HEALTH INSURANCE AND BILLING
Chapter 5 Quiz And All Correct Answers
Rated A+.
Which is another name for federal and state laws? - Answer statutes
Fiscal intermediaries were eliminated in 2010 to create a consolidation of Medicare Parts A and
B benefits so that all claims would be processed by one organization known as: - Answer
Medicare administrative contractors
Which is an intentional deception or misrepresentation that is reported knowing that it is not
correct? - Answer Fraud
According to HIPAA, which is an action that is not considered as accepted sound medical
business and results in the stealing of resources from the health care industry? - Answer
Abuse
The assignment of ICD-10-CM diagnosis codes that are not documented in the patient record
for the purpose of increasing reimbursement is known as: - Answer Upcoding
Which is a provision of the Federal False Claims Act that allows a private citizen to file a lawsuit
charging fraud perpetrated by government contractors? - Answer qui tam
Audits implemented by the DHHS to examine the billing practices of physicians at teaching
hospitals are called: - Answer PATH
The ANSI ASC X12N 837 is a - Answer variable-length file format that is used to submit
institutional, professional, dental, and drug claims
The use of black box edits was discontinued in 2000 when CMS did not renew its contract with a
private company that refused to publish NCCI code edits it developed because it considered
them: - Answer proprietary
Which was established by the Payment Error Prevention Program (PEPP) to request and screen
medical records for PEPP surveillance sampling for medical review, DRG validation, and medical
Chapter 5 Quiz And All Correct Answers
Rated A+.
Which is another name for federal and state laws? - Answer statutes
Fiscal intermediaries were eliminated in 2010 to create a consolidation of Medicare Parts A and
B benefits so that all claims would be processed by one organization known as: - Answer
Medicare administrative contractors
Which is an intentional deception or misrepresentation that is reported knowing that it is not
correct? - Answer Fraud
According to HIPAA, which is an action that is not considered as accepted sound medical
business and results in the stealing of resources from the health care industry? - Answer
Abuse
The assignment of ICD-10-CM diagnosis codes that are not documented in the patient record
for the purpose of increasing reimbursement is known as: - Answer Upcoding
Which is a provision of the Federal False Claims Act that allows a private citizen to file a lawsuit
charging fraud perpetrated by government contractors? - Answer qui tam
Audits implemented by the DHHS to examine the billing practices of physicians at teaching
hospitals are called: - Answer PATH
The ANSI ASC X12N 837 is a - Answer variable-length file format that is used to submit
institutional, professional, dental, and drug claims
The use of black box edits was discontinued in 2000 when CMS did not renew its contract with a
private company that refused to publish NCCI code edits it developed because it considered
them: - Answer proprietary
Which was established by the Payment Error Prevention Program (PEPP) to request and screen
medical records for PEPP surveillance sampling for medical review, DRG validation, and medical
