Medical Billing Software Risk Assessment & Management 2

Question 1

A medical billing software vendor offers a Business Associate Agreement (BAA) that limits liability to $10,000. What risk management concern should this raise for a large medical group?

Accepted Answer

The cap may be insufficient to cover breach costs averaging $200K+

Answer

HIPAA breach costs often exceed $200,000, so a $10,000 liability cap leaves the covered entity bearing most financial risk.

Question 2

Which control best mitigates the risk of a disgruntled billing employee submitting fraudulent claims?

Accepted Answer

Requiring dual authorization for claims above a defined dollar threshold

Answer

Dual authorization (two-person integrity) is a preventive control that prevents a single insider from submitting fraudulent claims undetected.

Question 3

A practice discovers its billing software automatically retries rejected claims without staff review. What risk does this create?

Accepted Answer

Repeated submission of incorrect codes, increasing False Claims Act exposure

Answer

Auto-resubmitting rejected claims without review can repeatedly submit erroneous or unsupported codes, creating False Claims Act liability.

Question 4

Under HIPAA's Security Rule, what is the purpose of conducting a Risk Analysis?

Accepted Answer

To identify and document potential vulnerabilities to ePHI confidentiality, integrity, and availability

Answer

HIPAA's Security Rule (§164.308(a)(1)) requires a thorough assessment of potential risks and vulnerabilities to ePHI as the foundation of a security program.

Question 5

A billing software update causes claim amounts to be overstated by 5%. What is the PRIMARY risk category this represents?

Accepted Answer

Operational risk due to a software defect impacting financial accuracy

Answer

A software defect causing financial misstatements is an operational risk that can also trigger overpayment recovery demands and False Claims Act scrutiny.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Risk Assessment & Management 2