How can we help?

You can also find more resources in our Help Center.

Study sets matching "reimbursement hipaa"

Study sets
Classes
Users

Study sets matching "reimbursement hipaa"

50 terms
Reimbursement, HIPAA, and compliance
What two groups of persons were added…
To what organization did the secretary…
What government program handles the fu…
There are three items that Medicare be…
people with disabilities and end stage renal disease
CMS (Center for Medicare and Medicaid Services) now known as…
Social Security Administration
deductibles, premiums and co-insurance
What two groups of persons were added…
people with disabilities and end stage renal disease
To what organization did the secretary…
CMS (Center for Medicare and Medicaid Services) now known as…
38 terms
Abbreviations for reimbursement, HIPAA, and compliance
AOA
NHE
DHHS
CMS
Administration on Aging
National Health Expenditure
Department of Health and Human Services
Centers for Medicare and Medicaid Services
AOA
Administration on Aging
NHE
National Health Expenditure
52 terms
Reimbursement, HIPAA, and compliance
What two groups of persons were added…
To what organization did the secretary…
What government program handles the fu…
There are three items that Medicare be…
people with disabilities and end stage renal disease
CMS (Center for Medicare and Medicaid Services) now known as…
Social Security Administration
deductibles, premiums and co-insurance
What two groups of persons were added…
people with disabilities and end stage renal disease
To what organization did the secretary…
CMS (Center for Medicare and Medicaid Services) now known as…
52 terms
Reimbursement, HIPAA, and compliance
What two groups of persons were added…
To what organization did the secretary…
What government program handles the fu…
There are three items that Medicare be…
people with disabilities and end stage renal disease
CMS (Center for Medicare and Medicaid Services) now known as…
Social Security Administration
deductibles, premiums and co-insurance
What two groups of persons were added…
people with disabilities and end stage renal disease
To what organization did the secretary…
CMS (Center for Medicare and Medicaid Services) now known as…
52 terms
Reimbursement, HIPAA, and compliance
What two groups of persons were added…
To what organization did the secretary…
What government program handles the fu…
There are three items that Medicare be…
people with disabilities and end stage renal disease
CMS (Center for Medicare and Medicaid Services) now known as…
Social Security Administration
deductibles, premiums and co-insurance
What two groups of persons were added…
people with disabilities and end stage renal disease
To what organization did the secretary…
CMS (Center for Medicare and Medicaid Services) now known as…
52 terms
Reimbursement, HIPAA, and compliance
What two groups of persons were added…
To what organization did the secretary…
What government program handles the fu…
There are three items that Medicare be…
people with disabilities and end stage renal disease
CMS (Center for Medicare and Medicaid Services) now known as…
Social Security Administration
deductibles, premiums and co-insurance
What two groups of persons were added…
people with disabilities and end stage renal disease
To what organization did the secretary…
CMS (Center for Medicare and Medicaid Services) now known as…
52 terms
Reimbursement, HIPAA, and compliance
What two groups of persons were added…
To what organization did the secretary…
What government program handles the fu…
There are three items that Medicare be…
people with disabilities and end stage renal disease
CMS (Center for Medicare and Medicaid Services) now known as…
Social Security Administration
deductibles, premiums and co-insurance
What two groups of persons were added…
people with disabilities and end stage renal disease
To what organization did the secretary…
CMS (Center for Medicare and Medicaid Services) now known as…
38 terms
Chapter 1 Reimbursement, HIPAA, & Compliance
False
True
True
True
Kickbacks from patients are allowed under certain circumstanc…
Fraud is an intentional deception or misconception or represe…
Nationally, unit value have been assigned for each service by…
The federal register is the official publication for all pres…
False
Kickbacks from patients are allowed under certain circumstanc…
True
Fraud is an intentional deception or misconception or represe…
55 terms
Chapter 1 Reimbursement, HIPAA, and Complance
Coding systems are used
Coder's responsibility to
Third-party payers
ICD-10 is for what
in outpatient and inpatient health care settings
accurately and completely code for optimum reimbursement
any organization, public or private, that pays or insures hea…
For Diagnosis
Coding systems are used
in outpatient and inpatient health care settings
Coder's responsibility to
accurately and completely code for optimum reimbursement
28 terms
Chapter 1 Reimbursement, HIPAA, and Compliance
What is your responsibility as a medic…
__________ (maximizing) is never appro…
What is the fastest growing patient se…
By 2060, the ________________ populati…
1. ensure accurate coding data... 2. obtain correct reimbursemen…
upcoding
elderly
65 or older
What is your responsibility as a medic…
1. ensure accurate coding data... 2. obtain correct reimbursemen…
__________ (maximizing) is never appro…
upcoding
124 terms
Chapter 1 Reimbursement, HIPAA, Compliance
What is 3rd party reimbursement?
