NCCT REVIEW LAW AND ETHICS EXAM QUESTIONS AND ANSWERS

NCCT REVIEW LAW AND ETHICS EXAM QUESTIONS AND ANSWERS 1. Which of the following activities is an example of abuse rather than fraud? A. upcoding B. misrepresenting the diagnosis C. inadvertent coding errors D. billing for services not rendered - Answer-inadvertent coding errors Rationale Abuse is an unintentional mistake. Fraud is an intentional misrepresentation for gain. Upcoding, misrepresenting the diagnosis, and billing for services not rendered are examples of fraud. Inadvertent coding errors are examples of abuse. 2. Which of the following legislation prohibits physicians from referring patients to an entity if the physician or a member of her immediate family has a financial relationship with the entity? A. Anti-kickback Statute B. Federal False Claims Act C. Exclusion Statute D. Stark Law - Answer-Stark Law Rationale Stark Law prohibits physicians from referring patients to an entity if the physician or immediate family member has a financial relationship with the entity so that a physician doesn't do referrals for personal gain. The Anti-Kickback Statute prohibits the physician from accepting gifts from an entity for referring patients. The Federal False Claims Acts states that it is illegal to make a false medical record or to file a false medical claim. The Exclusion Statue states certain circumstances in which entities can be banned from Medicare. 3. Which of the following is an example of a Stark Law violation? A. A physician using self-referral. B. Unbundling procedures. C. Asking for payment from a minor. D. A physician receiving kickbacks. - Answer-A physician using self-referral. Rationale Stark Law is a set of federal laws that prohibits physician self-referral, specifically a referral by a physician of a government insurance patient to an entity providing health services if the physician (or an immediate family member) has a financial relationship with that entity. 4. A specialist gives a general practitioner concert tickets every time he refers a patient to him. This is illegal according to A. anti-trust law. B. HIPAA. C. the Stark law. D. the Anti-Kickback law. - Answer-the Anti-Kickback law. Rationale The Anti-Kickback law prohibits offering, paying, soliciting or receiving anything of value to induce or reward referrals. This includes anything of value and can take many forms besides cash, such as free rent, expensive hotel stays and meals, and excessive compensation for medical directorships or consultancies. 5. During an annual audit, it is discovered that the office coding staff have up-coded procedures. Which of the following laws applies? A. Anti-kickback Law B. Stark Law C. HIPAA D. False Claims Act - Answer-False Claims Act Rationale The practice of upcoding is a violation of Medicare laws and falls under the umbrella of the False Claims Act. 6. Which of the following laws pertains to an insurance and coding specialist who knowingly presents an incorrect CMS 1500 for payment to a payer? A. Federal Civil False Claim Act B. OMNIBUS Act C. Stark Law D. Administrative Law - Answer-Federal Civil False Claim Act Rationale The Federal Civil False Claim Act prohibits the submission of knowingly false claims for the purpose of receiving extra, undue, money. 7. Which of the following regulates health care billing for services that are not medically necessary? A. Stark Law B. Patient's Bill of Rights C. Health Insurance Portability and Accountability Act D. Federal False Claims Act - Answer-Federal False Claims Act Rationale The Federal False Claim Act prohibits the submission of knowingly false claims for the purpose of receiving extra, undue, money. 8. Which of the following regulations prohibits a physician from referring a patient to a facility in which the physician holds a financial interest? A. HIPAA B. Federal False Claims Act C. Stark Law D. Affordable Care Act - Answer-Stark Law Rationale Stark Law prohibits a physician from referring a patient to a facility in which the physician holds a financial interest. This law was written so that physicians do not take advantage of a patient's health situation. It is to deter physicians from lying to make extra money. 9. A local laboratory sent a physician two tickets to the football game, as a thank you for referring patients to its testing center. Which of the following has been violated? A. False Claim Act B. Anti-Kickback Act C. HIPAA D. Fraud and Abuse Act - Answer-Anti-Kickback Act Rationale According to the Anti-Kickback Act, it is illegal for a physician to accept money or gifts, such as football tickets, for referring patients. This type of practice lessens the integrity of the services provided. Patients may be referred simply so that the physician receives a gift. 10. A lawyer has called and demanded information about a patient in the office. The insurance and coding specialist can share the information if A. she calls the patient and obtains permission. B. the lawyer tells her that he has permission from the patient. C. the lawyer provides his identification number. D. the patient has signed an authorization form. - Answer-the patient has signed an authorization form. Rationale For the release of any medical information, the patient must have completed and signed a release of information consent. A call to the patient is not adequate. The consent must be in writing. 11. The HITECH Act was created to promote the use of A. better physician documentation