AAPC CPB Chapter 1 Review Test Guide 2024.

AAPC CPB Chapter 1 Review Test Guide 2024. FCA - ANSWER False Claims Act (FCA): {"knowing" and "knowingly"}-Federal statue setting civil and criminal penalties to protect the government from being overcharged or sold substandard goods or services: -falsely billing the government -over-representing the amount of a delivered product ....or.... -under-stating an obligation to the government Minimum Necessary Standard. What should be sent if records are being requested?? - ANSWER The ? requires covered entities to take reasonable steps to limit the disclosure of PHI. Only the dates of service requested should be sent. The PHI would not need to be redacted. What does PHI stand for?? What does it include?? - ANSWER Protected Health Information-"individually identifiable health information" that includes many common identifiers, such as demographic data, name, address, birth date, and social security number. If a provider is excluded from federal health plans, what does that mean?? - ANSWER One of the most severe penalties associated with the Social Security Act is the ability of the Office of Inspector General (OIG) to exclude an entity or an individual from participation in any and all federal healthcare programs. This includes Medicare, Medicaid, VA programs, and TRICARE. An excluded individual cannot bill for services, provide referrals, prescribe medications or order services for any beneficiary of a federally administered health plan. HMO plans require the enrollee to?? - ANSWER To have referrals to see a specialist that is generated by patient's PCP. HMO plans are managed and overseen by?? - ANSWER The patient's PCP. The PCP is responsible to manage the referrals for panel of patients assigned to them. The Federal False Claim Act allows for claims to be reviewed for a standard of how many years after an incident?? - ANSWER The federal False Claims Act (31 USC § 3729) allows for claims to be brought up to seven years after the incident, but has been extended to 10 years in some cases, but this is not the standard. What entities are exempt from HIPAA and not considered to be covered entities?? (3) -