The False Claims Act (FCA):
a. cannot encourage whistle-blowers.
b. does not penalize mistakes or errors.
c. provides a penalty of 100,000 per claim.
d. was enacted after HIPAA.
(
Q. 2) Which developed the National Correct Coding Initiative?
a. AMA
b. CMS
c. DOJ
d. HIPAA
(
Q. 3) What are the civil penalties if a person is found guilty of Medicare fraud?
a. 5,000 per claim
b. 10,000 per claim
c. Up to 25,000
d. 5,000 to 10,000 per claim, plus triple damages
(
Q. 4) According to the Health Insurance Association of America, what is the largest area of health care fraud?
a. Billing for services not done
b. Misrepresenting diagnoses
c. Other and miscellaneous areas
d. Waivers of patient deductibles
(
Q. 5) What area of the government investigates possible cases of DRG creep?
a. Centers for Medicare and Medicaid Services
b. Department of Health and Human Services
c. Department of Justice
d. Office of the Inspector General
(
Q. 6) A patient is admitted to the hospital with complaints of chest pain and coughing. After examination and testing, the patient is diagnosed with pneumonia. The patient has a sputum culture, which is negative for the presence of any bacterium. After the patient is discharged, an ICD-10-CM code is assigned that identifies the patient as having bacterial pneumonia. Submitting a specific pneumonia ICD-10-CM code is a practice encouraged by the facility to increase its reimbursement rate from Medicare. This practice is known as __________.
a. abuse
b. fraud
(
Q. 7) Which legislation limited exclusions for preexisting medical conditions?
a. Balanced Budget Act
b. HIPAA
c. Stark I
d. TEFRA
(
Q. 8) A four-digit __________ code is reported on a chargemaster?
a. diagnosis
b. procedure
c. revenue
d. status
(
Q. 9) Which is used by hospitals to record outpatient encounter data?
a. Chargemaster
b. CMS-1500
c. Encounter form
d. Superbill
(
Q. 10) Mingo River Hospital executives want to determine the medical services provided during the past three years that have met the medical needs of the majority of patients treated by the facility. What reimbursement tool would best help the hospital executives?
a. Acute physiological and chronic health evaluation
b. Case mix
c. Chargemaster review
d. Severity of illness
Quick Reply
