Chapter 1 Quiz Flashcards
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. The records can be sent as part of HIPAA based on treatment, payment, and operations (TPO).
(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.
(A) Only the date of service on the claim should be sent to the payer. The records can be sent as part of HIPAA based on treatment, payment, and operations (TPO).
Medical records requested from a payer may be sent to the payer based on the Treatment, Payment, and Operations provision of HIPAA. However, in doing so, the Minimum Necessary provision should be followed and only the date of service requested should be sent.
A physician billed claims to Medicare and Medicaid for procedures that were not performed on 800 patients resulting in loss of 2.6 million dollars. 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
(B) Fraud; subject to the False Claims Act
Fraud is defined as making false statements or making misrepresenting facts to obtain an undeserved benet or payment from a federal health care program. This creates unnecessary costs to the federal plan. In this example billing for services that were not furnished or provided.
A physician received once space at a reduced rate for referring patients to the hospital’s out- patient physical therapy center. What Law does this violate?
(A) Anti-Kickback Statute
(B) Stark Law
(C) False Claims Act
(D) Truth in Lending Act
(A) Anti-Kickback Statute
The anti-kickback law states that anyone who knowingly or willingly accepts or offers any items or services to induce referral is a violation of the law.
Federal healthcare plans include what payers?
(A) Blue Cross, Medicare, Humana
(B) Medicare, Medicaid, TRICARE
(C) Medicare, TRICARE, Blue Cross
(D) Humana, VA, TRICARE
(B) Medicare, Medicaid, TRICARE
Federal health care plans are any plans paid through government reimbursement – Medicare, Medicaid, TRICARE, and VA programs are all administered by the Federal government.
When a subpoena is received by the practice for medical records, in what circumstances may the
records be released according to the HIPAA Privacy Rule?
(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 release of the information.
(D) Records cannot be released under any circumstance based on a subpoena.
(B) The subpoena is accompanied by a court order or the patient is notified and given a chance to object.
A covered entity may disclose PHI required by a court order or administrative tribunal. A sub-poena issued by a court clerk or an attorney in a case (someone other than a judge) is not synonymous with a court order. When a subpoena is issued, it should be accompanied by a court order to release the records. Only the records specified in the order may be disclosed. When the subpoena is not accompanied by a court order, the covered entity must make a reasonable effort to:
- Notify the person who is the subject of the PHI about the request, giving them a
chance to object to the disclosure; or to - Seek a qualified protective order for the information from the court.
HIPAA of 1996 includes a Security Rule that is established to provide what national standards for protecting and transmitting patient data. Which of the following is NOT true.
(A) The Security rule applies to health care providers, health plans, and any covered entity involved in the care of the patient.
(B) The Security Rule applies only to the entity that initiates the release of protected health information.
(C) Standards for storing and transmitting patient data in electronic form includes portable electronic devices.
(D) The Security Rule states that safeguards must be in place to prevent unsecured release of information.
(B) The Security Rule applies only to the entity that initiates the release of protected health information.
All entities are responsible for the protected health information, including the entity receiving the information. Portable electronic devices such as tablets and smart phones are to be made secure with passwords that are not shared between staff.
One of the most severe penalties that can be associated with violations of the Social Security Act is exclusion from federal health care 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.
(C) Physicians that have been excluded are prohibited from billing for any services to a federally administered health plan.
One of the most severe penalties associated with the Social Security Act is the ability of the Office of Inspector General (OIG) to exclude an entity or an individual from participation in any and all federal healthcare
programs. This includes Medicare, Medicaid, VA programs, and Tricare. An excluded individual cannot bill for services, provide referrals or prescribe medications or order services for any beneficiary of a federally
administered health plan.
HIPAA requires that privacy practice notices be provided in several circumstances. Which 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 placed into the patient’s file.
(D) Must be placed in the patient’s file.
HIPAA states that the privacy practice should be available electronically on any websites they maintain, and presented to patients as they present for care, as well as providing a notice upon request. The notice does not need to be filed in the patient’s file, however the signature showing that the patient received the notice should be filed.
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 Health Care Act.
(C) HIPAA
(D) Conditions of Participation
(A) Truth in Lending Act.
The Truth in Lending Act is also called the Consumer Credit Protection Act of 1968 that is designed to protect consumers dealing with lenders and creditors.
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
(D) Physician unique identifier number.
The physician unique identifier number is not included in the standard transactions, although it is to be included on the claim. Payment and remittance advice, eligibility in a health plan, and coordination of benefits all contain protected health information of the patient and are included in the transaction set.
