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A set of questions and answers related to aapc (american academy of professional coders) chapter 1 billing test exam. It covers key concepts and definitions relevant to healthcare billing, fraud prevention, and compliance. The questions address topics such as abuse, anti-kickback laws, beneficiary rights, hipaa regulations, and the false claims act. This resource is designed to help students and professionals in the healthcare field prepare for billing exams and understand important legal and ethical considerations in healthcare billing practices. It serves as a study aid for mastering essential terminology and regulations in medical coding and billing.
Typology: Exams
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Abuse - correct answer ✅An action that results in unnecessary costs to a federal healthcare program, either directly or indirectly Anti-Kickback - correct answer ✅Knowingly & willfully offering or accepting rewards or remuneration for services that are billable to a federal healthcare plan Beneficiary - correct answer ✅An Individual that is eligible for Medicare or Medicaid benefits based on the CMS guidelines Condition of Participations (CoP) - correct answer ✅Conditions that healthcare organizations must meet in order to participate with the plan or program Covered Entity - correct answer ✅According to HIPPA defined as health plans, healthcare clearinghouses, and healthcare
providers who electronically transmit any health info in connection with transactions in which HHS has adopted standards Criminal Healthcare fraud act - correct answer ✅Scheme to willingly defraud any healthcare benefit program False Claims Act - correct answer ✅Federal statute setting criminal & civil penalties for falsely billing the government, over representing the amount of a delivered product, or under stating an obligation to the goverment Fraud - correct answer ✅Making false statements or misrepresenting facts to obtain an undeserved benefit or payment from a federal healthcare program HIPPA - correct answer ✅Health Insurance Portability and Accountability Act of 1996
behalf of the US government. it seeks to protect those who bring forth lawsuit from dismissal etc Stark Law - correct answer ✅A Federal law that places limitations of certain physician referrals Truth in lending act - correct answer ✅Designed to assure the every customer who needs consumer credit is given meaningful information concerning credit that is given for over 4 installments or has a finance charge