Certified Billing and Coding Specialist (CBCS) Study Guide (Latest 2022)

Which of the following accurately describes the difference between informed and implied consent? A) Informed consent is required after a procedure, while implied consent is required before a procedure. B) Informed consent only refers to electronic documents, while implied consent refers to written and electronic documents. C) Informed consent is required in writing after explanation of a procedure, with time to ask questions, while implied consent is assumed. D) Informed consent applies to hospitals, while implied consent applies to physicians'' offices. C) Informed consent is required in writing after explanation of a procedure, with time to ask questions, while implies consent is assumed. The correct distinction between informed consent, which requires the patients' signature, and implied consent What is documentation? Documentation is a complete, accurate, up-to-date record of care a patient receives at a health care facility. 00:01 01:23 Disclosure refers to the way health information is: A) Handled by doctors B) Given to an outside person or organization C) Stored D) Organized B) Given to an outside person or Organization Disclosure refers to the dissemination of personal health information, which is covered by the HIPAA Privacy Rule What is the difference between consent and authorization? Authorization: Permission granted by the patient or the patient's representative to release information for reasons other than treatment, payment, or health care operations Consent: Is used only when the permission is for treatment, payment, or health care operations True or False: Physicians have the option to decide whether to explain privacy rules to their patients. False Physicians are legally obligated to explain privacy rules to their patients Auditing refers to which of the following? A) Writing claims B) Signing off on claims C) Sending claims to third-party payers D) Reviewing claims for accuracy and completeness D) Reviewing claims for accuracy and completeness Many facilities have internal auditing systems to review claims for accuracy and completeness. One of the main things an audit looks for is nonspecific or inaccurate use of diagnosis and procedure codes. True or False: Fraud is intentional misrepresentation of information for the purposes of receiving higher payments, while abuse happens unintentionally, often because of poor business practices. True An example of fraud is knowingly billing for services or supplies that were not provided. Abuse includes any practice that is not consistent with the goals of providing patients with services that are medically necessary, meet professionally recognized standards, and are fairly priced. Which of the following accurately defines upcoding? A) Assigning a code that will deliberately result in a higher payment B) Using a shorthand code system C) Including more than one procedure in one code D) Using multiple codes when a comprehensive code is available A) Assigning a code that will deliberately result in a higher payment Assigning a cough with the code for pneumonia is an example of upcoding, and it is fraud The Stark Law states that: A) Debt collection agencies can't use abusive or unfair practices to collect payment B) The government can't be charged for substandard goods or services C) Physicians can't refer patients to practitioners with whom they have a financial relationship D) Private health information must be kept secure C) Physicians can't refer patients to practitioners with whom they have a financial relationship Also referred to as the Physician Self-Referral Law, the Stark Law also prohibits the referred practitioner from presenting claims to Medicare The Office of the Inspector General is responsible for A) Protecting health information B) Fighting fraud C) Helping health care professionals stay compliant with the laws D) Disclosing health information B) Fighting fraud HIPAA established a comprehensive programs to combat fraud called the Health Care Fraud and Abuse Control (HCFAC) program, which is run by the OIG What is a claim? Claims are a complete record of the services provided by the health care professional, along with appropriate insurance information Identify two items of information that need to be on a claim Patient name, Patient's health record number, Patient's account number, Patient's demographic information, Subscribe, Subscriber (member) number, Group or plan number, Prior approval number, Provider name, National Provider Identifier (NPI), Provider's address and telephone number, Date(s) of service, Diagnosis code, Procedure code, Revenue code, Itemized charges for services, Number of services or duration of time, Secondary or other insurance information