CPAT Prep Federal Regulations And Governing Bodies

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 is the law that provides federal reimbursement for emergency health services furnished to undocumented aliens. This act expanded Medicare to include prescription drug coverage and implemented various reforms to improve the program. One of the provisions of this act is the reimbursement of emergency health services to undocumented aliens, ensuring that they receive necessary medical care in emergency situations.

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Fraud and Abuse Initiatives are enforced by the Department of Justice (DOJ). The DOJ is responsible for investigating and prosecuting cases of fraud and abuse in various areas such as healthcare, finance, and government programs. They work to ensure that individuals and organizations engaging in fraudulent activities are held accountable and that the public is protected from such practices.

The Medicare Integrity Program is designed to reduce payment errors and protect the Medicare Trust Fund. By implementing this program, the government aims to ensure that Medicare payments are accurate and that fraudulent or improper claims are detected and prevented. This helps to safeguard the financial stability of the Medicare program and ensures that funds are used appropriately to provide healthcare services to eligible beneficiaries.

Operation Restore Trust (ORT) was implemented with the purpose of addressing and preventing fraud, waste, and abuse. It was designed as a comprehensive initiative to combat these issues and ensure the proper use of resources. ORT aimed to improve the efficiency and effectiveness of various systems and processes, such as healthcare, government programs, or financial sectors, by identifying and taking action against fraudulent activities. This initiative sought to restore trust in these systems by holding accountable those who engaged in fraudulent behavior and protecting the interests of the public.

The MIP Medicaid Integrity Program was created under the Deficit Reduction Act (DEFRA).

HIPAA, which stands for Health Insurance Portability and Accountability Act, is also known as the Kennedy Kassenbaum Bill. This bill was named after its sponsors, Senator Edward Kennedy and Senator Nancy Kassenbaum. It was enacted in 1996 and aimed to protect the privacy and security of individuals' health information. The Kennedy Kassenbaum Bill introduced various regulations and requirements for healthcare providers, health plans, and other entities to ensure the confidentiality and integrity of patient health data.

Title XI of the Social Security Act authorizes the imposition of Civil Monetary Penalties (CMPs) when it is determined that an individual or entity has violated Medicare rules. This means that if someone or an organization is found to have breached the regulations set forth by Medicare, they can face penalties in the form of monetary fines. Title XI of the Social Security Act provides the legal framework for enforcing these penalties and ensuring compliance with Medicare rules.

The given correct answer is DEFRA, which stands for Deficit Reduction Act. This act froze physician fees, meaning that it implemented a freeze on the fees that physicians could charge for their services. This measure was likely taken as a part of efforts to reduce the budget deficit by controlling healthcare costs.

The correct answer is DEFRA, Deficit Reduction Act. This act amended the upper age limit to over 65 and older, but it did not include over 69 for spouses.

The correct answer is COBRA, the Consolidated Omnibus Budget Reconciliation Act. This act removed the age limit of 69 on spouses for employers of 20 or more. COBRA is a federal law that allows individuals to continue their health insurance coverage after leaving a job or experiencing a qualifying event. It provides temporary coverage for individuals and their dependents, ensuring that they have access to healthcare services even if they lose their job or have a change in their employment status.

The correct answer is TEFRA, which stands for Tax Equity and Fiscal Responsibility Act. This act was responsible for setting budget cuts that included Medicare Reimbursement.

The Tax Equity and Fiscal Responsibility Act (TEFRA) required Employer Group Health Plans (EGHPs) to be primary over Medicare for individuals aged 65-69, as long as the employer had 20 or more employees. This means that if an individual in this age group had both EGHP coverage and Medicare, the EGHP would be the primary payer for their healthcare expenses. TEFRA aimed to ensure that EGHPs provided adequate coverage for older employees and reduced the burden on Medicare.

