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Certified Professional Biller (CPB) Exam
| 1000 Questions and Answers |
Complete Study Guide & Exam
Preparation
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fraud in medical billing. Intentional deception for unauthorized payment
abuse in billing. Improper billing practices causing unnecessary cost without intent
Which is worse: fraud or abuse? Fraud due to intent
HIPAA stands for? Health Insurance Portability and Accountability Act
HIPAA protects _____ health information. protected
PHI means? Protected Health Information
ePHI refers to? Electronic Protected Health Information
CMS stands for? Centers for Medicare & Medicaid Services
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CMS regulates _____ and Medicaid billing rules. Medicare
Upcoding is billing a _____ level service than higher
performed.
Downcoding means? Billing lower level than documentation supports
Unbundling refers to? Separating services normally billed together
Which law prohibits self-referrals? Stark Law
Anti-Kickback Statute prohibits? Payment for referrals
Compliance program purpose? Prevent, detect, correct violations
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OIG recommends how many core compliance 7
elements?
First compliance element? Written policies and procedures
Second compliance element? Compliance officer and committee
Third compliance element? Effective training and education
Fourth element? Effective communication lines
Fifth element? Internal monitoring and auditing
Sixth element? Enforcement through disciplinary guidelines
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