CPC Compliance and Regulatory Practice Test Questions Answers with Explanation. Try our free American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) Compliance and Regulatory review questions and answers for better CPC certification prep.
CPC Compliance and Regulatory Practice Test
Basic Questions
Q1. What does HIPAA stand for?
- (A) Health Information Portability and Accountability Act
- (B) Health Insurance Privacy and Accountability Act
- (C) Health Insurance Portability and Accountability Act
- (D) Health Information Privacy and Accountability Act
Q2. What is the primary purpose of the Stark Law?
- (A) To prevent healthcare fraud and abuse
- (B) To regulate the confidentiality of patient records
- (C) To prohibit physician self-referral
- (D) To ensure proper medical billing practices
Q3. Which agency is responsible for enforcing the False Claims Act?
- (A) Centers for Medicare & Medicaid Services (CMS)
- (B) Department of Health and Human Services (HHS)
- (C) Office of Inspector General (OIG)
- (D) Department of Justice (DOJ)
Q4. What is the purpose of the Office of Inspector General (OIG) Work Plan?
- (A) To outline the OIG’s priorities for the coming year
- (B) To provide guidelines for medical coding practices
- (C) To ensure compliance with HIPAA regulations
- (D) To regulate the use of electronic health records
Q5. Under the False Claims Act, what can whistleblowers receive as a reward for reporting fraud?
- (A) Nothing
- (B) A fixed salary
- (C) A percentage of the recovered funds
- (D) A tax deduction
Q6. What is the main focus of the Health Information Technology for Economic and Clinical Health (HITECH) Act?
- (A) To improve health information privacy and security
- (B) To provide guidelines for medical billing practices
- (C) To enhance the quality of healthcare
- (D) To prevent physician self-referral
Q7. Which of the following is a key component of a corporate compliance program?
- (A) Regular audits and monitoring
- (B) Limiting patient access to their medical records
- (C) Increasing the number of billable services
- (D) Reducing the number of staff in the compliance department
Scenario-Based Questions
Q8. A coder discovers that a physician consistently upcodes office visits. What should the coder do according to compliance guidelines?
- (A) Ignore the issue to avoid conflict
- (B) Report the issue to the compliance officer
- (C) Correct the codes without informing anyone
- (D) Discuss it with the physician only
Q9. During an audit, it is discovered that several patient records were accessed without proper authorization. What should be the first step in addressing this breach?
- (A) Notify the affected patients immediately
- (B) Determine the extent and source of the breach
- (C) Dismiss the employees involved
- (D) Report the breach to law enforcement
Q10. A healthcare facility receives a subpoena requesting patient records for a legal case. What must be done to comply with HIPAA?
- (A) Immediately release the records without question
- (B) Verify the subpoena and ensure minimum necessary information is provided
- (C) Refuse to release the records
- (D) Notify the patient before releasing the records
Q11. A billing department receives an overpayment from Medicare. What is the correct course of action?
- (A) Keep the overpayment as a bonus
- (B) Notify Medicare and return the overpayment promptly
- (C) Adjust future claims to account for the overpayment
- (D) Use the overpayment to cover other expenses
Q12. A hospital is undergoing an external audit for potential Medicare fraud. What should the hospital’s compliance officer do?
- (A) Destroy any incriminating records
- (B) Cooperate fully with the auditors and provide requested documentation
- (C) Refuse to provide any records without a court order
- (D) Hire a legal team to obstruct the audit process
Q13. A healthcare provider’s electronic health record (EHR) system is hacked, and patient data is compromised. What is the immediate action required by HITECH Act regulations?
- (A) Notify law enforcement immediately
- (B) Conduct a thorough investigation and notify affected patients
- (C) Shut down the EHR system permanently
- (D) Ignore the breach to avoid public relations issues
Q14. A patient complains about a possible breach of their health information privacy. What is the appropriate response by the compliance officer?
- (A) Ignore the complaint
- (B) Investigate the complaint and take corrective action if necessary
- (C) Blame the patient for the breach
- (D) Dismiss the complaint as unimportant
Q15. An employee reports potential fraudulent billing practices within the organization. What protections are they afforded under the False Claims Act?
- (A) They can be terminated for making false claims
- (B) They are protected from retaliation and may receive a reward
- (C) They must keep the information confidential
- (D) They can be demoted to a lower position
See also:
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