What is the job/responsibility of the…
What is the 1st party?
What is the 2nd party?
Insurance payment
optimize payment by using accurate coding data and obtain cor…
you, the patient
provider of service
What is 3rd party reimbursement?
Insurance payment
What is the job/responsibility of the…
optimize payment by using accurate coding data and obtain cor…
50 terms
CHAPTER 1: REIMBURSEMENT, HIPAA, AND COMPLIANCEW
What two groups of persons were added…
To what government organization did th…
What government organization handles t…
There are three items that Medicare be…
-Diabled... -End Stage Renal Disease
-CMS: Centers for Medicare and Medicaid Services
-Social Security Administration
-Deductible... -Premiums... -Co-Insurance
What two groups of persons were added…
-Diabled... -End Stage Renal Disease
To what government organization did th…
-CMS: Centers for Medicare and Medicaid Services
27 terms
chapter 1 Reimbursement, HIPAA and Compliance
The major third-party payee in the Uni…
The Medicare program was established i…
Hospital Insurance is Medicare, Part
Supplemental Medical Insurance is Medi…
The government
1965
A
B
The major third-party payee in the Uni…
The government
The Medicare program was established i…
1965
124 terms
Chapter 1 Reimbursement, HIPAA, Compliance
What is 3rd party reimbursement?
What is the job/responsibility of the…
What is the 1st party?
What is the 2nd party?
Insurance payment
optimize payment by using accurate coding data and obtain cor…
you, the patient
provider of service
What is 3rd party reimbursement?
Insurance payment
What is the job/responsibility of the…
optimize payment by using accurate coding data and obtain cor…
25 terms
Reimbursement, HIPAA, and Compliance (Chapter 1)
What two groups of persons were added…
To what government organization did th…
What government organization handles t…
There are three items that Medicare be…
A. Persons eligible for disability benefits from Social Secur…
The centers for Medicare and Medicaid Services.
Social Security Administration handles the funds for the Medi…
Deductible, Premiums and Coinsurance.
What two groups of persons were added…
A. Persons eligible for disability benefits from Social Secur…
To what government organization did th…
The centers for Medicare and Medicaid Services.
28 terms
Reimbursement, HIPAA, and Compliance Chapter 1
Assignment
DHHS
Group Practice Model
Health Maintenance Organization (HMO)
Medicare's payment for the service, which participating physi…
Department of Health and Human Services
an organization of physicians who contract with a Health Main…
A health care delivery system in which an enrollee is assigne…
Assignment
Medicare's payment for the service, which participating physi…
DHHS
Department of Health and Human Services
10 terms
Chapter 1 Reimbursement, HIPAA, and Compliance
Beneficiary pays:
Medicare pays:
Part C: Medicare Advantage Organizations
Medicare Part D: Prescription Drug Ben…
deductible, premiums, coinsurance (20%), 100% of non-covered…
80% of covered Services
under part C are: ... 1) Medicare Health Maintenance Organizatio…
pays a portion of prescription drug expenses and cost sharing…
Beneficiary pays:
deductible, premiums, coinsurance (20%), 100% of non-covered…
Medicare pays:
80% of covered Services
38 terms
Chapter 1 Reimbursement, HIPAA, & Compliance
False
True
True
True
Kickbacks from patients are allowed under certain circumstanc…
Fraud is an intentional deception or misconception or represe…
Nationally, unit value have been assigned for each service by…
The federal register is the official publication for all pres…
False
Kickbacks from patients are allowed under certain circumstanc…
True
Fraud is an intentional deception or misconception or represe…
43 terms
Medical Billing: Reimbursement, HIPAA, a& Compliance
What is your responsibility as a coder?
Fastest growing patient segment is?
How much will health care spending rea…
When was medicare established?
Ensure accurate coding data, obtain correct reimbursement for…
The elderly, by 2050, 20% of population will be 65 or older
$4.4 millon
1965
What is your responsibility as a coder?
Ensure accurate coding data, obtain correct reimbursement for…
Fastest growing patient segment is?
The elderly, by 2050, 20% of population will be 65 or older
124 terms
Chapter 1 Reimbursement, HIPAA, Compliance HINT 222
What is 3rd party reimbursement?