The Balanced Budget Act (BBA) extended the life of the Medicare Trust fund and reduced Medicare spending. This act was implemented to address the growing concerns about the financial sustainability of Medicare and to ensure that the program can continue to provide healthcare services to beneficiaries in the long term. By reducing Medicare spending, the BBA aimed to control healthcare costs and make the program more financially stable.

The Balanced Budget Act (BBA) increased options for seniors in terms of health care. The BBA was a legislation passed to balance the federal budget and it included provisions that expanded Medicare coverage for seniors. This act aimed to control healthcare costs and improve the efficiency of Medicare programs. By increasing options, seniors were provided with more choices and access to healthcare services, ultimately improving their overall healthcare experience.

The Balanced Budget Act (BBA) improved benefits for staying healthy. The BBA was a law passed in the United States in 1997 that aimed to balance the federal budget by reducing government spending. One of the ways it did this was by implementing changes to healthcare programs, including Medicare and Medicaid. These changes included expanding coverage for preventive services and promoting wellness programs, which encouraged individuals to stay healthy and prevent the need for costly medical interventions. Therefore, the BBA improved benefits for staying healthy by prioritizing preventive care and promoting wellness initiatives.

The correct answer is BBA, Balanced Budget Act. The Balanced Budget Act was a piece of legislation that aimed to combat fraud and abuse. It was enacted to address concerns about the rising costs of healthcare and to ensure that government spending was in line with revenue. The act included provisions to reduce Medicare and Medicaid fraud, as well as measures to promote efficiency and accountability in healthcare delivery. Overall, the Balanced Budget Act played a significant role in curbing fraud and abuse in the healthcare system.

The Balanced Budget Act (BBA) is a legislation that aims to ensure that the federal budget is balanced by controlling government spending and increasing revenue. One of the ways it achieves this goal is by looking for ways to help Medicare, a government healthcare program, work efficiently in the future. This can include implementing cost-saving measures, improving payment systems, and promoting preventive care to reduce healthcare expenses. The BBA recognizes the importance of Medicare and seeks to make it sustainable and effective in the long term.

Title XXI was established under the Social Security Act.

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President Clinton signed the Balanced Budget Act (BBA). This act was passed in 1997 and aimed to balance the federal budget by reducing spending and increasing revenues. It included provisions such as cuts to Medicare and Medicaid, as well as tax increases. The BBA was seen as a significant step towards fiscal responsibility and was intended to address the growing budget deficit at the time.

The Balanced Budget Act (BBA) established the Medicare Advantage Plans.

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The given correct answer, False Claims Act, is likely the correct answer because the statement mentions that the act is known as the Lincoln Act, which is incorrect. The False Claims Act is a federal law that imposes liability on individuals and companies who defraud governmental programs. Therefore, it is reasonable to assume that the correct answer is the False Claims Act.

The act referred to as the Informer Act is commonly known as the False Claims Act. This act allows individuals to file lawsuits on behalf of the government against individuals or companies who have defrauded government programs. It encourages whistleblowers to come forward by offering them a percentage of the recovered funds as a reward. The False Claims Act has been instrumental in combating fraud and recovering billions of dollars for the government.

The False Claims Act was enacted during the Civil War. This act was passed by Congress in 1863 and was aimed at combating fraud against the government by individuals and companies. It allowed private citizens to file lawsuits on behalf of the government, known as qui tam lawsuits, and receive a portion of any recovered damages. The act was originally intended to address fraud committed by defense contractors during the war, but it has since been expanded to cover a wide range of fraudulent activities against the government.

Medicare was signed into law as an amendment to the Social Security Act. The Social Security Act, passed in 1935, established a system of social welfare programs in the United States. Medicare, which provides health insurance for individuals aged 65 and older, was added to the Social Security Act in 1965. This amendment expanded the scope of the Act to include healthcare coverage for elderly Americans.

The American Medical Association developed the Patient Bill of Rights legislation.

