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CBCS exam

CBCS rules and regulations

What does the OIG release annually and identifies areas they will focus on for review and investigations they believe are the most vulnerable programs for possible fraud/abuse? Work Plan
The stark law states that physicians can't refer patients to practitioners with whom they have a financial relationship. This law is considered the "self referral" law, also prohibits the referred practitioner form presenting claims to Medicare
What are Mutually Exclusive Edits? Two procedure codes which cannot reasonably be performed together based on code definitions or anatomical sites
Which law prohibits individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program? Anti-kickback law
Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury. These guidelines describes what will or will not be covered. National and Local Coverage Determinations
These services are performed by a non-physician practitioner, can be billed to Medicare under the physicians NPI number. The supervising physician must be present in the office and supervise the non-physician practitioner. Incident-to services
These type of tests are categorized as "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result." These are tests that most offices are able to perform without sending to an outside laboratory. CLIA note:Offices must apply for this license and keep current accurate logs of tests performed.
What is the name of a proactive program that ensures fulfilment with all applicable policies, procedures, laws and regulations. Compliance Plan note: It is designed to detect and correct violations, provide employee training, routine physician auditing of documentation and establish standards and procedures that are reasonably capable of reducing the prospect of criminal conduct
What is HIPAA? a. Standardization of electronic health transactions b. Privacy protection of individual health information c. Security of health information for patient d. All of the above d. all of the above
What are Fiscal Intermediaries? Private insurance companies that serve as the federal government's agents in the administration of the Medicare program
Created by: drea08