CPB Final Exam

CPB Final Exam Complete Solution 2023 A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? Ans- Qui Tam In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission? Ans- An office receives a call from the patient's husband asking for information about his wife's recent office visit. According to the Privacy Rule, what must a Business Associate and a Covered Entity have in order to do business? Ans- A contract HMO plans require the enrollee to: Ans- To have referrals to see a specialist that is generated by the patient's primary care provider. Which of the following is NOT a component of the PPO payer model? Ans- Require the enrollee to maintain a Primary Care Provider. Under the Privacy Rule a health plan, clearinghouses, and any entity transmitting health information is considered? Ans- Covered entity A request for medical records is received for a specific date of service from a patient's insurance company with regards to a submitted claim. No authorization for release of information is provided. What action should be taken? Ans- Release the requested records to the insurance company. Which of the following situations allows the release of PHI without authorization from the patient? AnsWorkers' Compensation HIPAA mandated what entity to adopt national standards for electronic transactions and code sets? AnsHHS What is the standard time frame established for record retention? Ans- There is no single standard for record retention; it varies by state and federal regulations. CMS defines _______ as billing for a lower level of care than is supported in documentation, making false statements to obtain undeserved benefits or payment from a federal healthcare program, or billing for a service that was not performed. Ans- Fraud A claim is submitted for a patient on Medicare with a higher fee than a patient on Insurance ABC. What is this considered by CMS? Ans- Abuse A person that files a claim for a Medicare Beneficiary knowing that the service is not correctly reported is in violation of what statute? Ans- False Claims Act Which of the following actions is considered under the False Claims Act? Ans- Up-coding or unbundling services A practice sets up a payment plan with a patient. If more than four installments are extended to the patient, what regulation is the practice subject to that makes the practice a creditor? Ans- Truth in Lending Act Medicare was passed into law under the title XVIII of what Act? Ans- Social Security Act Which of the following statements are true regarding healthcare regulations? Ans- Healthcare regulations may vary by state and by payer A physician office (covered entity) discovers that the billing company (business associate) is in breach of their contract. What is the first step to be taken? Ans- Take steps to correct the problem and end the violation OIG, CMS, and the Department of Justice are the government agencies enforcing ______? Ans- Federal fraud and abuse laws Fraud and Abuse penalties do NOT include: Ans- Ability to re-file claims in question A biller at a medical practice notices that all claims contain CPT code 81002. She questions the nurse who tells her that because they are an OB/GYN office they bill every patient for a urinalysis. What does this violate? Ans- False Claims Act Individuals have the right to review and obtain copies of the PHI. What is excluded from the right of access? Ans- Psychotherapy notes Medical Records are requested for a patient for a specific date of service. When records are copied, multiple dates of service are copied and sent in reply to the request. What standard does this violate? Ans- Minimum Necessary Patient has questions and concerns regarding the Privacy Practices in the clinic should be addressed by what party? Ans- Privacy Official What standard transactions are NOT included in EDI and adopted under HIPAA? Ans- Waiver of liability The Federal False Claim Act allows for claims to be reviewed for how many years after an incident? AnsSeven years While working in a large practice, Medicare overpayments are found in several patient accounts. The manager states that the practice will keep the money until Medicare asks for it back. What is that action considered? Ans- Fraud What penalties can be imposed for Fraud and/or Abuse related to the United States Code? Ans- a. Monetary penalties ranging from $10,000 to $50,000 for each item or service b. Imprisonment c. Exclusion from Federal Healthcare Programs (d.) All of the above Medicare overpayments should be returned within ____ days after the overpayment has been identified? Ans- 60 days What entities are exempt from HIPAA and not considered to be covered entities? Ans- Workers Compensation A private practice hires a consultant to come in and audit some medical records. Under the Privacy Rule, what is this consultant considered? Ans- A business associate A hospital records transported is moving medical records from the hospital to an off-site building. During the transport, a chart falls from the box onto the street. It is discovered when the transporter arrives at the off-site building and the number of charts is not correct. What type of violation is this? Ans- A breach When a practice sends an electronic claim to a commercial health plan for payment, what is this considered? Ans- A transaction Which statement is true regarding the Prompt Pay Act? A