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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 __________. 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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