CPB Final Exam Questions and answers, 100% Accurate, rated A+

CPB Final Exam Questions and answers, 100% Accurate, rated A+ Electronic data interchange - -EDI Treatment, payment and operations - -TPO Conditions of participation - -COP False claim act - -FCA Health information portability and accountability act - -HIPAA Preferred provider organization - -PPO Truth in lending act - -TILA Health maintenance organization - -HMO Release of information - -ROI Office of civil rights - -OCR Protected health information - -PHI Health and human services - -HHS Primary care provider - -PCP Department of justice - -DOJ Office of inspector general - -OIG Centers for medicare and Medicaid service - -CMS National correct coding initiative - -NCCI National coverage determination - -NCD Local coverage determination - -LCD Medicare administrative contractor - -MAC Medically unlikely edits - -MUE Current procedural terminology - -CPT Procedure to procedure - -P2P Unit of service - -UOS Certified professional biller - -CPB Certified professional coder - -CPC Affordable care act - -ACA Correct coding modifiers - -CCM Ambulatory surgery center - -ASC Remittance advice - -RA Explanation of benefits - -EOB Medical severity diagnosis related group - -MS-DRG Relative value units - -RVU Resource based relative value scale - -RBRVS Electronic medical record - -EMR Account receivable - -A/R Healthcare common procedure coding system - -HCPCS International classification of diseases - -ICD Physician fee schedule - -PFS Military treatment facility - -MTF Department of defense - -DOD Veteran affair - -VA Primary care manager - -PCM Occupational safety and health administration - -OSHA Civilian health and medical program of the department of veteran affairs - -CHAMPVA Federal employee compensation act - -FECA B. Healthcare consulting firms - -Which 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 - -A 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 - -A 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 - -According 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 - -All 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 - -When a practice sends an electronic claim to a commercial health plan for payment, what is this considered? C. An office receives a call from a patients spouse asking for information about the patients recent office visit - -In which of the following circumstances may PHI MAY NOT be disclosed without the patients authorization or permission? A. An office receives court order B. An office receives a request for medical records for a medicare audit C. An office receives a call from a patients spouse asking for information about the patients recent office visit D. The office released patient information to the Coroner's office upon the patients death A business associate - -A private practice hires a consultant to come in and audit some medical records. Under the privacy rule, what is this consultant considered? C. 60 - -Medicare overpayments should be returned within ___ days after the overpayment has been identified. A. 30 B. 120 C. 60 D. 365 Min Necessary - -Medical records are requested for a patient for a specific date of service. When records are copied, multiple dates of service are sent in reply to the request. What standard does this violate? C. No single standard - -What is the standard time frame established for records retention? A. 5 years B. 7 years C. No single standard D. Life C. HHS - -HIPAA mandated what entity to adopt national standards for electronic transactions? A. CMS B. Congress C. HHS D. AMA C. To have referrals to see a specialist that is generated by the patients PCP - -HMO plans require the enrollee to: A. Live in a specific geographic area