Protrain #1

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

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

Health care organizations should conduct general compliance training at least annually

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

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

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

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

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

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

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

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

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

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

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

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

Carcinoma in situ is used to describe:

only organizations and poorly managed organizations will experience claim denials

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:

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

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

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

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

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

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

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

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

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

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

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

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

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

a billing specialist can escape liability by pleading ignorance

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

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

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

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

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

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

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

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

Emergency care and pregnancy services are exempt from copayment requirements

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

Cash flow is:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

psychotherapy notes that have special protection under HIPAA include:

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

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

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

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

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

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

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

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

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

the primary goal of an insurance billing specialist is:

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

workers comp laws are the same in every state

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

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