CPB

Medicare will consider Magnetic Resonance Imaging of the Brain medically reasonable and necessary when used to aid in the diagnosis of lesions of the brain and to assist in therapeutic decision making in the following conditions: • For detecting or evaluating extra-axial tumors, A-V malformations, cavernous hemangiomas, small intracranial aneurysms, cranial nerve lesions, demyelination disorders including multiple sclerosis, lesions near dense bone, acoustic neuromas, pituitary lesion...

Abuse An action that results in unnecessary costs to a federal healthcare program, directly or indirectly. Anti-kickback Knowingly and willfully offering or accepting rewards or remuneration for services that are billable to a federal healthcare plan. Benefiiciary An individual that is eligible for Medicare or Medicaid benefits based on the CMS guidelines. Conditions of Participation (CoP) Conditions that healthcare organizations must meet in order to participate with the plan or prog...

hmo health maintence org hipaa health ins portability & accountibility act fraud falsifying documentation abuse over charging for services & supplies false claims act (fca) protects the gov from being overcharged for goods/sevices stark law no physician self-referral

Abuse - Intro to Healthcare An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly. Conditions of Participation (CoP) - Intro to Healthcare Conditions that healthcare organizations must meet in order to participate with the plan or program. Covered Entity - Intro to Healthcare According to HIPPA, defined as health plans, healthcare clearinghouses, and healthcare providers who electronically transmit any health information in connectio...

CPB Practice Exam A Questions And Answers

1. The biller at a medical practice has identified $575 in Medicare overpayments. After verification, they are presented to the office manager, who tells the biller not to write the refund check. The medical practice is going to put the money in their general account instead. What act does this action violate? A.Truth in Lending Act B.Health Insurance Portability and Accountability Act C.Administrative Simplification Rule D.False Claims Act - Answer-1.Answer: D. False Claims Act Ratio...

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