1. Not knowing what acronyms CPT and ICD-9-CM stand for could be a possible indicator of inappropriate billing practices by health care providers and claims handling by third party payors.


TRUE: Those having a strong knowledge base and understanding of these coding systems will know what the acronyms mean!


2. All health care providers billing third party payers are under investigation.


TRUE: Payers will conduct some form of evaluation or investigation to determine whether to pay a health care claim or not. The key here for providers is what happens as a result of the investigations - claims paid, claims referred for further investigation, claims denied, etc.


3. Health care providers promising "free" consultations as part of marketing efforts to attract new patients should not bill new patient exams on those receiving free consultations.


TRUE: New patient exams require that the provider meet or exceed the key components of an exam - History, Physical Exam and Medical Decision Making. The promised free consultation will include gaining historical data from the patient on their current and past health conditions, and, as such this data collection would be part of the History component of a new patient exam.


4. Health care providers not treating Medicare beneficiaries or billing Medicare need not be concerned about learning Medicare laws and rules.


FALSE: Today's health care provider will find that many insurers indicate that they follow Medicare guidelines when making their claims reimbursement decisions.


5. One of the most significant aspects of "HIPAA" were provisions it provided to enhance the investigation and prosecution of health care fraud.


TRUE: This act provided for new federal laws to prosecute health care fraud, expanded the ability of prosecutors to access information, financial rewards to investigators for successful prosecutions, etc.