AAPC-CPPM Certified Physician Practice Manager - Set 1 - Part 3

Correct Answer: Integrity Agreement

OIG guidance describes an Integrity Agreement as the document outlining obligations an individual practitioner, small group practice, or small provider accepts in a civil or administrative settlement. It is the counterpart of the Corporate Integrity Agreement used for larger entities. Option b is incorrect because this is a category of enforcement action summary posted on OIG's website, not the agreement that lists a small provider's ongoing obligations. Option c is incorrect because an advisory opinion is a topic in OIG's FAQs addressing proposed arrangements, not a settlement document that sets obligations for a small practice. Option d is incorrect because an IRO performs the reviews that a CIA requires; its work product is not the agreement in which obligations are set.

Correct Answer: Verification that the bill is accurate

OIG guidance says documentation is important to clinical patient care and serves a second function when a bill is submitted: it verifies that the bill is accurate as submitted. Option a is incorrect because comparing a practice's denial rate with other practices in the same specialty is described as a method for improving documentation quality, not as the second function of documentation. Option b is incorrect because improper inducements, kickbacks and self-referrals form a separate risk area, and the guidance does not describe documentation as the tool that identifies them. Option c is incorrect because audit samples are drawn from sources such as all reimbursed claims, one payor's claims or risk areas, not from the function documentation serves on a bill.

Correct Answer: Discharging the individual after a screening examination alone

A screening examination only determines whether an emergency medical condition exists. Once one is found, the hospital must provide stabilizing treatment or an appropriate transfer, or be deemed compliant through a documented refusal. Discharge after screening alone meets none of these. Option b is incorrect because this is the first duty the statute names, using the staff and facilities available at the hospital to provide further examination and treatment. Option c is incorrect because the statute lists transfer under the transfer subsection as the alternative to stabilizing treatment, so it is a recognized way to meet the duty. Option d is incorrect because the statute deems the duty met when care is offered, risks and benefits are explained, and the individual refuses, with written informed refusal sought.

Correct Answer: Incorrect; transfer includes discharge of the individual

The statute defines transfer as movement of an individual outside a hospital's facilities, including the discharge. A discharge home is therefore a transfer, and the policy's statement that it is not conflicts with the definition. Option a is incorrect because the definition reaches movement directed by anyone employed by, or affiliated or associated with, the hospital, so affiliated persons are covered, not excluded. Option b is incorrect because the definition contains no stability condition for discharge; its only exclusions are an individual declared dead or one who leaves without permission. Option d is incorrect because the statute defines transfer as movement outside a hospital's facilities and expressly includes discharge, so the definition is not limited to another hospital.

Correct Answer: Directed plan of correction

Under the intermediate sanctions provision, the Secretary may impose directed plans of correction, civil money penalties, or payment for the costs of onsite monitoring, alone or combined, in lieu of suspension, revocation, or limitation. Option a is incorrect because inspection is a routine compliance check for laboratories not accredited, not a sanction imposed after a finding of noncompliance. Option c is incorrect because a certificate of waiver is granted to laboratories performing only simple described procedures; it is a type of certificate, not a penalty. Option d is incorrect because revocation is a separate action under the suspension, revocation, and limitation provision, which intermediate sanctions are imposed in lieu of.

Correct Answer: It continues in effect for 45 days after notice

When an accreditation body withdraws or revokes a laboratory's accreditation, the certificate continues in effect for 45 days after notice, or until the effective date of any Secretary action under the suspension, revocation and limitation provision. Option a is incorrect because that period applies when the Secretary withdraws approval of the accreditation body itself, not when the body withdraws a laboratory's accreditation. Option b is incorrect because a certificate of waiver is issued only to laboratories performing the simple examinations described in the statute, and withdrawal of accreditation triggers no conversion. Option d is incorrect because the statute provides a continuation period after notice of withdrawal or revocation, so the certificate does not lapse immediately.

Correct Answer: Work Practice Controls

Work Practice Controls reduce the likelihood of exposure by altering the manner in which a task is performed. Prohibiting two-handed recapping of needles is the standard's own example of such a control. Option a is incorrect because it is an approach to infection control in which all human blood and certain body fluids are treated as if known to be infectious. Option c is incorrect because it is the written plan an employer establishes to eliminate or minimize exposure, and it schedules the methods of compliance rather than being one of those controls. Option d is incorrect because these are devices with a built-in safety feature that reduces exposure risk, so they work through equipment rather than a change in how a task is done.

Correct Answer: The one giving affected employees the greatest protection

The statute directs that when national consensus standards or established Federal standards conflict, the Secretary promulgates the standard that assures the greatest protection of the safety or health of the affected employees. Option a is incorrect because the statute sets no recency test for resolving a conflict; it directs the Secretary to look at the level of protection the competing standards give employees. Option b is incorrect because the statute gives employer and employee representatives a role in accompanying inspections, but it does not let either one choose among conflicting standards. Option c is incorrect because employer burden is not the tiebreaker in the standards provision; the Secretary is told to weigh safety and health protection for affected employees instead.

Correct Answer: Restriction of privileges for 14 days or less during an investigation

The statute does not require the procedures where a suspension or restriction of clinical privileges lasts no longer than 14 days while an investigation determines whether a professional review action is needed. Option a is incorrect because the exemption has a time limit, covering a suspension or restriction only for a period of not longer than 14 days. Option b is incorrect because the statute allows an immediate suspension for imminent danger but makes it subject to subsequent notice and hearing or other adequate procedures. Option d is incorrect because that belief is a separate standard in the statute's list, and the statute does not treat it as removing the notice and hearing requirement.

Correct Answer: Not reportable, because no individual practitioner is identified

A payment resulting from a suit or claim solely against an entity, such as a group practice, that does not identify an individual practitioner should not be reported to the NPDB. Reporting concerns payments made for a practitioner's benefit. Option a is incorrect because installments affect timing, since the first of multiple payments triggers a report, but they do not make an entity-only claim reportable. Option b is incorrect because self-insured entities report only payments made for the benefit of a practitioner; a claim solely against an entity does not identify one, so the payment is not reported. Option c is incorrect because a written claim is necessary for reporting but not enough alone; the payment must also be made for an identified individual practitioner.