Study sets matching "reimbursement hipaa"

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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…
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
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
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
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
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…
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.
Chapter 1 Reimbursement, HIPAA, and Compliance
AOA
Medicare Part A
Medicare Part B
beneficiaries
Administration On Aging
Hospital Insurance; hospital/facility care, hospice, some in…
Supplemental Medical Insurance; physician services and durabl…
individuals covered under Medicare
AOA
Administration On Aging
Medicare Part A
Hospital Insurance; hospital/facility care, hospice, some in…
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
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
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…
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
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
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.
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…
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
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
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…
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)
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
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…
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
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…
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
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
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…
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…
HIPAA Flashcards
HIPAA (1996)
PHI
NOPP (Notice of Privacy Practices)
Business Associate
Health Insurance Portability and Accountability Act (1996)
Protected Health Information
Informs patients of their rights, describes how Institutions…
A person/entity that performs certain functions or activities…
HIPAA (1996)
Health Insurance Portability and Accountability Act (1996)
PHI
Protected Health Information
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…
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)
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 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
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.
116 terms
Coding and Reimbursement
Which of the following potential cause…
Coding fraud prevention techniques wou…
use of query forms sent from coders to…
Which of the following is NOT one of t…
pressure from facility to submit claims as quickly as possible
having each employee review their own work
changing the diagnosis slightly would result in increased rei…
hire a consultant to help design compliance programs
Which of the following potential cause…
pressure from facility to submit claims as quickly as possible
Coding fraud prevention techniques wou…
having each employee review their own work
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
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…
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
35 terms
Healthcare Finance & Reimbursement Abbreviations and Definitions
ABN
CDI
CDM
CMI
Advance Beneficiary Notice
Clinical Documentation Improvement
Charge Description Master
Case Mix Index
ABN
Advance Beneficiary Notice
CDI
Clinical Documentation Improvement
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