What is the job/responsibility of the…
What is the 1st party?
What is the 2nd party?
Insurance payment
optimize payment by using accurate coding data and obtain cor…
you, the patient
provider of service
What is 3rd party reimbursement?
Insurance payment
What is the job/responsibility of the…
optimize payment by using accurate coding data and obtain cor…
25 terms
SBSW, Reimbursement, HIPAA, and Compliance Chapter 1.
What two groups of persons were added…
To what government organisation did th…
What government organization handles t…
There are 3 items that Medicare benefi…
Persons eligible for disability benefits from Social Security…
CMS Centers for Medicare and Medicaid Services.
Social Security Administration.
Deductibles, premiums, and coinsurance.
What two groups of persons were added…
Persons eligible for disability benefits from Social Security…
To what government organisation did th…
CMS Centers for Medicare and Medicaid Services.
43 terms
Medical Billing: Reimbursement, HIPAA, a& Compliance
What is your responsibility as a coder?
Fastest growing patient segment is?
How much will health care spending rea…
When was medicare established?
Ensure accurate coding data, obtain correct reimbursement for…
The elderly, by 2050, 20% of population will be 65 or older
$4.4 millon
1965
What is your responsibility as a coder?
Ensure accurate coding data, obtain correct reimbursement for…
Fastest growing patient segment is?
The elderly, by 2050, 20% of population will be 65 or older
18 terms
Quiz - Chapter 1: Reimbursement, HIPAA, and Compliance
Part A
Part D
Part B
100%, 50%, 50%, 50%, 50%
Hospice care
Prescription drug
Physician visits
If a surgeon performs more than one procedure on the same pat…
Part A
Hospice care
Part D
Prescription drug
46 terms
Chapter 01 Exercise Reimbursement, HIPAA, & Compliance
The coder's responsibility is to ensur…
The Federal Register is the official p…
Nationally, unit values have been assi…
Fraud is an intentional deception or m…
True
True
True
True
The coder's responsibility is to ensur…
True
The Federal Register is the official p…
True
13 terms
Homework - Chapter 1: Reimbursement, HIPAA, and Compliance
A, B
CMS
Social Security Administration
65 and over, some disabilities, kidney…
Two insurance programs were established in 1965 by amendments…
The Secretary of DHHS has delegated responsibility for Medica…
Who administers funds for Medicare?
Who is eligible for Medicare?
A, B
Two insurance programs were established in 1965 by amendments…
CMS
The Secretary of DHHS has delegated responsibility for Medica…
18 terms
Guide to HIPAA
HIPAA
Health Insurance Portability and Accou…
Title I of HIPAA
Title II of HIPAA
Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act (HIPA…
Protects health insurance coverage for workers and their fami…
Known as the Administrative Simplification (AS) provisions, r…
HIPAA
Health Insurance Portability and Accountability Act
Health Insurance Portability and Accou…
The Health Insurance Portability and Accountability Act (HIPA…
45 terms
Reimbursement
What two groups of persons were added…
To what organization did the secretary…
What government program handles the fu…
There are three items that Medicare be…
people with disabilities and end stage renal disease
CMS (Center for Medicare and Medicaid Services)
Social Security Administration
deductibles, premiums and co-insurance
What two groups of persons were added…
people with disabilities and end stage renal disease
To what organization did the secretary…
CMS (Center for Medicare and Medicaid Services)
32 terms
Reimbursement
What is coordination of benefits
Is a personal check a guaranteed payment
What is a preexisting condition
Most physician/patient contracts are
Two insurance carriers working together and coordinating the…
False
An illness or injury acquired before enrollment in an insuran…
Implied
What is coordination of benefits
Two insurance carriers working together and coordinating the…
Is a personal check a guaranteed payment
False
19 terms
Reimbursement Exam 1
The physician's office sent a request…
All of the following are discounted fe…
A patient saw a neurosurgeon for treat…
