NHA NEW CBCS PRACTICE
TESTS- questions with verified
answers.
Medical Ethics - Ans>>>Standards of conduct based on moral principles.
Generally accepted as a guide for behavior towards patients,
physicians, co-workers, the government, and insurance compaines.
Compliance Regulations - Ans>>>billing-related cases are based on
HIPAA and False Claims Act.
,Health Insurance Portability and Accountability Act of 1996 (HIPPA) -
Ans>>>Created the Health Care Frad and Abuse Control Prpgram
enacted nt check for fraud and abuse in the Medicare and Medicaid
programs, and private payers.
Two provisions of HIPPA - Ans>>>Titile I: Insurance Reform
Title II: Administrative Simplification
Insurance Reform. -Primary purpose to provide continuous insurance
coverage for workers and their dependents when they change or lose
their jobs. - Ans>>>-Limits the use of preexisting conditions exclusions
-Prohibits discrimination for part or present poor health
-Guarantees cetraom employees and individuals the right to purchase
health insurance coverage after losing a job
- Allows renewal of health insurance coverage regardless of an
individual's health condition that is covered under the particular policy
Administrative Simplification-The goal is to focus on the health care
practice setting to reduce administrative cost and burdens. -
Ans>>>Two parts:
1. Development and implementation of standardized health-related
financial and administrative activities electronically.
2. Implementation of privacy and security procedures to prevent the
misuse of health information by ensuring confidentiality.
,False Claim Act (FCA) - Ans>>>Federal law that prohibits submittimg a
fraudulent claim or making statement or representation in connection
with a claim.
National Correct Coding Initiative (NCCI) - Ans>>>Developed by the
CMS to promote national correct coding methodologies and to control
improper coding that leads to inappropriate payment of part B health
insurance claims.
Two type of NCCA edits - 1. Column 1 /Column 2 or Comprehensive
Component Edits: identifies code pairs that should not be billed
together because one code. Column 1 includes all the services
described by another code in Column 2. - Ans>>>2. Mutually Exclusive
Edits: identifies code pairs that, for clinical reason, are unlikely to be
performed on the same patient on the same day.
Office of Inspector General (OIG) - Ans>>>Investigates and prosecute
health care fraud and abuse.
Fraud - Ans>>>Knowingly and intentionally deceiving or
misrepresenting information that may result in unauthorized benefits.
Abuse - Ans>>>Defined as incidents or practices, not usually considered
fradulaent that are inconsistant with the accepted medical business or
fiscal practices in the industry.
, Patient Confidentiality- All patients have the right to privacy, and all
information should remain privileged. - Ans>>>Discuss patient
information with only the patient's physician or office personnel that
need cetain information to do their job. Obtained a signed consent
form to release medical infomation to the insurance company or other
individual.
Under HIPPA Privacy Rule, providers may use patient's Protected Health
Information (PHI) without specific authorization for - Ans>>>Treatment:
primarily for the purpose of discussion fo the patient's case with other
providers.
Payment: providers submit claims on behalf of patients.
Operations: for purposes such as stafff training and quality
improvment.
Employern Liability - Ans>>>Physicians are legally responsible for their
own conduct and any action of their employees (their designee)
perform within the context of their employment. Refered to as
"vacarious liability"also known as "respondent superior" which means
"let the master answer".
Employee Liabiltiy - Ans>>>"Errors and omissions insurance" is
protection against loss of monies by failure through error or
unintentional omission on the part of the individual or service
submitting the insurance claim.
TESTS- questions with verified
answers.
Medical Ethics - Ans>>>Standards of conduct based on moral principles.
Generally accepted as a guide for behavior towards patients,
physicians, co-workers, the government, and insurance compaines.
Compliance Regulations - Ans>>>billing-related cases are based on
HIPAA and False Claims Act.
,Health Insurance Portability and Accountability Act of 1996 (HIPPA) -
Ans>>>Created the Health Care Frad and Abuse Control Prpgram
enacted nt check for fraud and abuse in the Medicare and Medicaid
programs, and private payers.
Two provisions of HIPPA - Ans>>>Titile I: Insurance Reform
Title II: Administrative Simplification
Insurance Reform. -Primary purpose to provide continuous insurance
coverage for workers and their dependents when they change or lose
their jobs. - Ans>>>-Limits the use of preexisting conditions exclusions
-Prohibits discrimination for part or present poor health
-Guarantees cetraom employees and individuals the right to purchase
health insurance coverage after losing a job
- Allows renewal of health insurance coverage regardless of an
individual's health condition that is covered under the particular policy
Administrative Simplification-The goal is to focus on the health care
practice setting to reduce administrative cost and burdens. -
Ans>>>Two parts:
1. Development and implementation of standardized health-related
financial and administrative activities electronically.
2. Implementation of privacy and security procedures to prevent the
misuse of health information by ensuring confidentiality.
,False Claim Act (FCA) - Ans>>>Federal law that prohibits submittimg a
fraudulent claim or making statement or representation in connection
with a claim.
National Correct Coding Initiative (NCCI) - Ans>>>Developed by the
CMS to promote national correct coding methodologies and to control
improper coding that leads to inappropriate payment of part B health
insurance claims.
Two type of NCCA edits - 1. Column 1 /Column 2 or Comprehensive
Component Edits: identifies code pairs that should not be billed
together because one code. Column 1 includes all the services
described by another code in Column 2. - Ans>>>2. Mutually Exclusive
Edits: identifies code pairs that, for clinical reason, are unlikely to be
performed on the same patient on the same day.
Office of Inspector General (OIG) - Ans>>>Investigates and prosecute
health care fraud and abuse.
Fraud - Ans>>>Knowingly and intentionally deceiving or
misrepresenting information that may result in unauthorized benefits.
Abuse - Ans>>>Defined as incidents or practices, not usually considered
fradulaent that are inconsistant with the accepted medical business or
fiscal practices in the industry.
, Patient Confidentiality- All patients have the right to privacy, and all
information should remain privileged. - Ans>>>Discuss patient
information with only the patient's physician or office personnel that
need cetain information to do their job. Obtained a signed consent
form to release medical infomation to the insurance company or other
individual.
Under HIPPA Privacy Rule, providers may use patient's Protected Health
Information (PHI) without specific authorization for - Ans>>>Treatment:
primarily for the purpose of discussion fo the patient's case with other
providers.
Payment: providers submit claims on behalf of patients.
Operations: for purposes such as stafff training and quality
improvment.
Employern Liability - Ans>>>Physicians are legally responsible for their
own conduct and any action of their employees (their designee)
perform within the context of their employment. Refered to as
"vacarious liability"also known as "respondent superior" which means
"let the master answer".
Employee Liabiltiy - Ans>>>"Errors and omissions insurance" is
protection against loss of monies by failure through error or
unintentional omission on the part of the individual or service
submitting the insurance claim.
