CPB Final Questions & Answers

Electronic data interchange - ANSWERSEDI Treatment, payment and operations - ANSWERSTPO Conditions of participation - ANSWERSCOP False claim act - ANSWERSFCA Health information portability and accountability act - ANSWERSHIPAA Preferred provider organization - ANSWERSPPO Truth in lending act - ANSWERSTILA Health maintenance organization - ANSWERSHMO Release of information - ANSWERSROI Office of civil rights - ANSWERSOCR Protected health information - ANSWERSPHI Health and human services - ANSWERSHHS Primary care provider - ANSWERSPCP Department of justice - ANSWERSDOJ Office of inspector general - ANSWERSOIG Centers for medicare and Medicaid service - ANSWERSCMS National correct coding initiative - ANSWERSNCCI National coverage determination - ANSWERSNCD Local coverage determination - ANSWERSLCD Medicare administrative contractor - ANSWERSMAC Medically unlikely edits - ANSWERSMUE Current procedural terminology - ANSWERSCPT Procedure to procedure - ANSWERSP2P Unit of service - ANSWERSUOS Certified professional biller - ANSWERSCPB Certified professional coder - ANSWERSCPC Affordable care act - ANSWERSACA Correct coding modifiers - ANSWERSCCM Ambulatory surgery center - ANSWERSASC Remittance advice - ANSWERSRA Explanation of benefits - ANSWERSEOB Medical severity diagnosis related group - ANSWERSMS-DRG Relative value units - ANSWERSRVU Resource based relative value scale - ANSWERSRBRVS Electronic medical record - ANSWERSEMR Account receivable - ANSWERSA/R Healthcare common procedure coding system - ANSWERSHCPCS International classification of diseases - ANSWERSICD Physician fee schedule - ANSWERSPFS Military treatment facility - ANSWERSMTF Department of defense - ANSWERSDOD Veteran affair - ANSWERSVA Primary care manager - ANSWERSPCM Occupational safety and health administration - ANSWERSOSHA Civilian health and medical program of the department of veteran affairs - ANSWERSCHAMPVA Federal employee compensation act - ANSWERSFECA B. Healthcare consulting firms - ANSWERSWhich of the following is not a covered entity in the privacy rule? A. Commercial insurance companies B. Healthcare consulting firms C. Pediatric practices D. Billing services D. Anti-kickback law - ANSWERSA new laboratory opens in town. The manager is trying to increase their business by calling offices and offering to pay $20.00 for every Medicare patient you send to them for laboratory services. What does this violate? A. Stark Law B. HIPAA C. Qui Tam D. Anti-kickback law D. Copy each date of service individually and send to the health plan - ANSWERSA records request is received from a health plan for three different dates of service in a chart months apart. What should the biller do? A. Copy entire chart and send it to make sure that the health plan has everything they need and will not request more records. B. Copy everything from the first date through the third date, even if it is not included in the request. It would cover the total timeframe the health plan is looking at for the request. C. Copy each date of service and black out all identifying information in the copies before sending to the health plan. D. Copy each date of service individually and send to the health plan A contract with HIPAA - ANSWERSAccording to the privacy rule, what must a Business associate and a covered entity must have in order to do business? A. Failure to maintain adequate medical records - ANSWERSAll of the following are considered fraud except? A. Failure to maintain adequate medical records B. Reporting a diagnosis code that the patient doesn't have but is payable by medicare C. Falsifying documentation to support service that was billed to receive payment. D. Billing every new patient at the highest level E/M visit no matter what Transaction - ANSWERSWhen a practice sends an electronic claim to a commercial health plan for payment, what is this considered?