CRCR Healthcare Compliance and Regulations 4

Question 1

Which exception to the Stark Law allows a hospital to pay a physician for services personally performed by that physician at fair market value?

Accepted Answer

Personal Services Arrangements Exception

Answer

The Personal Services Arrangements Exception permits compensation to physicians for services they personally provide at fair market value under a written agreement.

Question 2

Billing for a service that was never performed is classified as which type of fraud?

Accepted Answer

Phantom billing

Answer

Phantom billing refers to submitting claims for services, procedures, or supplies that were never actually provided to the patient.

Question 3

Under the Anti-Kickback Statute, the safe harbor for personal services requires that the aggregate compensation be set in advance and not exceed what standard?

Accepted Answer

Fair market value

Answer

The personal services safe harbor requires that aggregate compensation is set in advance, consistent with fair market value, and not determined by volume or value of referrals.

Question 4

A hospital submits a claim using procedure codes that should be billed together under a single bundled code. This practice is called:

Accepted Answer

Unbundling

Answer

Unbundling is the practice of billing separately for services that payers require to be billed under a single bundled code, resulting in higher reimbursement.

Question 5

Which CMS program uses statistical analysis to identify aberrant billing patterns and flag providers for potential audit?

Accepted Answer

Fraud Prevention System (FPS)

Answer

The Fraud Prevention System (FPS) uses predictive analytics and data mining to identify aberrant billing patterns before and after payment.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Healthcare Compliance and Regulations 4