According to the oig - Study guides, Class notes & Summaries

CPCO PREP EXAM REVIEW QUESTIONS AND ANSWERS, GRADED A+/ VERIFIED Does Medicare pay for all tests ordered by Providers? - -No, they need to determine if it's covered and medically necessary. For larger physician practices, how often does the OIG suggest reporting compliance activities to the board of directors? - -Regularly According to the OIG, medically unnecessary services can be billed to Medicare for what purpose? - -To receive a denial so a claim can be submitted to a secondary p...

CPC FINAL EXAM PREP • Question 1 10 out of 10 points What form is provided to a patient to indicate a service may not be covered by Medicare and the patient may be responsible for the charges? Selected Answer: Correct Answer: Response Feedback: d. ABN d. ABN Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential ou...

What anatomical or compartment contains all the thoracic viscera except the lungs? - Mediastinum Who is responsible for enforcing the HIPAA security rule - Office of Civil Rights (OCR) ABN - Advance Beneficiary Notice According to the OIG, internal monitoring and auditing should be performed by what means? - Periodic audits What does the abbreviation MAC stand for? - Medicare Administrative Contractor How many lobes make up the RIGHT lung? - the right has 3 lobes the left has 2 lobes Con...

What anatomical or compartment contains all the thoracic viscera except the lungs? CORRECT ANSWER-Mediastinum Who is responsible for enforcing the HIPAA security rule CORRECT ANSWER-Office of Civil Rights (OCR) ABN CORRECT ANSWER-Advance Beneficiary Notice According to the OIG, internal monitoring and auditing should be performed by what means? CORRECT ANSWER-Periodic audits What does the abbreviation MAC stand for? CORRECT ANSWER-Medicare Administrative Contractor How many lobes ...

B. If documentation supports the service, have the staff contact the carrier to reprocess the claims. Code 33010 was valid for the date of service billed. Rationale: The effective dates of codes are date of service driven. New CPT® codes become effective January 1st of every year. When auditing, verify codes based on the codes that were valid during the date of service. - Answer- In February 2020, an auditor is asked to review 10 records for date of service 12/1/2019 to make sure the claims we...

AAPC - Final Exam Questions And Answers All Correct Local Coverage Determinations are administered by whom? a. State Law b. NCDs c. Each regional MAC d. LMRPs - ANS c. Each regional MAC ABN stands for _____. a. Advanced Benefits Notification b. Advisory Beneficial Notice c. Admitting Beneficiary Notice d. Advance Beneficiary Notice - ANS d. Advance Beneficiary Notice What type of health insurance provides coverage for low-income families? a. Commercial HMO b. ...

The Joint Commission (JC) requires the Factors that Affect Learning must be assessed for a hospital or hospital owned physician practice as well as other health care facilities. When assessing this element what does this include? A. The patient's ability to read, method of learning and understanding. B. Any language or physical disabilities. C. Cultural beliefs. D. All the above - ANSWER D. All the above Report copies and printouts, films, scans, and other radio logic service ima...

What anatomical or compartment contains all the thoracic viscera except the lungs? CORRECT ANSWER-Mediastinum Who is responsible for enforcing the HIPAA security rule CORRECT ANSWER-Office of Civil Rights (OCR) ABN CORRECT ANSWER-Advance Beneficiary Notice According to the OIG, internal monitoring and auditing should be performed by what means? CORRECT ANSWER-Periodic audits What does the abbreviation MAC stand for? CORRECT ANSWER-Medicare Administrative Contractor How many lobes ...

CPCS - Certified Provider Credentialing Specialist Questions and Answers 100% Pass Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? Yes According to TJC, who may amend the medical staff bylaws? Governing body/board. Failure to meet the established qualifications and criteria for appointment should be reported to whom? The applicant NCQA requires the MCO to obtain a minimum of how may years of work history? Five years According to the...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) 1.Protect our programs 2.Protect your patients 3.Protect the Provider #:~:text=Proper%20documentation%2C%20both%20in%20patients,to%20protect%20y ou%20the%20provider. At...