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CLA Study Group 1
Chapter 1 pre test
| Question | Answer |
|---|---|
| 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 __________. | Fraud |
| According to the HIPPA law, a medical practice engaged in the submission of electronic claims to a health plan is considered a: | Covered Entity |
| 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 ______. | Abuse |
| What are the adopted standards for electronic transactions under HIPAA? | ASC x12 Version 5010 and NCPDP |
Created by:
mseverino
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