CCT Billing and Coding Compliance 2

Question 1

What is the National Provider Identifier (NPI)?

Accepted Answer

A unique 10-digit identification number issued to healthcare providers by CMS under HIPAA

Answer

A state-issued license number assigned to healthcare providers

Answer

A billing code assigned by private insurance companies to contracted providers

Answer

A Medicare beneficiary identification number used on insurance cards

Question 2

What does 'incident to' billing allow under Medicare Part B?

Accepted Answer

Billing for services provided by non-physician practitioners under direct physician supervision at the physician's full reimbursement rate

Answer

Billing for services rendered in a hospital emergency department under one facility fee

Answer

Billing for preventive screenings without a supporting diagnosis code

Answer

Combining charges from multiple dates of service onto a single claim

Question 3

Under the False Claims Act, what is 'qui tam' litigation?

Accepted Answer

A whistleblower lawsuit filed by a private individual on behalf of the government

Answer

A government audit of healthcare claims for potential overpayments

Answer

A lawsuit filed by the DOJ directly against a healthcare provider

Answer

An administrative appeal process for denied Medicare claims

Question 4

What is a 'clean claim' in Medicare billing?

Accepted Answer

A claim that contains all required information and can be processed without requesting additional data

Answer

A claim submitted with no diagnosis codes attached

Answer

A claim submitted electronically rather than on paper

Answer

A claim that has already been approved and paid by the payer

Question 5

What is 'phantom billing' in the context of healthcare fraud?

Accepted Answer

Billing for services, procedures, or supplies that were never actually provided to the patient

Answer

Billing for services at a higher complexity level than was actually provided

Answer

Billing under another provider's NPI without their knowledge

Answer

Submitting a claim after the timely filing deadline has passed

Question 6

What is an Advance Beneficiary Notice (ABN) primarily used for?

Accepted Answer

To inform a Medicare beneficiary that Medicare may not cover a service and the patient may be financially responsible

Answer

To notify a patient before surgery of potential medical complications

Answer

To obtain prior authorization from Medicare before providing an elective service

Answer

To formally appeal a Medicare claim denial on behalf of a beneficiary

Question 7

What does 'coordination of benefits' (COB) mean in billing compliance?

Accepted Answer

The process that determines the order in which multiple insurance plans pay when a patient has more than one coverage

Answer

The process of combining multiple diagnosis codes onto a single claim form

Answer

The distribution of a single payment across multiple providers for the same service

Answer

The process of verifying patient insurance eligibility prior to rendering services