Medical Billing Software Risk Assessment & Management 5

Question 1

A medical group's billing software allows unlimited claim voids and resubmissions with no approval workflow. What is the primary compliance risk?

Accepted Answer

Uncontrolled voids can mask fraudulent activity such as skimming payments before resubmission

Answer

Unlimited void access without an approval trail enables employees to void posted payments, pocket the funds, and resubmit the claim as if it were new.

Question 2

A practice is evaluating two billing software vendors. Vendor A has SOC 2 Type II certification; Vendor B does not. What does this difference mean for risk assessment?

Accepted Answer

Vendor A has had its security controls independently audited and verified over a period of time, reducing vendor risk

Answer

SOC 2 Type II means an independent auditor tested the operating effectiveness of security controls over at least six months, providing stronger assurance than Type I.

Question 3

What is the significance of the '60-day repayment rule' (CMS Overpayment Rule) for billing software risk management?

Accepted Answer

Once an overpayment is identified, it must be reported and returned within 60 days or it becomes a False Claims Act violation

Answer

Under 42 CFR §401.305, failing to return a known Medicare/Medicaid overpayment within 60 days of identification triggers False Claims Act exposure.

Question 4

A risk assessment identifies that staff frequently share billing software login credentials. Which risk does this most directly create?

Accepted Answer

Inability to attribute actions to specific individuals, destroying the audit trail and enabling undetected fraud

Answer

Shared credentials eliminate individual accountability, making it impossible to determine who performed a specific action in the billing system.

Question 5

During a risk assessment, the team identifies that the billing system has not been patched in 18 months. How should this risk be categorized?

Accepted Answer

High severity, because unpatched systems are a primary attack vector for ransomware and data breaches

Answer

Unpatched systems are a critical vulnerability; the majority of successful cyberattacks exploit known vulnerabilities for which patches already exist.

Medical Billing Software Practice Test

Medical Billing Software Practice Test

Medical Billing Software Risk Assessment & Management 5