation of the patient in the recovery room after anesthesia
The definition of CPT® surgical packaging can be found in the Surgical Guidelines in the
CPT® Codebook (immediately after the Anesthesia Codes section). Multiple choice C
is the correct answer because modifier 78 is reported on a procedure code to
indicate that a patient is returning to the OR due to a complication (unplanned return).
occurred during the postoperative period of the initial procedure.

Which health plan is NOT covered by HIPAA?
A.Medicaid
B. Medicare
C. Compensation of employees
D. Private plans
c
Workers' compensation is excluded from the definition of a health care plan under the
Health Insurance Portability and Accountability Act (HIPAA). Workers
compensation plans are not required to comply with HIPAA privacy standards,
security or code sets.
Which of the following is an example of electronic data?
A. A digital x-ray
B. An explanation of the benefits
C. A prior notice to the beneficiary
D. A written prescription
Although B, C or D can be done electronically, this is by definition not mandatory
done electronically. A digital x-ray is an x-ray with an image that is stored
electronically rather than on film, and so A is the correct answer.
Guidance on which of the following code sets are included as part of the code set
requirements under HIPAA?
A. CPT® Category III Codes
B.ICD-10-CM
C. HCPCS Level II
D. ADA Dental Codes
ICD-10-CM guidelines are the only guidelines specifically mentioned in HIPAA.
While HIPAA requires the use of the other code sets mentioned, there is no specific code
mention of the other guidelines in the law. This information can be found in the official ICD10-CM coding guidelines and reported in your ICD-10-CM codebook:
These guidelines are a set of rules developed to guide and
supplements the official conventions and instructions contained in the ICD-10
CM himself. These guidelines are based on the coding and sequencing instructions
in Parts I, II, and III of ICD-10-CM, but provide additional instructions.
Adherence to these guidelines when assigning ICD-10-CM diagnosis and
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