Medical Billing Software Regulatory Frameworks & Compliance 3

Question 1

The Anti-Kickback Statute (AKS) prohibits which of the following arrangements in medical billing?

Accepted Answer

Charging Medicare patients a copayment waiver as standard policy

Answer

Routinely waiving Medicare copayments without individualized financial hardship assessment violates the AKS because it can induce patients to use services covered by federal programs.

Question 2

A claim submitted to Medicare for a service that was never rendered constitutes a violation of the:

Accepted Answer

False Claims Act (FCA)

Answer

The False Claims Act imposes civil liability on any person who knowingly submits a false or fraudulent claim for payment to the federal government.

Question 3

Which CMS program uses statistical sampling and extrapolation to recover overpayments across a provider's entire claim population?

Accepted Answer

Recovery Audit Contractor (RAC)

Answer

RAC auditors use statistical sampling and extrapolation, meaning a finding in a sample can be applied to all similar claims in the review period.

Question 4

Under Medicare's Timely Filing Rule, the standard deadline for submitting an initial claim is:

Accepted Answer

One calendar year (12 months) from date of service

Answer

Medicare requires initial claims to be filed within one year (365 days) of the date of service, or the claim will be denied.

Question 5

ICD-10-CM coding guidelines require that a 'probable' or 'suspected' diagnosis:

Accepted Answer

Be coded as confirmed in the inpatient setting only

Answer

In the inpatient setting, conditions documented as probable, suspected, or likely may be coded as established; this rule does not apply to outpatient coding.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Regulatory Frameworks & Compliance 3