fraud/abuse/professional issues quiz

Question 1

Which of the following are common types of Medicare Fraud?

• Consistently using procedure codes that describe more extensive services than actually performed
• Altering claim forms, electronic claims records, medical documentation etc. to obtain a higher payment amount
• Misrepresenting as medically necessary non-covered services by billing using covered procedure codes
• Billing for services that were not rendered
• All of the above

Answer 1

all of the above

Question 2

A physical therapist consistently uses a CPT code that is he knows is inappropriate, and does so because the reimbursement is higher. This is an example of:

Answer 2

fraud

Question 3

Which of the following is the best definition of Medicare Fraud?

• Unintentionally executing or attempting to execute a scheme to defraud the Medicare Program by means of false or fraudulent pretenses, representation or promises
• Intentionally deceiving or misrepresenting the truth, knowing that it could result in some unauthorized benefit to himself/herself, or some other individual
• Any attempt to steal money from a Medicare beneficiary
• Assault on a Medicare beneficiary in the course of patient treatment

Answer 3

• Intentionally deceiving or misrepresenting the truth, knowing that it could result in some unauthorized benefit to himself/herself, or some other individual

Question 4

Select the correct answer: “Waste” in the Medicare system includes_____________:

• Practices that are not consistent with the goals of providing patients with services that are medically necessary, meet professionally recognized standards, and are fairly priced
• Practices that, either directly or indirectly, result in unnecessary costs to the Medicare Program.
• a or b

Answer 4

a or b

Question 5

Which Statute prohibits a physician from making a referral for certain designated health services to an entity in which the physician (or a member of his or her family) has an ownership/investment interest or with which he or she has a compensation arrangement?
!

Answer 5

physician self-referall “stark” statute

Question 6

Which Statute was violated in the Power Wheelchair Scam discussed in class?

Answer 6

false claims act

Question 7

APTA divides Direct Access into 3 different categories. “Patient access with provisions” may include which of the following? (Mark all that apply)

• 8 visits with a PT is allowed before the patient must see a physician
• Children seen by a PT as part of school access requirements are not required to have a physician referral
• 30 days of treatment with a PT before patient must see physician
• Specific continuing education is required before a licensed PT can see patients direct access

Answer 7

all of the above

• 8 visits with a PT is allowed before the patient must see a physician
• Children seen by a PT as part of school access requirements are not required to have a physician referral
• 30 days of treatment with a PT before patient must see physician
• Specific continuing education is required before a licensed PT can see patients direct access

Question 8

Which of the following settings is LEAST likely to allow direct access by it’s employed physical therapists?

Private practice
Corporate owned practice
Hospital-based outpatient

Answer 8

hospitla based outpatient

Question 9

T/F
Unrestricted Direct Access in Colorado occurred when entry-level education increased to the DPT.

Answer 9

FALSE

Question 10

When a patient is referred to a physical therapist by a physician, what happens to the physical therapist’s liability risk?

Answer 10

UNCHANGED

Question 11

T/F
According to the Colorado Physical Therapy Practice Act and Rules, ALL physical therapists in Colorado can use the term “Doctor” as part of their introduction to a colleague or patient.

Answer 11

FALSE