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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


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