AAPC CPB Exam Questions with correct Answers

HRA - Answer- Health Reimbursement Account What part of Medicare pays for prescriptions - Answer- Part D What type of plan allows an insurer to administer straight indemnity insurance, an HMO, or a PPO insurance plans to its members? - Answer- Triple Option Plan HIPAA - Answer- Health Insurance Portability and Accountability Act of 1996 Fraud (CMS defines) - Answer- Making false stmts or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program. Ie. misusing codes on claims, billing for services not medically necessary, higher fees charged, etc Penalties for fraud - Answer- Monetary penalties, exclusion from Federal healthcare program, imprisonments Fraud Claimsexample Acct - Answer- Billing a code that is not performed is a violation HMO plans require - Answer- A referral from PCP to see a specialist CMS Abuse - Answer- Charge unnecessary cost to federal healthcare program What is the standard time frame established for record retention? - Answer- There is no standardretention requirement, it varies by state and federal regulations. CMS 5 year time line for providers to submit cost reports. 7 years is the length of time that false claims can be investigated. Privacy Rule Purpose - Answer- Is to protect individual privacy, while promoting high quality healthcare and public health and well being What entities are exempt from HIPAA Andy are not considered to be covered entities - Answer- HIPAA allows exemption for entities providing only worker's compensation plans, employers with less than 50 employees as well as government funded programs such as food stamps and community health centers Federal Fraud and abuse laws are enforced by - Answer- Dept of Justice (DOJ), Dept oh Health & Human Srvc Officer of Inspector's General (OIG), and the Centers for Medicare and Medicaid Truth in Lending Act requires full disclosure of... - Answer- Cash price, annual percentage rate, down payment, resulting unpaid balan