CPC Compliance & Regulatory Practice Questions
Compliance & Regulatory makes up 2 of every 50 questions on a Tigertest CPC practice test. Here are 8 of the 8 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Based on AAPC's published CPC exam areas, the ICD-10-CM Official Guidelines, CMS rules and CPT conventions. Original questions; no code-book lookups.
1. Under the HIPAA Privacy Rule, using or sharing only the PHI needed for a task is the:
- A.Right of access standard
- B.Minimum necessary standard
- C.Notice of privacy practices
- D.Breach notification rule
Answer: B. The minimum necessary standard limits uses and disclosures of PHI to what the task requires. It does not apply to disclosures for treatment.
2. Which law penalizes knowingly submitting false claims to federal health programs?
- A.Anti-Kickback Statute
- B.HITECH Act
- C.Stark Law
- D.False Claims Act
Answer: D. The False Claims Act imposes penalties for each false claim plus damages. Stark covers self-referrals and the Anti-Kickback Statute covers paying for referrals.
3. The Stark Law mainly restricts:
- A.Physician self-referrals
- B.Coding at a higher level
- C.Sharing PHI without consent
- D.Billing for services not given
Answer: A. Stark bars a physician from referring Medicare patients for designated health services to an entity the physician or a family member has a financial relationship with, unless an exception applies.
4. Offering or paying anything of value to induce referrals of federal program business violates the:
- A.No Surprises Act
- B.HITECH Act
- C.Anti-Kickback Statute
- D.Federal Privacy Act of 1974
Answer: C. The Anti-Kickback Statute is a criminal law against knowingly exchanging remuneration for federal health care program referrals. Safe harbors protect some arrangements.
5. Billing separately for services that should be reported with one comprehensive code is:
- A.Downcoding
- B.Balance billing
- C.Unbundling
- D.Upcoding
Answer: C. Unbundling splits a comprehensive service into its parts to raise payment. Upcoding reports a higher level than documented.
6. Which Medicare notice tells a patient before a service that Medicare may not pay for it?
- A.Advance Beneficiary Notice
- B.Explanation of Benefits
- C.Medicare Summary Notice
- D.Notice of Privacy Practices
Answer: A. The Advance Beneficiary Notice of Noncoverage (ABN) is given before the service so the patient can choose whether to receive it and accept financial liability.
7. NCCI procedure-to-procedure edits identify:
- A.Codes that need prior approval
- B.Maximum units per day for a code
- C.Diagnoses that support a code
- D.Code pairs not billed together
Answer: D. PTP edits list pairs of codes that should not normally be reported together for the same patient and date. Maximum units per day are medically unlikely edits (MUEs).
8. How many core elements does the OIG list for an effective compliance program?
- A.Three
- B.Seven
- C.Five
- D.Ten
Answer: B. The OIG's General Compliance Program Guidance (2023) keeps the seven elements, including written policies, a compliance officer, training, auditing and corrective action.
Practice all 8 compliance & regulatory questions, and the rest of the 200-question bank, in the free CPC training sets. Questions you miss come back until you have mastered them.
Start practicingFree to start. No account needed.