Protrain #1

according to IRS; income tax returns shoud be maintained permanently.

The maximum dollar value that the insurance company assigns to each medical service is referred to as:

The organization responsible for the design and distribution of the CMS-1500 is the

which prohibits submitting claims or referral of pt's if provider has financial interest with those providing service

psychotherapy notes that have special protection under HIPAA include:

The key to substantiating procedure and diagnosis code selections for proper reimbursement is:

supplemental health care program (SHCP) allows beneficiaries to see civilian provider with no deductible or copay

According to the birthday rule; if mom & dad have same birthday; which applies:

UCR (usual, customary and reasonable) is used mostly in reference to managed care services.

Health care organizations should conduct general compliance training at least annually

The specific dollar amount the pt must pay annually before the insurance will cover anything is known as the: co-payment

THE ORGANIZATION RESPONSIBLE FOR THE DESIGN OF THE CMS-1500 IS:

The CPT modifier used to identify the professional component of a radiology procedure is:

stage __ or __ pressure ulcer acquired after admission is considered a "never event" and will not be covered by Medicare

billing specialists should confirm with employer, if the organizations ____ insurance will protect them for litigation

When a patient does not have insurance, the contract for treatment exists between the:

Policies and procedures should be explained to new employees within the first 4 months of employment

only organizations and poorly managed organizations will experience claim denials

EMTALA requires that everyone who comes to an emergency room must be evaluated and stabilized unless they are uninsured

Cash flow is:

REPORTING CLAIM, USING INCORRECT PROCEDURE CODE THAT RESULTS IN PAYMENT MORE THAN WHAT IT SHOULD BE IS VIOALTION OF:

Under HIPAA, insurance companies could extend their limits for coverage of preexisiting conditions

Health care fraud and abuse violations can result in criminal and civil liabilty for:

what level of education is required for someone who seeks employment as an insurance coder?

group health insurance covers employees and their dependents with lower premiums than an individual policy (contract)

workers comp laws are the same in every state

SUPREME COURT RULED THE AFFORDABLE CARE ACT REQUIREMENT TO HAVE HEALTH INSURANCE OR FACE PENALTY AS UNCONSTITUTIONAL

The organization responsible for the design and distribution of the CMS-1450

workers comp programs are included under HIPAA and therefore must comply with all HIPAA standards

A billing specialist should join a professional organization, they could provide valuable resources

Purpose of HIPAA transaction and code set regulations was to standardize code sets, claim forms and reduce costs

an exception to HIPAA (confideniality waived) is in suspicious death, when proper authorities must be notified

a stable, chronic condition is expected to last at least 1 year and pt. is at their treatment goals.

Insurance company process to review claims, compare with benefit coverage and determine if they will be paid is known as

what is the name of the book a physician's office uses to code a procedure?

Office of the Inspector General has issued compliance guidelines which are published in the Federal Register

The ___ form accompanies all Medicaid payment checks ad details all transactions

Carcinoma in situ is used to describe:

gives members freedom of choice among dr's and hospitals and give shigh level if dr's listed on the plan is called a/an:

to give, release or transfer information to another entity is called consent

the primary goal of an insurance billing specialist is:

Required under HIPAA which classifies each health care provider by education, training and specialty?

Pt comes to ED w/chest pain- after testing, Dr rules: acute myocardial infarction. Chest pain is principle diagnosis.

GUIDELINES FOR CLAIMS SUBMISSION SUCH AS COVERED SERVICES, AND REIMBURSEMENT RATES ARE DICTATED BY:

the focus of reducing administrative costs and burdens are the goals of which HIPAA?

HIPAA requires employers to obtain ____ numbers to identify themselves during enrolling employees in health plan

Which federal agency is responsible 4 implementation of rules, regulations & health policies governing Medicare program

Most states have ____ for Medicaid pt's if they require medical care while out of state

mostly, the government and private insurances ban waiving the copayment portion of the patients fee

If you are certified through a professional organization, you must do continuing education to maintain certification

terms enclsoed in parenthesis following the main term are referred to as:

The abbreviation for the deficit reduction act of 1984 is: DEFRA

Healthcare services which are accepted to be reasonable and adequate for the diagnosis and treatment is referred to as:

You should not give patients the option of "would you like to pay now or have us send you a bill?"

contracting a medical billig company for insurnace claim submisison is called:

confidentiality between physician and pt is automatically waived when the pt is being treated in a workers comp case

An electronic health record (EHR) is an individual provider record of pt - includes med history allergies & appointments

the current HIPAA compliant standard format being used for electronic claim submissions is the:

beginning in the 1990's increases in fraudulent workers comp cases have been reported in big cities

conditions that existed and were treated before the health insurance policy was written are called

a billing specialist can escape liability by pleading ignorance

Under the spousal impoverishment protection law; protection does not count:

A medical practice can have more than 1 fee schedule unless specific state laws restrict this practice

All payers use same definition of "medically necessary" resulting in identical payor policies for coverage of service

Refusal to treat the poor or underinsured at private hospital and transferring them to public hospital is known as:

Most states have ___ for Medicaid payments if medical care is needed while out of state on vacation or for work.

Shortening words and using abreviations that don't follow grammar when writing or sending electronic communication is:

a remittance advice (RA) form accompanies all medicaid checks and details approved, paid, and denied claims.

Emergency care and pregnancy services are exempt from copayment requirements

Under workers comp laws employees are required to purchase insurance to cover injuries that occur while they are at work

workers comp programs are ioncluded under the definition of a "health plan" under HIPAA and must comply with those rules

The patient protection and ACA and health care education reconciliation act passed in what year

a facility which offers accomodations for pt's not sick enought to be in hospital but are too serious to remain at home:

A self employed insurance biller who does independent contracting is responsible for:

Pt. protection, affordable care act, and health care education reconciliation act are federal legislation passed in 2010

Which is health care facility for pt's who are not sick enough to be hospitalized but too serious to be treated at home

Supreme Court ruled the Affordable Care Act requirement for individual to get insurance or face penalty unconstitutional

Supreme court ruled the ACA rule that if you don't have health insurance you pay penalty unconstitutional