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CLA Study Group 1
Chapter 1 pre test
|The biller at a practice has id $575 in MCR overpayments. The medical practice is going to put the money in their general account after verification instead. What act does this action violate?
|False Claims Act
|In reviewing practice records, it is found that an office is billing Medicare for drugs that it was obtaining at no charge from drug companies. This would constitute __________.
|According to the HIPPA law, a medical practice engaged in the submission of electronic claims to a health plan is considered a:
|A biller for a healthcare organization brings a case against the company after her complaints made internally about kickbacks to doctors were ignored. The case is successful, and she receives a 21 percent reward . What type of action does this represent?
|Qui Tam Action
|A request for records is received at practice from a health plan for three dates of service for a patient. Instead of copying all the visits between each dos requested, only the specific dates requested are copied and sent. This follows what standard?
|The Minimum Necessary Standard
|The physicians in the practice are concerned about the large patient balances. They want to assess a finance charge on all balances over $300 on a mo basis of 4% until paid in full. What law will need to be reviewed in order to pursue this?
|Truth In Lending
|The following are among the adopted standardized code sets under HIPPA: NDC, CDT, _________.
|ICD-10-CM, ICD-10-PCS, HCPCS, and CPT
|According to HIPAA, a _______ is a person that conducts business with a covered entity that involves the use or disclosure of individually identifiable health information.
|A business associate
|A medical practice has been found to be routinely submitting bills to Medicare as the primary payer when Medicare is the secondary payer. This would constitute ______.
|What are the adopted standards for electronic transactions under HIPAA?
|ASC x12 Version 5010 and NCPDP