Medical Billing Software Regulatory Frameworks & Compliance 5

Question 1

The HITECH Act expanded HIPAA enforcement by increasing the maximum civil monetary penalty tier to:

Accepted Answer

$1.5 million per violation category per year

Answer

HITECH raised the maximum HIPAA civil monetary penalty to $1.5 million per violation category per calendar year.

Question 2

A medical billing software system that automatically scrubs claims for National Correct Coding Initiative (NCCI) edits is helping providers avoid:

Accepted Answer

Unbundling or mutually exclusive procedure code combinations

Answer

NCCI edits identify procedure code pairs that should not be billed together because one is bundled into the other or they are mutually exclusive.

Question 3

Which entity has authority to exclude providers from participation in all federal health care programs, not just Medicare?

Accepted Answer

Office of Inspector General (OIG)

Answer

The OIG has authority under Section 1128 of the Social Security Act to exclude individuals and entities from all federal health care programs.

Question 4

Under Medicare's incident-to billing rules, services billed under the supervising physician's NPI must be performed:

Accepted Answer

In the physician's office with the physician present in the suite

Answer

Incident-to billing requires the supervising physician to be physically present in the office suite (not necessarily the same room) when the NPP performs the service.

Question 5

The COB (Coordination of Benefits) process in medical billing software ensures that:

Accepted Answer

Patients with dual coverage are never billed more than their actual out-of-pocket cost

Answer

COB rules ensure combined payments from primary and secondary payers do not exceed the actual charges, protecting patients from overpayment.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Regulatory Frameworks & Compliance 5