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Which of the following actions is considered under the False Claim Act? Upcoding or unbundling services A health plan sends a request for medical records in order to adjudicate a claim. Does the office have to notify the patient or have them sign a release to send the information? No, since the information is used for payment activities it is not necessary to notify or obtain authorization from the patient The Federal False Claim Act allows for claims to be reviewed for a standard of how many ...

Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd. C. Mary, because her birth year is before Joe's birth year. D. Joe, because his birth month and day are before Mar...

The combining form meaning "joint" is: a. aden/o b.-itis c.-algia d. arthr/o d. arthr/o A suffix meaning "inflammation" is a. -itis b. -osis c. -ac d.-al a. -itis Tumor of a gland a. arthrosis b. arthroscope c. adenoma d. sarcoma c. adenoma Ren/o and nephr/o both mean a. heart b. liver c. gland d. kidney d kidney Which term relates to the brain a. anemia b. cerebral c. rhinitis d. thrombosis b. cerebral A doctor who perform autopsies and examines biopsy samples is a a. oncologis...

When coding in operative report what action would NOT be recommended? Coding from the header with out reading the body of the report If an NCD doesn't exist for a particular service/procedure performed on a Medicare patient who determines coverage? Medicare administrative contractor (MAC) MAC stands for what!? Medicare administrative contractor What is the definition of coding? Translating documentation into numerical/alphabetical codes used to obtain reimbursement. How many components sh...

C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny.) What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services within the coming year?: A) OIG Compliance Plan Guidance B) OIG Security Summary C) OIG Work Plan D) OIG Investigation Plan D (...

What type of provider goes through approximately 26 1/2 months of education and is licensed to practice medicine with the oversight of a physician? Physician Assistant (PA) The ____ describes whether specific medical items, services, treatment procedures, or technologies are considered medically necessary under Medicare National Coverage Determinations LCD's only have jurisdiction in their ____ area. Regional ABN stands for Advance Beneficiary Notice HIPPA was made into law in what year? ...

"hold harmless clause" * found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays. A compliance plan may offer several benefits, including: * more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status A healthcare clearing house is a entity that processes nonstandard health information they receive from anothe...

What document assists provider offices with the development of Compliance Manuals? OIG Compliance Program Guidance What document is referenced to when looking for potential problem areas identified by the government indicating scrutiny of the services? OIG Work Plan Why do you give ABN form To warn Medicare may not cover Why was hitech enacted. To promote use of health info tech What is mips Merit based Incentive Payment System ties physicians Medicare payments to their individual group subm...

Local Coverage Determinations are administered by whom? a. State Law b. NCDs c. Each regional MAC d. LMRPs c. Each regional MAC ABN stands for _____. a. Advanced Benefits Notification b. Advisory Beneficial Notice c. Admitting Beneficiary Notice d. Advance Beneficiary Notice d. Advance Beneficiary Notice What type of health insurance provides coverage for low-income families? a. Commercial HMO b. Medicaid c. Medicare d. Commercial PPO b. Medicaid Which type of information is NOT maintained...

What anatomical or compartment contains all the thoracic viscera except the lungs? Mediastinum Who is responsible for enforcing the HIPAA security rule Office of Civil Rights (OCR) ABN Advance Beneficiary Notice According to the OIG, internal monitoring and auditing should be performed by what means? Periodic audits What does the abbreviation MAC stand for? Medicare Administrative Contractor How many lobes make up the RIGHT lung? the right has 3 lobes the left has 2 lobes Condition in whic...