50 terms

marcy's medical insurance Quiz 1

marcy reif
Once the insurance billing specialist has learned how to prepare claims for Medicare, he or she can use these same instructions for all third-party payers.
SNOMED may one day be the standard vocabulary for computer-based health records worldwide.
An established patient is anyone who has previously received professional services from the physician or another physician of the same specialty who belongs to the group practice
It is not mandatory that a practice's compliance plan meet all of HIPAA's 7 basic components
Healthcare facilities are using what type of reviews to reduce the many problems associated with reviews made after billing and claims have been submitted?
Who can be affected by HIPAA's privacy rules regarding PHI? (select all that apply.)
Nurses and physicians
B) Insurance billing specialists
C) Computer software technicians
D) Instructors of medical assistant program
What should internal monitoring of the practice's compliance do?
Increase employee conscientiousness
B) Decrease unintentional disclosure of PHI
C) Address risk areas associated with claims processing
D) Ensure third-party payer guidelines are being followed
All activities performed within duties and responsibilities defined in an employee's job description fall under vicarious liability rule.
A) True
B) False
Private insurance companies with whom the provider does not have a contractual agreement will send the check to the patient regardless of whether the patient has signed an assignment of benefits.
Nonprivileged information about a patient consists of the patient's
city of residence
The confidentiality of medical records is protected by federal, state, and common law
It is generally accepted that the physician (or physician group practice) owns a patient's health record
If the medical biller or coder discovers an error in documentation, he or she should
Clarify it with the documenter
A certification program for an insurance billing specialist offered by some educational facilities is called
Certified medical insurance specialist (CMIS)
Being prompt, prepared, polite, positive, productive are the 5 P's of
Workplace behavior
A two- or three-part form that incorporates a combination bill, insurance form, and routing document used in both computer- and paper-based systems is called an encounter form
The CMS website is one of the best tools for keeping current with Medicare and Medicaid
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the physician
The best way for an insurance specialist to keep up to date in the profession is to read health care industry association publications, attend seminars on billing and coding, and participate in e-mail listserv discussions
Under HIPAA, privacy and confidentiality is about who has the right to do which of the following?
A) Access PHI
The Correct Coding Initiative (CCI) detects improperly coded claims through the use of computer edits.
The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as
respondeat superior.
B) let the master answer.
C) vicarious liability
Privileged information is related to the treatment and progress of patients
The efficient medical insurance specialist usually groups together all outstanding charges of patients who have the same type of insurance and processes these insurance claims at the same time
The retention period for Medicare and Medicaid health records is
6 years
What is a possible consequence of HIPAA non-compliance?
B) Liability claims
C) Criminal charges
D) Imprisonment
Fraud is an intentional deception made for personal gain.
In some states, giving an insured client advice on purchase or discontinuance of insurance policies is construed as being an insurance agent
What is a term used to indicate that a person or business has taken all reasonable steps or precautions to ensure the performance of an act meets with certain legal and ethical standards?
Due diligence
Common office procedures an insurance billing specialist might perform in the course of a typical day include all of the following except
Following up on patient care
31. State laws may bar the use of a signature stamp
What are the two provisions of HIPAA?
Health insurance reform
Administrative simplification
33. Physicians are required to use the documentation guidelines developed by the AMA and CMS, formerly the HCFA
The primary goal of an insurance claims assistance professional (CAP) is to assist the consumer in obtaining maximum benefits and to tell the patient what checks to write to providers to make sure there are no overpayments
One of the main objectives of the Security Rule is to protect PHI
Without exception, third parties must obtain a patient's written consent before information contained in his or her medical record will be released
What should medical record documentation always support on the health CMS-1500 claim form?
ICD-9-CM diagnosis codes
Illegal coding practices are subject to penalties, fines, and/or imprisonment
It is very important for everyone who works in health care to have a solid legal background in legal/ethical issues involving the delivery of health care
40. Software edits automatically screen insurance claims electronically for errors
Which skill is not needed to become a successful insurance billing specialist?
If a child has health insurance coverage from two parents, according to the birthday law
the health plan of the person whose birthday (month and day) falls earlier in the calendar year will pay first
The flow of information is a vital component in an organization
44. What action could happen if an employee knowingly submits a fraudulent Medicare or Medicaid claim at the direction of the employer and subsequently the medical practice is audited?
The employee and the employer could be brought into litigation by the state or federal government
What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment?
Notify your physician
Which of the following is not a reason for accurate documentation from the payers' point of view?
A) Ensure that services billed were actually provided.
B) Ensures that services are consistent with insurance contract benefits.
C) Ensure medical necessity and appropriateness of the services provided.
D) Ensure that services billed were performed by a licensed medical doctor.
Under HIPAA, any person or business involved in health care is considered a covered entity.
What characteristics describe the type of contract that exists between a patient and physician?
On average, less than one third of a medical practice's income is received in the form of third-party reimbursements
The process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry is known as eHealth information management