The Why and How to Develop Documentation, Coding and Billing Compliance in Primary Care – Post Test

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Question 1 of 10

1. Question
1. Benefits of having a compliance plan in place include all EXCEPT:
- a. It is mandated in the False Claims Act that all medical entities have a Plan in place
- b. It allows opportunities to find errors in your operations that if corrected could help the practice out economically and legally
- c. It allows an avenue to keep consensus about procedures and processes
- d. It serves as a standard that, when not followed by staff, can serve as a documents to justify actions to separate from an employee
Question 2 of 10

2. Question
2. True comments related to areas of opportunities for revenue in your practice that can be found through a compliance plan include (select the best ONE that applies)
- a. Poor documentation to support medical necessity of a test/procedure
- b. Procedures documented as performed but not billed
- c. Office billing code level and documentation are not matching
- d. All are areas of potential revenue opportunities
Question 3 of 10

3. Question
3. Taking a prior note, copying it, and bringing it forward into the current note (“copy/paste”)
- a. Is now less scrutinized in the “providers over paper” movement by CMS
- b. Provides an auditor the opportunity to deny the claim based on “no medical necessity” because no new thought work was applied to the present encounter
- c. Is a way to streamline care delivery with subspecialists
- d. Does not increase liability from a medico-legal standpoint
Question 4 of 10

4. Question
4. Advance Beneficiary Notice of Non-payment (ABN) document
- a. Must be issued before delivery of service to the Medicare patient
- b. Must be given to every Medicare patient at any encounter where an expense is possible
- c. When not signed does not keep you from forcing payment from a Medicare patient
- d. Waives the out of pocket maximum Medicare patients will pay
Question 5 of 10

5. Question
5. Regarding risk adjustment documentation and coding,
- a. Providers should select as many codes as possible, because all diagnosis codes are risk adjusted and matter
- b. There have been several attempts to find fraudulent practices here, but the returns on these efforts have been limited and faded over time
- c. The intensity of a patient’s condition (risk score) is conveyed through the most clinically specific diagnosis code billed on a claim
- d. Risk score intensity is inversely affected by demographics (age, location, etc.) and is only minimally increased with the patient’s diagnosis billed on a claim
Question 6 of 10

6. Question
6. The most important thing to know about the Office of Inspector General is that
- a. Audit and compliance efforts are usually educational in nature
- b. The power and scope of the OIG has been drastically limited in the past 3 years
- c. The yearly “Work Plan” outlines the areas of focus and should serve as a roadmap for internal practice investigation for compliance
- d. The “Work Plan” is released every two years and must be voted on by Congress before deployment – hence the lack of movement in efforts since 2019
Question 7 of 10

7. Question
7. Recent areas of OIG focus include (Select the ONE best answer):
- a. CMS oversight of the Two-Midnight Rule for inpatient admissions
- b. Medicare telehealth services during the COVID-19 pandemic
- c. Advance Care Planning Service compliance with Medicare requirements
- d. All were on the OIG Work Plan in the last three years
Question 8 of 10

8. Question
8. Advance Care Planning was recommended as an audit focus for practices because
- a. In 2018, the 99497 and 99498 had high denial rates (10% and 20% respectably)
- b. Most Medicare plans don't cover the service
- c. The reimbursement for ACP is the highest per RVU in the Medicare Shared Savings Program and use is on the rise
- d. NPPs have recently (2020) been excluded from service delivery
Question 9 of 10

9. Question
9. The audit focus for Transition Care Management, Chronic Care Management, and some of the behavioral health service delivery was due to
- a. Reimbursements have been tripled in 2022
- b. There being many hand-offs and staff involvement that need to be hard wired to justify physician billing of the service
- c. Mental health and social determinants playing a bigger role in each of these three areas
- d. Billing staff needing extra work to do during the pandemic
Question 10 of 10

10. Question
10. Having the staff be engaged in compliance initiatives and provide yearly feedback on any concerns related to such during the yearly employee evaluation session is recommended as a way to (select ALL that apply)
- a. Limit Qui Tam whistleblower actions on the practice
- b. Promote unity and teamwork
- c. Advance “best practice” ideas from those employees on the front lines
- d. Force out “bad actors” from the organization

The Why and How to Develop Documentation, Coding and Billing Compliance in Primary Care – Post Test

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