What is the purpose of HIPAA in healthcare?
HIPAA establishes national standards to protect patient health information and ensure privacy and security.
What does the False Claims Act prohibit?
The False Claims Act penalizes individuals or organizations that knowingly submit fraudulent claims for payment to the government.
Which federal agency is responsible for enforcing HIPAA regulations?
The Office for Civil Rights (OCR) is responsible for enforcing HIPAA's privacy and security rules.
What is the purpose of the OIG Work Plan?
The OIG Work Plan outlines the areas the Office of Inspector General will monitor for fraud, waste, and abuse in federal programs.
What is considered a breach under HIPAA?
A HIPAA breach occurs when there is unauthorized access, use, or disclosure of protected health information (PHI).
What does the term 'upcoding' refer to?
Upcoding is a fraudulent practice where a provider uses a higher-paying code than the service provided warrants.
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Which regulation restricts physician self-referrals?
The Stark Law prohibits physicians from referring patients to entities in which they have a financial interest for certain services.
Why is compliance training important for coding professionals?
Compliance training helps coding professionals stay updated with regulations and avoid errors or fraud in medical coding and billing.
What is the National Correct Coding Initiative (NCCI) designed to prevent?
NCCI edits promote correct coding and prevent inappropriate payment of Medicare Part B claims.