Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction?
a. Payment and remittance advice
b. Eligibility in a health plan
c. Coordination of benefits
d. Physician unique identifier number - AN...
AAPC CPB - CHAPTER 1: QUESTIONS &
ANSWERS 100% CORRECT!!
Eight standard transactions were adopted for Electronic Data Interchange (EDI) under
HIPAA. Which of the following is NOT included as a standard transaction?
a. Payment and remittance advice
b. Eligibility in a health plan
c. Coordination of benefits
d. Physician unique identifier number - ANSWERSd. Physician unique identifier number
A claim is received by a payer that subsequently requests the medical records for the
date of service on the claim. What procedure should be followed by the practice?
a. Only the date of service on the claim should be sent to the payer
b. The records for the claim can be sent after authorization is received from the patient
c. The entire patient record should be sent as part of HIPAA based on treatment,
payment and operations
d. The payer is required to provide authorization signed from the patient prior to
requesting the medical records - ANSWERSa. Only the date of service on the claim
should be sent to the payer.
HIPAA requires that privacy practice notices be provided in several circumstances.
Which one of the following is NOT required?
a. Must be available on any website the practice maintains
b. Must be provided upon request
c. Must be presented to all patients
d. Must be places in the patient's file - ANSWERSd. Must be placed in the patient's file
When a subpoena is received by the practice for medical records, in what
circumstances may the records be released?
a. The subpoena allows for the release of the medical records
b. The subpoena is accompanied by a court order or the patient is notified and given a
chance to object
c. The individual must sign an authorization for the release of the information
d. Records cannot be released under any circumstance based on a subpoena -
ANSWERSb. The subpoena is accompanied by a court order or the patient is notified
and given a chance to object
A physician received office space at a reduced rate for referring patients to the
hospital's outpatient physical therapy center. What law does this violate?
, a. Anti-kickback Statute
b. Stark Law
c. False Claims Act
d. Truth in Lending Act - ANSWERSa. Anti-kickback Statute
Federal healthcare plans include what payers?
a. Blue Cross, Medicare, Humana
b. Medicare, Medicaid, Tricare
c. Medicare, Tricare, Blue Cross
d. Humana, VA, Tricare - ANSWERSb. Medicare, Medicaid, Tricare
One of the most severe penalties that can be associated with violations of the Social
Security Act is exclusion from federal healthcare plans. Which of the following
statements is true of excluded individuals?
a. Physicians that have been excluded can bill the patient for services but cannot bill
federal health plans
b. Physicians that have been excluded can refer their patients to other facilities for
treatment.
c. Physicians that have been excluded are prohibited from billing for any services to a
federally administered health plan.
d. Physicians that have been excluded are exempt from billing for services but are
allowed to write prescriptions and order tests. - ANSWERSc. Physicians that have been
excluded are prohibited from billing for any services to a federally administered health
plan.
A physician billed claims to Medicare and Medicaid for procedures that were not
performed on 800 patients resulting in a loss of $2.6 million. Is this fraud or abuse?
a. Fraud; subject to the Anti-kickback Statute
b. Fraud; subject to the False Claims Act
c. Abuse; subject only to education of the provider
d. Abuse; subject to the Stark Law - ANSWERSb. Fraud; subject to the False Claims
Act
The regulation of finance charges or interest applied to outstanding balances in the
medical practice is under what law?
a. Truth in Lending Act
b. Criminal Healthcare Act
c. HIPAA
d. Conditions of Participation - ANSWERSa. Truth in Lending Act
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