AAPC CPB Chapter 1 Review Questions and Answers Graded A+
False Claims Act (FCA): {"knowing" and "knowingly"}-Fed-
eral statue setting civil and criminal penalties to protect the
government from being overcharged or sold substandard
goods or services:
FCA
-falsely billing the government
-over-representing the amount of a delivered product
....or....
-under-stating an obligation to the government
The ? requires covered entities to take reasonable steps
Minimum Necessary Standard. What should be sent if to limit the disclosure of PHI. Only the dates of service
records are being requested?? requested should be sent. The PHI would not need to be
redacted.
Protected Health Information-"individually identifiable
health information" that includes many common iden-
What does PHI stand for?? What does it include??
tifiers, such as demographic data, name, address, birth
date, and social security number.
One of the most severe penalties associated with the So-
cial Security Act is the ability of the Oflce of Inspector
General (OIG) to exclude an entity or an individual from
If a provider is excluded from federal health plans, what participation in any and all federal healthcare programs.
does that mean?? This includes Medicare, Medicaid, VA programs, and TRI-
CARE. An excluded individual cannot bill for services, pro-
vide referrals, prescribe medications or order services for
any beneficiary of a federally administered health plan.
To have referrals to see a specialist that is generated by
HMO plans require the enrollee to??
patient's PCP.
The patient's PCP. The PCP is responsible to manage the
HMO plans are managed and overseen by??
referrals for panel of patients assigned to them.
The federal False Claims Act (31 USC § 3729) allows for
claims to be brought up to seven years after the incident,
, AAPC CPB Chapter 1 Review Questions and Answers Graded A+
The Federal False Claim Act allows for claims to be re-
but has been extended to 10 years in some cases, but this
viewed for a standard of how many years after an inci-
is not the standard.
dent??
HIPAA allows exemption for entities providing only work-
What entities are exempt from HIPAA and not considered er's compensation plans, employers with less than 50
to be covered entities?? (3) employees as well as government funded programs such
as food stamps and community health centers.
The purpose of the Privacy Rule is to protect individual pri-
What is the purpose of the Privacy Rule? vacy, while promoting high quality healthcare and public
health and well-being.
The Department of Justice (DOJ), the Department of Health
& Human Services Oflce of Inspector General (OIG), and
, , and of Justice are the government
the Centers for Medicare and Medicaid (CMS) are the
agencies enforcing ??
government agencies that enforce the Federal fraud and
abuse laws.
The Anti-Kickback law-a federal law that makes it a crimi-
A new radiology company opens in town. The manag-
nal ottense to knowingly or willingly otter, pay, solicit, or
er calls your practice and otters to pay $20 for every
receive any remuneration to induce or reward referrals
Medicare patient you send to them for radiology services.
of items or services reimbursable by a federal healthcare
What does this otter violate??
program.
CMS and other health plans have conditions that health-
care organizations must meet to participate with the plan
or program. CoPs are designed to protect patient health
What are conditions of participation (CoP)??
and safety, and to ensure quality of care. These apply to
What types of entities do CoP's apply to for health plans??
entities such as: ambulatory surgical centers, hospitals,
hospices, clinics, psychiatric hospitals, long term care fa-
cilities, and transplant centers.
Patient questions and concerns regarding the Privacy HIPAA rules indicate that all entities should designate a
Practices in the clinic should be addressed by what party?? Privacy Oflcial that will develop and implement privacy
False Claims Act (FCA): {"knowing" and "knowingly"}-Fed-
eral statue setting civil and criminal penalties to protect the
government from being overcharged or sold substandard
goods or services:
FCA
-falsely billing the government
-over-representing the amount of a delivered product
....or....
-under-stating an obligation to the government
The ? requires covered entities to take reasonable steps
Minimum Necessary Standard. What should be sent if to limit the disclosure of PHI. Only the dates of service
records are being requested?? requested should be sent. The PHI would not need to be
redacted.
Protected Health Information-"individually identifiable
health information" that includes many common iden-
What does PHI stand for?? What does it include??
tifiers, such as demographic data, name, address, birth
date, and social security number.
One of the most severe penalties associated with the So-
cial Security Act is the ability of the Oflce of Inspector
General (OIG) to exclude an entity or an individual from
If a provider is excluded from federal health plans, what participation in any and all federal healthcare programs.
does that mean?? This includes Medicare, Medicaid, VA programs, and TRI-
CARE. An excluded individual cannot bill for services, pro-
vide referrals, prescribe medications or order services for
any beneficiary of a federally administered health plan.
To have referrals to see a specialist that is generated by
HMO plans require the enrollee to??
patient's PCP.
The patient's PCP. The PCP is responsible to manage the
HMO plans are managed and overseen by??
referrals for panel of patients assigned to them.
The federal False Claims Act (31 USC § 3729) allows for
claims to be brought up to seven years after the incident,
, AAPC CPB Chapter 1 Review Questions and Answers Graded A+
The Federal False Claim Act allows for claims to be re-
but has been extended to 10 years in some cases, but this
viewed for a standard of how many years after an inci-
is not the standard.
dent??
HIPAA allows exemption for entities providing only work-
What entities are exempt from HIPAA and not considered er's compensation plans, employers with less than 50
to be covered entities?? (3) employees as well as government funded programs such
as food stamps and community health centers.
The purpose of the Privacy Rule is to protect individual pri-
What is the purpose of the Privacy Rule? vacy, while promoting high quality healthcare and public
health and well-being.
The Department of Justice (DOJ), the Department of Health
& Human Services Oflce of Inspector General (OIG), and
, , and of Justice are the government
the Centers for Medicare and Medicaid (CMS) are the
agencies enforcing ??
government agencies that enforce the Federal fraud and
abuse laws.
The Anti-Kickback law-a federal law that makes it a crimi-
A new radiology company opens in town. The manag-
nal ottense to knowingly or willingly otter, pay, solicit, or
er calls your practice and otters to pay $20 for every
receive any remuneration to induce or reward referrals
Medicare patient you send to them for radiology services.
of items or services reimbursable by a federal healthcare
What does this otter violate??
program.
CMS and other health plans have conditions that health-
care organizations must meet to participate with the plan
or program. CoPs are designed to protect patient health
What are conditions of participation (CoP)??
and safety, and to ensure quality of care. These apply to
What types of entities do CoP's apply to for health plans??
entities such as: ambulatory surgical centers, hospitals,
hospices, clinics, psychiatric hospitals, long term care fa-
cilities, and transplant centers.
Patient questions and concerns regarding the Privacy HIPAA rules indicate that all entities should designate a
Practices in the clinic should be addressed by what party?? Privacy Oflcial that will develop and implement privacy
