CPB final exam study exam part 1 package deal Questions & Answers

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? - ANSWERSFalse Claims Act In addition to the standardization of the codes ...

Electronic data interchange - ANSWERSEDI Treatment, payment and operations - ANSWERSTPO Conditions of participation - ANSWERSCOP False claim act - ANSWERSFCA Health information portability and accountability act - ANSWERSHIPAA Preferred provider organization - ANSWERSPPO Truth in l...

Medically Unlikely Edits (MUEs) - ANSWERSnumber of units that can be reported for a service or procedure on the same day Medicare and Medicaid - ANSWERSMedicare pays first, and Medicaid pays last. Medicare and TRICARE - ANSWERSTRICARE is secondary Early and Periodic Screening, Diagnostic, a...

What organization is responsible in evaluating the medical necessity, appropriateness, and efficiency of the use of healthcare services and procedures? A. Utilization Review Organization B. Managed Care Organization C. Quality Assurance Organization D. External Quality, Review, Organization - AN...

Abuse - ANSWERSActions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment - ANSWERSProvider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable - ANSWERSThe amount ...