In which type of reimbursement methodo…
Claim
ACO
Work Comp
Retrospective payment
The physician's office sent a request…
Claim
All of the following are discounted fe…
ACO
17 terms
PROF Chapt 11 Reimbursement
2.8, 8200, 17
Cost containment... Disease prevention... Ev…
increased premium to employer, premium…
Accountable care organizations (ACOs)
o Increasing cost for health care... ♣ ____ trillion or about ?/…
o Health care reform efforts focus on:... name 3
Barriers ACA
were created to reduce duplication of services and reduce costs
2.8, 8200, 17
o Increasing cost for health care... ♣ ____ trillion or about ?/…
Cost containment... Disease prevention... Ev…
o Health care reform efforts focus on:... name 3
19 terms
HIPAA
HIPAA
PHI
Covered entities
Treatment
Health Insurance Portability and Accountability Act
protected health information, as individually identifiable
health care providers, health plans, and health care... clearing…
consultation between health care providers... regarding a patien…
HIPAA
Health Insurance Portability and Accountability Act
PHI
protected health information, as individually identifiable
36 terms
HIPAA
federal federal
covered entity
business associate
protected health information
HIPAA is a __ statute with requirements spelled out in __ reg…
CE
BA
PHI
federal federal
HIPAA is a __ statute with requirements spelled out in __ reg…
covered entity
CE
32 terms
HIPAA review questions
Compliance is the process of
Transactions in which health care info…
Baby Nelson was born January 20, 2005,…
A code system used for managing patine…
Meeting regulation, recommendations, and expectations of fede…
1. e-Health information Management... 2. eHIM
YYYYMMDDHHMM 200501200715
1. Systematized nomenclature of human and Veterinacy medicine…
Compliance is the process of
Meeting regulation, recommendations, and expectations of fede…
Transactions in which health care info…
1. e-Health information Management... 2. eHIM
30 terms
HIT 230 - CH 2 Reimbursement & Insurance
The code sets to be used for healthcar…
The first three characters in an ICD-9…
What organizations maintain the ICD-9-…
Where are the ICD-9-CM coding guidelin…
The Health Insurance Portability and Accountability Act of 19…
Category
National Center for Health Statistics (NCHS) and the Centers…
Coding Clinic for ICD-9-CM
The code sets to be used for healthcar…
The Health Insurance Portability and Accountability Act of 19…
The first three characters in an ICD-9…
Category
30 terms
Hipaa privacy chapter 17
Business associates
Complainant
Divulge
Incidental disclosure
Individuals or organizations that perform or assistance cover…
The person making a complaint against another person or organ…
To make known, as a confidence or secret
A secondary use of health information that cannot reasonably…
Business associates
Individuals or organizations that perform or assistance cover…
Complainant
The person making a complaint against another person or organ…
46 terms
Chapter 17 - HIPAA
P.H.I
Covered Entity
HIPAA Limits
Provisions
Protected health information
an organization that transmits in electronic form during a tr…
the use of restrictive pre-existing conditions with regards t…
hipaa contains two of them
P.H.I
Protected health information
Covered Entity
an organization that transmits in electronic form during a tr…
21 terms
HIPAA
HIPAA
HIPAA was required to be implemented b…
Signed permission from the pt ____ be…
Any information except:... T... P... O
Health insurance portability and accountability act
2003
Must, any
Treatment... Payment... Operations
HIPAA
Health insurance portability and accountability act
HIPAA was required to be implemented b…
2003
75 terms
Billing and Reimbursement
Covered service
Non covered service
Medically necessary services
Premiums
Medical procedures and treatments included as services under…
Medical procedure not included in a plan's benefits.
Payment criterion that requires medical treatments to be appr…
Money the insured pays to a health plan for a policy.
Covered service
Medical procedures and treatments included as services under…
Non covered service
Medical procedure not included in a plan's benefits.
