CPB Final Exam with complete solutions

TPO - Answer- Treatment, Payment & Operations CMPs - Answer- Civil Monetary Penalties EDI - Answer- Electronic Data Interchange HHS - Answer- Health and Human Services TILA - Answer- Truth in Lending Act ROI - Answer- Release of Information OCR - Answer- Office of Civil Rights CMS - Answer- Centers for Medicare and Medicaid Services PHI - Answer- Protected Health Information DOJ - Answer- Department of Justice FCA - Answer- False Claims Act OIG - Answer- Office of Inspector General HMO - Answer- health maintenance organization SHIP - Answer- State Health Insurance Assistance Program HSA - Answer- Health Savings Account URO - Answer- utilization review organization MCR - Answer- Medicare MCO - Answer- Managed Care Organization PPO - Answer- preferred provider organization HRA - Answer- Health Reimbursement Account FPL - Answer- Federal Poverty Level CDHP - Answer- Consumer Driven Health Plan MPFS/PFS - Answer- Medicare Physician Fee Schedule/Physician Fee Schedule PCM - Answer- primary care manager PCP - Answer- primary care provider RVU - Answer- Relative Value Unit MCD - Answer- Medicaid COB - Answer- coordination of benefits DOB - Answer- date of birth SOF - Answer- signature on file ID - Answer- identification number HIPAA - Answer- Health Insurance Portability and Accountability Act CPB - Answer- Certified Professional Biller COBRA - Answer- Consolidated Omnibus Reconciliation Act MSP - Answer- Medicare Secondary Payer ASC - Answer- Ambulatory Surgical Center CAH - Answer- Critical Access Hospital DME - Answer- durable medical equipment FL - Answer- Form Locator NCCI - Answer- National Correct Coding Initiative NUCC - Answer- National Uniform Claim Committee MAC - Answer- Medicare Administrative Contractor NPI - Answer- National Provider Identifier ASCA - Answer- Administrative Simplification Compliance Act Do PPOs require the enrollee to maintain a PCP? - Answer- No Upcoding or unbundling services would be considered under what act? - Answer- False Claims Act Under the privacy rule what are health plan, clearinghouses, and any entity transmitting health information considered? - Answer- covered entity What action should be taken when a request for medical records is received from a patients insurance company for a specific date of service but w/o an ROI authorization? - Answer- Release the requested records to the insurance company. HIPAA mandated what entity to adopt national standards for electronic transactions and code sets? - Answer- HHS What is the standard time frame established for record retention? - Answer- There is no single standard record retention, it varies by state and federal regulation. What is defined by CMS as billing for a lower level of care than is supported in documentation, making false statements to obtain undeserved benefits or payment from a federal healthcare program, or billing for services that were not performed? - Answer- Fraud What does CMS consider a claim submitted for a patient on Medicare with a higher fee than a patient on Insurance ABC as? - Answer- Abuse Is a waiver of liability included as a standard transaction in EDI and adopted under HIPAA? - Answer- No What statute is violated when a person files a claim for a Medicare beneficiary knowing that the service is not correctly reported? - Answer- False Claims Act A practice sets up a payment plan with a patient. If more than four installments are extended to the patient, wha