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

The NPI is a unique 10-digit identification number issued by CMS to HIPAA-covered healthcare providers, used to identify providers in all standard electronic transactions.

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

'Incident to' billing allows services by non-physician practitioners (e.g., nurses, medical assistants) provided under direct physician supervision to be billed under the supervising physician's NPI at 100% of the Medicare fee schedule.

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

Qui tam provisions of the False Claims Act allow private individuals (relators/whistleblowers) to file lawsuits on behalf of the government against those who defraud federal programs and share in any monetary recovery.

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 clean claim contains no defects or improprieties and includes all required data elements, allowing the payer to adjudicate it without needing to request additional information.

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

Phantom billing involves submitting claims for services or items that were never actually rendered to the patient, constituting outright fraud against Medicare, Medicaid, or other payers.

(CCT) Certified Compliance Technician Practice Test

(CCT) Certified Compliance Technician Practice Test

CCT Billing and Coding Compliance 2