67 terms
Medical Reimbursement: Ch 4, 7, 8 Review
medical record
integrated record
fines and penalties, excluded from Med…
section is in error, date, time, corre…
Written or graphic information about patient care is termed _…
__________ is written or dictated to record chronological fac…
If a medical practice is audited by Medicare officials and in…
An electronic record should be corrected by making a note tha…
medical record
Written or graphic information about patient care is termed _…
integrated record
__________ is written or dictated to record chronological fac…
58 terms
Law and Ethics Ch. 8 HIPAA
HIPAA
PHI
Privacy
Covered Entities
Health Insurance Portability and Accountability Act... A federal…
Protected health information. Contains information that has o…
Freedom from unauthorized intrusion. Protected by the 1st, 3r…
Healthcare providers that transmit HIPAA transactions electro…
HIPAA
Health Insurance Portability and Accountability Act... A federal…
PHI
Protected health information. Contains information that has o…
21 terms
HIPAA
what is HIPAA
what us the HIPAA privacy rule
what are the 3 main components of the…
what is the transaction rule
The Health Insurance Portability and Accountability Act
informs you of privacy practices and how to protect privacy o…
1) transaction rule ... 2) security rule ... 3) privacy rule
to simplify and standardize how certain electronic transactio…
what is HIPAA
The Health Insurance Portability and Accountability Act
what us the HIPAA privacy rule
informs you of privacy practices and how to protect privacy o…
Unit 4: Reimbursement
reimbursement process
patient registration
billing for services
retrospective reimbursement
patient registration... treatment... billing for services
referral... insurance verification... identify co-payments... identify…
CPT and ICD-9 codes... payment methods... fee schedules
negotiated after services provided
reimbursement process
patient registration... treatment... billing for services
patient registration
referral... insurance verification... identify co-payments... identify…
Reimbursement
What two groups of persons were added…
To what organization did the secretary…
What government program handles the fu…
There are three items that Medicare be…
people with disabilities and end stage renal disease
CMS (Center for Medicare and Medicaid Services)
Social Security Administration
deductibles, premiums and co-insurance
What two groups of persons were added…
people with disabilities and end stage renal disease
To what organization did the secretary…
CMS (Center for Medicare and Medicaid Services)
94 terms
Reimbursement Exam 1
Two types of healthcare reimbursement…
self pay, traditional retrospective pa…
capitated payment, global payment, pro…
unit of payment, time orientation, deg…
fee-for-service, episode-of-care
fee for service
episode of care
characteristics of methodologies
Two types of healthcare reimbursement…
fee-for-service, episode-of-care
self pay, traditional retrospective pa…
fee for service
17 terms
Legal ch 12 ROI Reimbursement and Fee Structure
The HIPAA Privacy Rule permits
Fees related to providing copies of ac…
Costs factored into ROI costs
Steps in assessing costs for e-discovery
reasonable, cost-based charges for labor, postage, and suppli…
-Covered entity must provide the first accounting in any 12 m…
-Systems and hardware to accommodate the ROI function... -Applic…
1. Identify all places that could store patient information.…
The HIPAA Privacy Rule permits
reasonable, cost-based charges for labor, postage, and suppli…
Fees related to providing copies of ac…
-Covered entity must provide the first accounting in any 12 m…
132 terms
HIT 215 reimbursement ch 1 & 2
reimbursement
done by coding
before 1996
HIPAA
pymt to healthcare providers & facilities for svcs done to pa…
communication of svcs from provider to 3rd party payer
were no standards for coding ... used ICD-9 but not up to date
standardized coding - use ICD-9 & HCPCS
reimbursement
pymt to healthcare providers & facilities for svcs done to pa…
done by coding
communication of svcs from provider to 3rd party payer
65 terms
HIT 215 reimbursement ch 2
reimbursement
done by coding
before 1996
HIPAA
pymt to healthcare providers & facilities for svcs done to pa…
communication of svcs from provider to 3rd party payer
were no standards for coding ... used ICD-9 but not up to date
standardized coding - use ICD-9 & HCPCS
reimbursement
pymt to healthcare providers & facilities for svcs done to pa…
done by coding
communication of svcs from provider to 3rd party payer
130 terms
PRG Guide RHIT Exam Questions -- Medical Billing and Reimbursement Systems
1. The case-mix management system that…
2. The prospective payment system used…
3. Under APCs, the payment status indi…
4. All of the following items are "pac…
C. Resource Utilization Groups (RUGs).
B. OASIS (Outcome and Assessment Information Set).
D. is packaged into the payment for other services.
D. medical visits.
1. The case-mix management system that…
C. Resource Utilization Groups (RUGs).
2. The prospective payment system used…
B. OASIS (Outcome and Assessment Information Set).
103 terms
Principles in Healthcare Reimbursement
Assignment of benefits
Coinsurance
Deductible
Diagnoses
authorization by policyholder that allows a health plan to pa…
the portion of charges that an insured person must pay for he…
An amount of money that an insured person must pay annually b…
a physician's opinion of the nature of patients' illness or i…
Assignment of benefits
authorization by policyholder that allows a health plan to pa…
Coinsurance
the portion of charges that an insured person must pay for he…
24 terms
Reimbursement final
Medicare definition of "fraud"
Medicare definition of "abuse"
when was the False Claim Act passed
basic elements of a Medicare Complianc…
billing for a service that was not rendered
submitting a procedure code that describes a service that was…
during the civil war
designation of a compliance officer, committee, policies and…
Medicare definition of "fraud"
billing for a service that was not rendered
Medicare definition of "abuse"
submitting a procedure code that describes a service that was…
1 of 10