The correct answer is OBRA 1986, Omnibus Budget Reconciliation Act of 1986. This Act was a federal law that was passed in 1986 and it had a significant impact on healthcare in the United States. One of the key provisions of OBRA 1986 was the establishment of the Medicare and Medicaid Anti-Fraud and Abuse Amendments, also known as the MAAC. The MAAC aimed to combat fraud and abuse in the Medicare and Medicaid programs by implementing stricter regulations and penalties for healthcare providers. Therefore, OBRA 1986 is the correct answer as it set the MAAC.

The correct answer is OBRA 1986, Omnibus Budget Reconciliation Act of 1986. This act made large group health plans of 100 or more primary for Medicare patients and their dependents due to a disability other than end stage renal disease.

The correct answer is OBRA 1989, the Omnibus Budget Reconciliation Act of 1989. This act included the provision for the Resource-Based Relative Value Scale (RBRVS), which is a system used to determine the reimbursement rates for physicians' services under Medicare. The RBRVS assigns relative values to different medical services based on factors such as the time, skill, and resources required to provide the service. This provision was aimed at controlling healthcare costs and ensuring fair reimbursement for physicians.

The correct answer is BBA, which stands for Balanced Budget Act. This act imposes the ABN. The Balanced Budget Act is a legislation that was passed in 1997 in the United States. It aimed to reduce the federal budget deficit and included provisions related to healthcare, including changes to Medicare and Medicaid. The act imposed the Advance Beneficiary Notice (ABN) requirement, which notifies Medicare beneficiaries in advance if a service or item they are receiving may not be covered by Medicare.

The Balanced Budget Act (BBA) authorizes the Centers for Medicare and Medicaid Services (CMS) to implement the Prospective Payment System (PPS) and Ambulatory Payment Classifications (APCs). The PPS is a payment system for Medicare services based on predetermined rates, while APCs are a payment system for outpatient services. The BBA allows CMS to establish these payment systems, which help to control costs and ensure efficient and fair reimbursement for healthcare services.

The correct answer is the Improper Payment Information Act. This act required the CERT program.

The National Correct Coding Initiative (NCCI) was established to ensure that medical codes are correctly bundled and to set standards for billing. It helps prevent unbundling of codes and identifies instances of fraud and abuse in medical billing. The NCCI plays a crucial role in maintaining accuracy and integrity in the coding and billing process.

ICD-9 codes, also known as International Classification of Diseases, 9th Revision, were indeed developed by the World Health Organization (WHO). These codes are used for medical classification and coding purposes, allowing healthcare providers to accurately document and classify diseases, injuries, and other health conditions. The WHO is responsible for maintaining and updating the ICD codes, ensuring that they are globally recognized and consistent across different healthcare systems.

The correct answer is OBRA 1986, Omnibus Budget Reconciliation Act of 1986. This act requires HCPCS coding on the UB04 for Medicare outpatient services.

The American Medical Association is responsible for implementing CPT coding changes. CPT codes are used to describe medical procedures and services provided by healthcare professionals. The AMA updates and maintains the CPT code set, and they regularly release new editions of the CPT code book to reflect changes in medical practices. Therefore, it is the American Medical Association that implements these coding changes.

Revenue Codes were developed by the National Uniform Billing Committee (NUBC). The NUBC is responsible for creating and maintaining the uniform billing form that healthcare providers use to submit claims for reimbursement. Revenue Codes are used to classify the type of services or items provided to a patient during their stay at a healthcare facility. These codes help ensure accurate billing and reimbursement for healthcare services.

The correct answer is the Consumer Protection Act of 2005. This law was enacted to protect consumers and ensure fair practices in the marketplace. One of the provisions of the act required all creditors to provide credit counseling to individuals before they could file for bankruptcy. This requirement aimed to educate consumers about their financial situation and explore alternatives to bankruptcy, promoting responsible financial behavior and reducing the number of bankruptcy filings.

