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Using code numbers to increase payment when case documentation does not warrant it is ___?

both illegal and unethical

Telephone conversations by providers in front of patients should be ___?

Avoided

Stealing money that has been entrusted to one's care is known as____?

embezzlement

Obtaining and recording patient data before that person's first visit is known as?

pre-registration

Assigning a code without documentation from the provider is?

both illegal and unethical

A billing specialist is entrusted with?

holding patients' medical information in confidence, collecting monies, being a reliable resource for co-workers. (all of the above)

Reporting incorrect information to the government-funded programs i?

Illegal

Confidential information includes?

Everything that is heard about a patient, everythign that is seen regarding a patient, everything that is read about a patient. (all of the above)

Medical ethics include?

standards of conduct

Excemptions to the right of privacy rule include?

gunshot wound cases

Coding services that were not performed for payment is?

both illegal and unethical

Medical etiquette refers to?

consideration for others.

administrative medical office responsiblities include?

claims submission

Insurance specialist certificate programs include?

diagnostic coding, computer technology, anatomy. (all of the above)

Unbundling services when an available single code includes all services is?

both illegal and unethical

The earliest written code of ethical principles for the medical profession is the ?

Code of Hammurabi

Coding a condition as primary when the majority of the treatment is for a preexisting condition is?

both illegal and unethical

Billing for services or supplies not provided is?

Fraud and illegal

Employees should be required to attend a compliance training session at least?

annually

Physicians are paid based on ____ units?

Relative Value

To bill Medicare beneficiaries at a higher rate than other patients is considered?

abuse

The amount of money an insurance billing specialist earns is dependent on which of the following factors?

Size of employing institution, knowledge, experience. (all of the above)

Reporting incorrect information to a private insurance carrier is?

both illegal and unethical

Confidentiality is automatically waived in cases of?

gunshot wounds, child abuse, extremely contagious diseases. (all of the above)

A self-employed medical insurance biller that does independed contracting is responsible for?

accounting, billing, advertising. (all of these answers)

A patient is considered an inpatient to the hospital on admission?

for an overnight stay

When admitted as a workers' compensation case, the patient will not have an insurance card.

TRUE

The significant reason for which a patient is admitted to the hospital is coded using the?

principal diagnosis

The person who interviews the patient and obtains personal and insurance information and the admitting diagnosis is a/an ?

Admitting Clerk

One the UB-04 claim form, the second digit of the four-digit bill code in Field 4 indicates the type of?

Facility

On the UB-04 form, the patient's date of birth should be entered using 6 digits in block 14.

FALSE

PAT is an abbreviation for?

Pre-Admission Testing

Classifications of surgical and nonsurgical procedures and miscellaneous therapeutic and diagnosis procedures are found in?

ICD-9 CM Volume 3

What is defined as a preexisting condidtion that, because of its effect on the specific princiap diagnosis, will require more intensive therapy or cause an increase in length of stay by at least 1 day in approximately 75% of cases.

Comorbidity

Cases that cannot be assigned an appropriate DRG because of atypical situations are called?

Cost Outliners

The abbreviation of the phrase that indicates when claims are submitted electronically is?

E.D.I. -Electronic Data Interchange

A four-digit code corresponding to each narrative description or standard abbreviation that identifies a specific accommodation, ancillary service, or billing calculation related to services billed is called a/an?

REVENUE CODE

The claim form used for outpatient hospital services is the?

UB-04

The purpose of the DRG-based system is to hold down rising health care costs.

TRUE

Confidential information about patients should never be discussed with?

co-workers, family, friends. (any of these answers)

There is more chance for advancement working in a hospital facility than in a private physician's office.

TRUE

Daily progress notes are entered on the patient's medical record by a/an?

NURSE

When a patient is admitted who has managed care contract for an emergency to a hospital, the managed care program needs to be notified within?

48 hours

The claim form transmitted to the insurance carrier for reimbursement for inpatient hospital services is called the?

UB-04

The DRG-based system changed hospital reimbursement form a fee-for-service system to a lump sum, fixed-fee payment based on the ____ rather than on time or services rendered.

DIAGNOSIS

a EIN is assigned by HIPPA for Tax purposes.

FALSE

Advantage of electronic claims is online error-edit process software.

TRUE

En encounter form is a documented record about services rendered to patient.

TRUE

SOF is not used on electronic claims.

TRUE

837P replaces the paper CMS-1500

TRUE

NPI numbers are not required by Medicare.

FALSE

HIPAA governs how a covered entity handles health information.

TRUE

PMS is a system that prepares, sends, recieves & processes electronic claims.

TRUE

Assigned code to represent data & is done for security purposes.

ENCRYPTION

Entity that recieves EDI & translates it into standard HIPAA format.

CLEARING HOUSE

What is online instant information?

Real Time

What enables funds to be debited, credited or transferred electronically?

EFT

What is the exchange of data in a standardized format through computer systems?

EDI

What gives information on charges paid or denied?

ERA

Group of claims for different patients sent at the same time from 1 facility?

BATCH

Software for practice managment?

PMS

A single charge per hospital admission paid by the managed care plan.

Flat Rate

An outpatient classifciation scheme developed by Health Systems International based on procedures rather than on diagnosis.

Diagnosis-related groups, (DRG'S)

A comprehensive listing of charges based on procedure codes that states fee maximums paid by the health plan.

Fee Schedule

A single charge for a day in the hospital regardless of actual charges or costs incurred.

Per Diem

Dollar amount to a participating provider for health care services rendered to a plan member according to a fee schedule set by the managed care plan.

Charges.

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