CPB final exam study exam part 1 Questions & Answers

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? - ANSWERSFalse Claims Act In addition to the standardization of the codes (ICD-10, CPT, HCPCS, and NDC) what other identifier is used on all claim? a. Unique passcode b. Unique identifier for employers and providers c. Social Security number of the provider d. Social Security number of the office manager - ANSWERSb. Unique identifier for employers and providers When a practice sends an electronic claim to a commercial health plan for payment, what is this considered? a. A code set b. A transaction c. A data set d. Minimum necessary - ANSWERSb. A transaction What is the purpose of the Privacy Rule? - ANSWERSto make sure that individuals' health information is properly protected 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 services that were not performed is defined as what by CMS? a.Fraud b.Abuse c.a Stark violation Anti-kickback - ANSWERSa. Fraud What does the abbreviation HIPAA stand for? - ANSWERSHealth Insurance Portability and Accountability Act Which of the following services is NOT covered under Medicare Part B? A) Outpatient services B) Diagnostic Tests C) Dental exams D) Rehab services - ANSWERSAnswer: C Medicare Part B covers outpatient services, rehab services, medical equipment (but not adaptive equipment), diagnostic tests, and preventative care. Eye, hearing and dental services are not covered by any part of Medicare and require supplemental insurance. A group contracts with a third-party administrator to manage paperwork. This group pays for the operation of the insurance plan and the costs of administration. What type of plan does this represent? - ANSWERSB. Self-funded ERISA What does the acronym CHIP stand for? - ANSWERSChildren's Health Insurance Program A new physician comes into the practice that is just out of medical school. He will need to be able to see patients in the office and at the hospital. What process will he need to undergo in order to be able to participate with Medicare and other health plans? - ANSWERScredentialing What are the 2022 Medicare deductible and co-insurance amounts for outpatient services on Part B? - ANSWERSDeductible= 233$ per year Co insurance= 20% of approved amount Physician-Hospital Organizations (PHO), Management Service Organization (MSO) and Integrated Provider Organization (IPO) are examples of what type of healthcare models? - ANSWERSIntegrated Delivery Systems Which of the following is NOT evaluated in the credentialing process? a. Physician's education b. Physicians residency c. Physician's request for privileges d. Physician's license(s) - ANSWERSc. Physician's request for privileges The type of coverage that a patient has and what services are covered is defined as the patient's insurance - ANSWERSBenefits What authorizes information to be sent to the insurance payer so payment of medical benefits can be processed? a. MSP b. Consent for payment c. Encounter form d. Chargemaster List - ANSWERSb. Consent for payment