Medical Billing Software Regulatory Frameworks & Compliance 2

Question 1

Under HIPAA's Minimum Necessary Standard, a billing specialist should request only the PHI required to:

Accepted Answer

Accomplish the intended billing purpose

Answer

The Minimum Necessary Standard limits PHI disclosure to only what is needed to fulfill the specific billing function at hand.

Question 2

Which federal law requires Medicare and Medicaid providers to maintain billing records for a minimum of 6 years?

Accepted Answer

Health Insurance Portability and Accountability Act (HIPAA)

Answer

HIPAA requires covered entities to retain records, including billing documentation, for at least 6 years from creation or last effective date.

Question 3

A provider receives a Medicare Remittance Advice (RA) showing a claim denied as 'not medically necessary.' The correct next step under CMS guidelines is to:

Accepted Answer

Review LCD/NCD criteria and appeal if documentation supports necessity

Answer

CMS guidelines require providers to review Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) before appealing medical necessity denials.

Question 4

The OIG Work Plan is primarily used by compliance officers and billers to:

Accepted Answer

Identify areas of billing scrutiny targeted by federal investigators

Answer

The OIG Work Plan publishes the areas where the Office of Inspector General plans to focus fraud and abuse audits each year.

Question 5

Which modifier is appended to a claim when a service is provided by a Qualified Non-Physician Practitioner (NPP) under physician supervision in a teaching setting?

Accepted Answer

Modifier GE

Answer

Modifier GE indicates that the service was performed by a resident without the presence of a teaching physician under the primary care exception.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Regulatory Frameworks & Compliance 2