Test Your Rules & Regulations Knowledge

Multiple Choice

1. What does the OIG release annually and identifies areas they will focus on for review and investigations they believe are the most vulnerable programs for possible fraud/abuse?

a. Compliance Plan

b. HIPAA plans

c. Work Plan

d. ZPIC’s

2. This law is considered the "self referral" law and under this law, if a physician or a member of a physician's immediate family has a financial relationship with a healthcare entity, the physician may not make referrals to that entity for the furnishing of designated health services under the Medicare program. What is the name of this law?

a. Anti-kickback law

b. False Claims Act

c. Stark Law

d. Not an acutal law and is Medicare Guidelines

3. What are Mutually Exclusive Edits?

a. Two procedure codes which cannot reasonably be performed together based on code definitions or anatomical sites

b. A modifier that is included in the CCI edits to identify if a set of codes can be unbundled

c. Surgical Package Guidelines that are mandated by Medicare

d. ICD-9 and CPT guidelines for correct coding

4. Which law prohibits individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program?

a. False Claims Act

b. Anti-kickback law

c. Stark Law

d. OIG Compliance

5. Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury. These guidelines describes what will or will not be covered and provides requirements that must be met in order to process payment.

a. Correct Coding Initiative

b. Corporate Integrity Agreements

c. Comprehensive Error Rate Testing

d. National and Local Coverage Determinations

6. These services are performed by a non-physician practitioner and can be billed to Medicare under the physicians NPI number. The supervising physician must be present in the office and supervise the non-physician practitioner. Billing these type of services is called?

a. Batch Billing

b. Incident-to services

c. Fee-for-services

d. Capitation

7. These type of tests are categorized as "simple laboratory examinations and procedures that have an insignificant risk of an erroneous result." These are tests that most offices are able to perform without sending to an outside laboratory. Offices must apply for this license and keep current accurate logs of tests performed. What is the name of this license?

a. ABN

b. DME



8. What is the name of a proactive program that ensures fulfilment with all applicable policies, procedures, laws and regulations. It is designed to detect and correct violations, provide employee training, routine physician auditing of documentation and establish standards and procedures that are reasonably capable of reducing the prospect of criminal conduct.

a. Compliance Plan


c. OIG Work Plan

d. Stark Laws

9. What is HIPAA?

a. Standardization of electronic health transactions

b. Privacy protection of individual health information

c. Security of health information for patient

d. All of the above

10. What are Fiscal Intermediaries?

a. Office of Inspector General contractors that implement a system to identify improper payments, fraud and abuse in the Medicare system

b. Organizations hired by CMS to perform wide range of medical review, data analysis and Medicare evidence-base policy auditing services

c. Private insurance companies that serve as the federal government's agents in the administration of the Medicare program

d. Centers for Medicare and Medicaid or also known as CMS


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