WorksheetsCBCS Unit One and Two Review
Total questions: 28
Worksheet time: 14mins
A physician’s office develops a user-friendly process for staff members to report suspected billing fraud and abuse. Which recommended component of a compliance program does this example demonstrate?
Internal monitoring and auditing
corrective action
Open lines of Communication
Rick Assessment
_____ is required when there is a risk of harm that may or may not be obvious.
Informed Consent
Implied Consent
Written Consent
Verbal Consent
.
According to the HIPAA Privacy Rule, what principle requires a provider to make reasonable efforts to limit information only to the intended purpose?
Release of Information
Implied Consent
Implied Release
Minimum Necessity
Which scenario is an example of a beneficiary inducement?
A pharmaceutical company offers a psychiatrist remuneration to prescribe certain medications to Medicare patients.
A physician refers Medicaid patients to an occupational therapy practice owned by a sibling.
A durable medical equipment supplier offers gift cards to physicians who order their wheelchairs for Medicare patients.
A physician waives copays to entice new Medicare patients to come to the practice.
A healthcare provider identifies several overpayments during the self-disclosure process outlined in the OIG provider self-disclosure protocol. What must the provider do? Select all that apply:
Review a random sample of 100 claims to estimate damages
Report the findings to the OIG Fraud Hotline
Review at least 10 claims per service to assess for other improper payments
Return all overpayments to the government
Audit at least five claim for each federal healthcare program
A physician’s office develops a user-friendly process for staff members to report suspected billing fraud and abuse. Which recommended component of a compliance program does this example demonstrate?
internal monitoring and auditing
corrective action
open lines of communication
risk assessment
Which statement best describes coverage if a dependent has insurance through their employer and their parents?
The birthday rule determines primary coverage.
The employee insurance is secondary.
The employer determines which insurance is primary.
Their employee insurance is primary.
To be eligible for TRICARE, an individual (and their dependents) must be registered in _____
DEERS
ACA
CHAMPVA
Medicare (Part A and B)
The _____ rule is used to determine which insurance plan is primary when a dependent has two healthcare plans.
Coordination of Benefits
Medicaid Eligibility
Third-Party Liability
Birthday
Which of the following statements regarding an ABN is false?
The ABN must be completed, delivered in advance, and reviewed with the Medicare beneficiary (patient).
Any questions from the patient or patient’s representative can be answered after the ABN is signed by the patient or their proxy.
Medicare requires providers to issue an ABN of noncoverage when a service or procedure most likely will not be covered by insurance.
If the patient is unable to make medical decisions on their own behalf, the form must be reviewed with the patient’s representative who has authority as the healthcare proxy (often a family member).
Third-party liability (TPL) is a federal regulation that requires states to take measures to _____
increase claim payments by the payer of last resort
identify other third-party liability before claims are paid
ensure HIPAA compliance in claims submission
increase clean claims submitted to third-party payers
Which of the following is NOT a Medicare Part B ABN notifier?
Suppliers of Medical Products
Hospice
Independent Laboratories
Outpatient Facilities
Medicare Part ___, also known as Medicare Advantage, is offered by private companies as an alternative to Original Medicare.
C
A
B
D
When two or more insurance plans are responsible for payment, the primary plan pays first and must _____
split the charges with the secondary plan
determine what the secondary plan is responsible for
provide the maximum benefits
pay a percentage of the charges
Malik’s employer provides health insurance coverage to employees. The employer requires employees to pay a portion of the premium costs. Malik is responsible for $1,200 yearly, which is divided evenly by the number of pay periods in the year and automatically deducted from each of Malik’s paychecks. If Malik is paid twice a month, how much will be taken out of each paycheck?
$1200
$600
$100
$50
Clear and concise provider’s documentation helps in establishing____
Medical Necessity
Patient Satisfaction
Billing Errors
Insurance Premiums
Medicare Part ____ would cover a member who is admitted to a hospital for observation due to pneumonia.
Part A
Part B
Part C
Part D
Which of the following describes the practice of routinely submitting claims that have the same coding or modifier errors?
Upcoding
Overpayment
Abusive Billing Pattern
Billing for Services not Rendered
Which of the following requires a patient's authorization prior to disclosure?
Protected health information (PHI)
Charging excessively for services in error
mistakenly reporting duplicate charges
Release of Information log
A billing and coding specialist should identify that a Medicare Recovery Audit Contractor (RAC) can review medical records for which of the following reasons?
To investigate if a patient was denied Medicare coverage.
To investigate whether a provider is self referring for ancillary services.
To investigate potential improper Medicare payments.
To investigate whether a Medicare beneficiary was subject to a HIPAA violation.
During which of the following steps of the revenue cycle does effective communication begin?
Utilization management review
Health care encounter and documentation
Billing
Registration and scheduling
A billing and coding specialist should identify that the Office of Inspector General (OIG) has which of the following roles?
To investigate disclosure of protected health information.
To evaluate workplace safety standards.
To administer the Patient Protection and Affordable Care Act.
To identify Medicare fraud and abuse.
A patient is scheduled for a procedure with an allowed amount of $2,500, and the annual deductible of $700 has been met. The coinsurance agreement is 70/30. Which of the following is the patient's responsibility?
$2,500
$1450
$1750
$750
A patient who has Medicare coverage requests a pain medication refill following hip replacement surgery. For which of the following parts of Medicare should the patient’s eligibility be verified for the prescription?
Part A
Part B
Part C
Part D
A billing and coding specialist is reviewing a patient's record. The specialist should recognize that which of the following should be signed by the patient is there is a concern that Medicare might not pay for the service?
Informed Consent Form
Patient Referral Authorization Form
Advanced Beneficiary Notice (ABN)
Notice of Privacy Practices (NPP)
A billing and coding specialist is calculating a patient's financial responsibility for a procedure. The charge for the procedure is $1400 and the provider is in the patients insurance providers network. The allowable amount for the procedure is $500 with no deductible required. If the insurance plan pays at 80/20, what is the patient's total coinsurance amount?
$100
$280
$400
$500
A patient fell and was injured while picking up a catering order during their break for an all-employee staff meeting. Which of the following third-party payers is responsible for this encounter?
Auto Insurance
Workers Compensation
Homeowners Insurance
Group Health Plan
A billing and coding specialist is preparing the registration for a patient who is covered under their spouses insurance. Which of the following items is required to complete registration?
Patient Demographics
Credit Card
Spouse’s Social Security Card
Work History
