At the ZPIC's discretion, penalties may include:
a. Suspension of disbelief
b. Denial of payments
c. Recoupment of underpaid claims
d. Denial of further insurance coverage
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Q. 2) The OIG provides compliance program guidance including educational materials to
a. Planned Parenthood offices
b. Hospitals
c. Schools and churches
d. Sports complexes
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Q. 3) Who are Providers of Service under Medicare? What are the eligibility requirements? List five or more nonparticipating facilities that Medicare does NOT make payments to.
What will be an ideal response?
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Q. 4) What is meant by a patient encounter form?
a. A form reporting all patient encounters (i.e., visits) to the MCP
b. Nothing; there is no such thing
c. A report detailing sexual harassment on the part of the physician
d. A form used exclusively by the Group/IPA
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Q. 5) Which of the following lung conditions is considered a common WC claim?
a. Silicosis
b. Pneumonia
c. Bronchitis
d. Tuberculosis
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Q. 6) The Physician's Final Report is usually the last report, stating that the patient has been discharged.
Indicate whether this statement is true or false.
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Q. 7) Discuss confidentiality when processing workers' compensation claims. What rights does an employee have? What kinds of information do both the medical biller and claims examiner need to submit a claim?
What will be an ideal response?
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Q. 8) What happens when a physician agrees to accept Medicare assignment for a bill?
a. The physician may bill the patient directly.
b. Medicare pays the physician directly for that bill.
c. The physician loses credibility in the community.
d. The total fee that a physician may receive from Medicare is limited by what the patient can afford.
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Q. 9) Define and explain temporary disability claims. What is the role of the state in such claims? The medical biller? The claims examiner?
What will be an ideal response?
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Q. 10) Which of the following is the OIG responsible for?
a. Reviewing agency spending plans prepared by HHS management
b. Outlining steps that HHS management should take to obtain meaningful audit coverage
c. Conducting risk assessments of HMOs receiving funding, including non-Medicaid programs
d. Assessing providers' capability to manage funds in accordance with federal regulations
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