The Fair Debt Collections Act is the correct answer because it is a federal law that regulates the practices of debt collectors. It imposes strict limitations on how debt collectors can communicate with consumers, including restrictions on call times and harassment. The act also prohibits debt collectors from providing false or misleading information to consumers. Overall, the Fair Debt Collections Act aims to protect consumers from abusive and unfair debt collection practices.

The Fair Debt Collections Act is commonly referred to as Title VIII of the Consumer Credit Protection Act. This act was established to protect consumers from unfair and abusive debt collection practices. It sets guidelines for debt collectors and outlines the rights of consumers when it comes to debt collection. By referring to the Fair Debt Collections Act as Title VIII of the Consumer Credit Protection Act, it emphasizes that this act is a part of the broader legislation that aims to safeguard consumer rights in the realm of credit and debt.

The Fair Credit Billing Act is a legislation that provides protection to consumers in the event of billing errors on their credit card statements. It requires credit card issuers to promptly investigate and correct any errors reported by the cardholder. In this case, the statement suggests that under the Fair Credit Billing Act, a patient has a 60-day window to notify the hospital of any errors on their bill. The hospital, in turn, is required to respond to the complaint within 30 days. This ensures that patients have a reasonable amount of time to identify and rectify any billing mistakes.

Title VI of the Consumer Credit Protection Act is the correct answer because it is a federal law that specifically focuses on protecting consumer rights to privacy and confidentiality of credit reports. This act ensures that credit reporting agencies and other entities handling consumer credit information adhere to strict guidelines and safeguards to prevent unauthorized access, use, or disclosure of this sensitive information. It establishes the framework for consumer rights and remedies in case of any violations, providing maximum protection to consumers in terms of their privacy and confidentiality regarding their credit reports.

The Truth in Lending Act requires lenders to disclose the amount of interest and percentage rates in writing to borrowers. This ensures that borrowers have all the necessary information about the cost of borrowing before making a decision. By providing this information in writing, borrowers can review and compare different loan offers to make an informed choice. The act aims to promote transparency and protect consumers from unfair lending practices by ensuring they have access to accurate and complete information about the terms and costs of credit.

The Fair Credit Billing Act is a law that regulates the practices of creditors and protects consumers in credit transactions. It allows consumers to dispute billing errors and provides guidelines for resolving these disputes. The act also outlines the rights and responsibilities of both creditors and consumers in credit transactions. Therefore, under the Fair Credit Billing Act, a credit report can only be accessed if there is a need to extend credit to a consumer.

The correct answer is The Truth in Lending Act. The Truth in Lending Act is a federal law that requires lenders to disclose certain information to borrowers before extending credit. It is also known as Regulation Z because it is implemented by the Federal Reserve Board under its Regulation Z. The act aims to promote transparency and protect consumers by ensuring that they have access to accurate and meaningful information about the terms and costs of credit.

Advanced medical directives refer to legal documents that allow individuals to express their preferences and instructions regarding their medical treatment in the event that they become unable to communicate their wishes. The Patient Self Determination Act is a federal law in the United States that requires healthcare providers to inform patients about their rights to make decisions about their medical treatment, including the use of advanced medical directives. Therefore, the Patient Self Determination Act is another name for advanced medical directives.

The correct answer is BBA, which stands for Balanced Budget Act. This federal regulation extended the Medicare ESRD Coordination period from 18-30 months. The Balanced Budget Act was passed in 1997 and included various provisions aimed at reducing the federal budget deficit. One of these provisions was the extension of the coordination period for Medicare beneficiaries with End-Stage Renal Disease (ESRD), which refers to the period during which Medicare is the secondary payer for ESRD-related services. The extension from 18-30 months allowed for a longer period of coordination of benefits for these beneficiaries.

The correct answer is OBRA 1990, Omnibus Budget Reconciliation Act of 1990. This act required hospitals to accept Medicare and Medicaid patients.