CPPM STUDY QUESTIONS WITH COMPLETE SOLUTIONSCPPM STUDY QUESTIONS WITH COMPLETE SOLUTIONSCPPM STUDY QUESTIONS WITH COMPLETE SOLUTIONSCPPM STUDY QUESTIONS WITH COMPLETE SOLUTIONS
What is the role of JCAHO? - ANSWER-operates fee based accreditation programs to subscriber hospitals and other health ca...
CPPM STUDY QUESTIONS WITH
COMPLETE SOLUTIONS
What is the role of JCAHO? - ANSWER-operates fee based accreditation programs to
subscriber hospitals and other health care organizations
The OIG does not focus on what? - ANSWER-Training
The False Claims Act Statue : - ANSWER-makes it illegal to submit claims to MCR
/MCD bills that contain charges for services charged in excess of the usual charges
ABN's are generally used in a pediatric environment. - ANSWER-False
Carve Out Policy - ANSWER-contracted agreement between an insurance company
and another company which provides special services to its members, such as
prescription drugs or cancer treatment
What is a Medicare participating provider? - ANSWER-A provider who accepts
assignment of benefits for MCR claims
What are the the three mechanisms of payment for Medical and surgical procedures
inpatient Vs. outpatient? - ANSWER-Outpatient Surgical Services - APC reimbursed
procedures not on inpatient list only
Inpatient Surgical Services - DRG reimbursed
Freestanding ASC - Fee based
MOD - 50 or RT/LT is an example of what? - ANSWER-Carrier Specific Rules
Under HIPAA, a provider that submits a claim to a health plan and a health plan
assesses and pays the claim the provider ________________ a Business Associates of
the other. - ANSWER-Is not
In regard to HIPAA, reasonable depends on what? - ANSWER-size of covered entity
and nature of the business
The Privacy Rule creates an ________ of privacy protection for research that _______
governed by the existing Federal human subject to regulations. - ANSWER-equal
standards; is and is not
The HIPAA Privacy Rule requirements for minimum necessary are: - ANSWER-
designed to be sufficiently flexible to accommodate the various circumstances of any
covered entity
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