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5 Written questions

5 Matching questions

  1. HIPPA defines "fraud" as:
  2. A __ is responsible for supervising & coordinating healthcare services for enrollees:
  3. Examples of "abuse" include:
  4. The term that describes requirements created by accreditation organizations is ___.
  5. The Blue Shield concept grew out of the lumber & mining camps of the ___ region at the turn of the century?
  1. a primary care provider
  2. b Pacific Northwest
  3. c standards
  4. d -excessive charges for services, equipment, or supplies
    -submitting claims for items or services that are not medically necessary to treat the patient's stated condition
    -improper billing practices that result in a payment by a government program when that claim is the legal responsibility of another third-party payer
    -voilations of participating provider agreements w/insurance companies
  5. e an intentional deception misrepresentation that someone makes, knowing it is false, that could result inan unauthorized payment

5 Multiple choice questions

  1. -billing for services not furnished
    -misrepresenting the diagnosis to justify payment
    -soliciting, offering, or receiving a kickback
    -unbunding codes
    -falsifying certificates of medical necessity, plans of treatment, & medical records to justify payment
  2. Baylor University in Dallas, Texas
  3. catastrophic or prolonged
  4. Franklin Health Assurance Company
  5. database, problem list, initial plan, progress notes

5 True/False questions

  1. The government health plan that provides healthcare services to Americans over the age of 65 is called ___?replace fee-for-service plans with affordable, quality care to healthcare consumers

          

  2. The primary intent of HIPPA legislation is to__create better access to health insurance, limit fraud & abuse, and reduce administrative costs.

          

  3. Healthcare coverage offered by ___ is called group health insurance.replace fee-for-service plans with affordable, quality care to healthcare consumers

          

  4. Whick term best describes those who receive managed healthcare plan services?replace fee-for-service plans with affordable, quality care to healthcare consumers

          

  5. The difference between "fraud" & "abuse" is:the individual's intent