AAPC CPB Chapter 1 Review QUESTIONS WITH COMPLETE SOLUTIONS
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AAPC CPB
AAPC CPB Chapter 1 Review QUESTIONS WITH COMPLETE SOLUTIONS
FCA Correct Answer: False Claims Act (FCA): {"knowing" and "knowingly"}-Federal statue setting civil and criminal penalties to protect the government from being overcharged or sold substandard goods or services:
-falsely billing the g...
aapc cpb chapter 1 review questions with complete solutions
what does the acronym phi stand for
a new radiology company opens in town the manager calls your practice and offers to pay 20 f
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AAPC CPB Chapter 1 Review QUESTIONS
WITH COMPLETE SOLUTIONS
FCA Correct Answer: False Claims Act (FCA): {"knowing" and "knowingly"}-
Federal statue setting civil and criminal penalties to protect the government from
being overcharged or sold substandard goods or services:
-falsely billing the government
-over-representing the amount of a delivered product
....or....
-under-stating an obligation to the government
Minimum Necessary Standard. What should be sent if records are being
requested?? Correct Answer: The ? requires covered entities to take reasonable
steps to limit the disclosure of PHI. Only the dates of service requested should be
sent. The PHI would not need to be redacted.
What does PHI stand for?? What does it include?? Correct Answer: Protected
Health Information-"individually identifiable health information" that includes
many common identifiers, such as demographic data, name, address, birth date,
and social security number.
If a provider is excluded from federal health plans, what does that mean?? Correct
Answer: One of the most severe penalties associated with the Social Security Act
is the ability of the Office of Inspector General (OIG) to exclude an entity or an
individual from participation in any and all federal healthcare programs. This
includes Medicare, Medicaid, VA programs, and TRICARE. An excluded
individual cannot bill for services, provide referrals, prescribe medications or order
services for any beneficiary of a federally administered health plan.
HMO plans require the enrollee to?? Correct Answer: To have referrals to see a
specialist that is generated by patient's PCP.
HMO plans are managed and overseen by?? Correct Answer: The patient's PCP.
The PCP is responsible to manage the referrals for panel of patients assigned to
them.
The Federal False Claim Act allows for claims to be reviewed for a standard of
how many years after an incident?? Correct Answer: The federal False Claims Act
(31 USC § 3729) allows for claims to be brought up to seven years after the
, incident, but has been extended to 10 years in some cases, but this is not the
standard.
What entities are exempt from HIPAA and not considered to be covered entities??
(3) Correct Answer: HIPAA allows exemption for entities providing only worker's
compensation plans, employers with less than 50 employees as well as government
funded programs such as food stamps and community health centers.
What is the purpose of the Privacy Rule? Correct Answer: The purpose of the
Privacy Rule is to protect individual privacy, while promoting high quality
healthcare and public health and well-being.
______, _____, and _____ of Justice are the government agencies enforcing
________?? Correct Answer: The Department of Justice (DOJ), the Department of
Health & Human Services Office of Inspector General (OIG), and the Centers for
Medicare and Medicaid (CMS) are the government agencies that enforce the
Federal fraud and abuse laws.
A new radiology company opens in town. The manager calls your practice and
offers to pay $20 for every Medicare patient you send to them for radiology
services. What does this offer violate?? Correct Answer: The Anti-Kickback law-a
federal law that makes it a criminal offense to knowingly or willingly offer, pay,
solicit, or receive any remuneration to induce or reward referrals of items or
services reimbursable by a federal healthcare program.
What are conditions of participation (CoP)??
What types of entities do CoP's apply to for health plans?? Correct Answer: CMS
and other health plans have conditions that healthcare organizations must meet to
participate with the plan or program. CoPs are designed to protect patient health
and safety, and to ensure quality of care. These apply to entities such as:
ambulatory surgical centers, hospitals, hospices, clinics, psychiatric hospitals, long
term care facilities, and transplant centers.
Patient questions and concerns regarding the Privacy Practices in the clinic should
be addressed by what party?? Correct Answer: HIPAA rules indicate that all
entities should designate a Privacy Official that will develop and implement
privacy policies and procedures and be a contact person for individuals with
questions.
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