CPB Chapter 1 review

A hospital records transporter is moving medical records from the hospital to an off-site building. During the transport, a chart falls from the box on to the street. It is discovered when the transporter arrives at the off-site building and the number of charts is not correct. What type of violation is this? a. A breach b. A minimum necessary violation c. A disclosure violation d. Fraud

a. A breach

A biller at a medical practice notices that all claims contain CPT code 81002. She questions the nurse who tells her that because they are an OB/Gyn office, they bill every patient for a urinalysis. What does this violate? a. False Claim Act b. Anti-kickback c. Stark Law d. Qui Tam action

a. False Claim Act

OIG, CMS, and Department of Justice are the government agencies enforcing ________. a. Federal fraud and abuse laws b. HIPAA violations c. Medical malpractice d. Qui Tam violations

a. Federal fraud and abuse laws

CMS defines ___________ as billing for a lower level of care than is supported in documentation, making false statements to obtain undeserved benefits or payment from a federal healthcare program, or billing for services that were not performed. a. Fraud b. Abuse c. a Stark violation d. an Anti-kickback

a. Fraud

HIPAA is abbreviation for a. Health Insurance Portability and Accountability Act b. Health Insurance Plans and Accountability Act c. Health Initiative Plans and Accessibility Act d. Health Insurance Portability and Accountability Action

a. Health Insurance Portability and Accountability Act

A practice agrees to pay $250,000 to settle a lawsuit alleging that the practice used X-rays of one patient to justify services on multiple other patients' claims. The manager of the office brought the civil suit. What type of case is this? a. Qui Tam b. Stark case c. Anti-Kickback d. HIPAA

a. Qui Tam

A private practice hires a consultant to come in and audit some medical records. Under the Privacy Rule, what is this consultant considered? a. An employee b. A business associate c. A covered entity d. A clearinghouse

b. A business associate

Which of the following is not a covered entity in the Privacy Rule? a. Commercial insurance company b. A healthcare consulting firm c. A Pediatric practice d. A billing service

b. A healthcare consulting firm

When a practice sends an electronic claim to a commercial health plan for payment, what is this considered? a. A code set b. A transaction c. A data set d. Minimum necessary

b. A transaction

Which of the following statements is TRUE? a. Healthcare regulations are federally established and take precedence over any local regulations. b. Healthcare regulations may vary by state and by payer. c. All payers follow the same regulations and guidelines. d. Healthcare regulations do not apply to all place of service.

b. Healthcare regulations may vary by state and by payer.

Medical records are requested for a patient for a specific date of service. When records are copied, multiple dates of service are copied and sent in reply to the request. What standard does this violate? a. Covered entity b. Minimum necessary c. Conditions of Participation d. Truth in Lending

b. Minimum necessary

Patient questions and concerns regarding the Privacy Practices in the clinic should be addressed by what party? a. The billing staff b. Privacy official c. The physician d. Any employee

b. Privacy official

Which of the following situations allow the release of PHI without authorization from the patient? a. Request for life insurance b. Workers' compensation c. Physician's office to release to a family member d. Request from family member

b. Workers' compensation

Medicare overpayments should be returned within ___ days after the overpayment has been identified? a. 30 days b. 120 days c. 60 days d. 1 year

c. 60 days

In which of the following circumstances may PHI not be disclosed without the patient's authorization or permission? a. An office receives a court order. b. An office receives requests for medical records for a Medicare audit. c. An office receives a call from a patient's husband asking for information about his wife's recent office visit. d. An office releases patient information to the Coroner's office upon the death of a patient.

c. An office receives a call from a patient's husband asking for information about his wife's recent office visit.

If a provider is excluded from federal health plans, what does that mean? a. II, IV b. I, III c. II, III d. I, III, IV

c. II, III

Individuals have the right to review and obtain copies of their PHI. What is excluded from the right of access? c. Psychotherapy notes Answers:a. Diagnosis b. All lab results c. Psychotherapy notes d. Results of diagnostic tests

c. Psychotherapy notes

A physician office (covered entity) discovers that the billing company (Business Associate) is in breach of their contract. What is the first steps to be taken? a. Contact HHS and report the billing company b. Terminate the contract c. Take steps to correct the problem and end the violation d. Contact your attorney

c. Take steps to correct the problem and end the violation

HMO plans require the enrollee to a. Live in a specific geographic area b. See their provider quarterly c. To have referrals to see a specialist that is generated by patient's PCP d. Go to the ER when unable to make appointment with regular docto

c. To have referrals to see a specialist that is generated by patient's PCP

A records request is received from a health plan for three dates of service in a chart months apart. What should the biller do? a. Copy the entire chart and send it to make sure that the health plan has everything they need and will not request more records. b. Copy everything from the first date through the third date, even if it is not included to cover the timeframe the health plan is looking at for the request. c. Copy each date of service and black out all identifying information in the copies before sending to the health plan. d. Copy each date of service individually and send to the health plan.

d. Copy each date of service individually and send to the health plan.

According to the Privacy Rule, what must a Business Associate and covered entity have in order to do business? a. A mutually exclusive agreement describing the services that will be rendered by the business associate b. A notice of privacy c. A background check of both parties to ensure full disclosure d. A contract with specific safeguards on the individually identifiable health information used or disclosed by the business associate

d. A contract with specific safeguards on the individually identifiable health information used or disclosed by the business associate

Fraud and abuse penalties do NOT include: a. Monetary penalties b. Exclusion from Federal healthcare programs c. Imprisonment d. Ability to refile claims in question

d. Ability to refile claims in question

Medicare was passed into law under the title XVIII of what Act? a. HMO b. Stabilization Act c. HIPAA d. Social Security Act

d. Social Security Act

Which of the following actions is considered under the False Claim Act? a. Submitting claims for drugs b. Filing Incident-to claims c. Releasing records without authorization d. Upcoding or unbundling services

d. Upcoding or unbundling services

What standard transactions is NOT included in EDI and adopted under HIPAA? a. Referrals and Authorizations b. Eligibility in the health plan c. Healthcare claim status d. Waiver of liability

d. Waiver of liability