(Complete) Certified Breastfeeding Counselor-CBC/
Breastfeeding Consultant Course/ PCE Certified
Breastfeeding Counselor| Exams All With Complete
Solutions| 2024 Q-Bank
Medical Ethics - ANSWERStandards 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 - ANSWERbilling-related cases are based on HIPAA and False
Claims Act.
Health Insurance Portability and Accountability Act of 1996 (HIPPA) -
ANSWERCreated 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 - ANSWERTitile I: Insurance Reform
Title II: Administrative Simplification
Insurance Reform - ANSWER-Primary purpose to provide continuous insurance
coverage for workers and their dependents when they change or lose their jobs.
-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 - ANSWER-The goal is to focus on the health care
practice setting to reduce administrative cost and burdens.
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) - ANSWERFederal law that prohibits submittimg a fraudulent
claim or making statement or representation in connection with a claim.
National Correct Coding Initiative (NCCI) - ANSWERDeveloped 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 - ANSWER1. Column1/Column 2(perviously called
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 (Column 2).
2. Muttually Exclusive Edits: identifeis code pairs that, for clinical reason, are unlikely
to be performed on the same patient on the same day.
Office of Inspector General (OIG) - ANSWERInvestigates and prosecute health care
fraud and abuse.
Fraud - ANSWERKnowingly and intentionally deceiving or misrepresenting
information that may result in unauthorized benefits.
Abuse - ANSWERDefined as incidents or practices, not usually considered fradulaent
that are inconsistant with the accepted medical business or fiscal practices in the
industry.
Patient Confidentiality - ANSWERA;ll patients have the right to privacy, and all
information should remain privileged. 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 - ANSWERTreatment: 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 - ANSWERPhysicians 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 - ANSWER"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.
Medical Records - ANSWERDocumentaiton of the patient's social and medical
history, family history, physical examination findings, progress notes, radiology, and
lab results, consultation reports, and correspondence to patient.
Medical Report - ANSWERPart of the medical record and is a perment legal
document that formally states the cosequences of the patient's examination or
treatment in letter or report form.
Information needed when billing the insurance company - ANSWERDate of service
(DOS), place of service (POS), type of service (TOS), diagnosis (dx or DX), and
procedures.
, Retention of Medical Records - ANSWERGoverned by state and local laws and may
bary from state-to-state. Most physicians are required to retain records indefinitley;
deceased patient records should be kept for at least (5) years.
-algia - ANSWERpain
-emia - ANSWERblood condition
-itis - ANSWERinflammation
-megaly - ANSWERenlargement
-meter - ANSWERmeasure
-oma - ANSWERtumor, mass
-osis - ANSWERabnormal condition
-pathy - ANSWERdisease condition
-rrhagia - ANSWERbursting forth of blood
-rrhea - ANSWERdischarge, flow
-sclerosis - ANSWERhardening
-scopy - ANSWERto view
-centesis - ANSWERsurgical puncture
-ectomy - ANSWERremoval, resection, excision
-gram - ANSWERrecord
-graphy - ANSWERprocess of recording
-lysis - ANSWERsepatation, breakdown, destruction
-pexy - ANSWERsurgical fixation
-plasty - ANSWERsurgical repair
-rrhaphy - ANSWERsuture
-stomy - ANSWERopening
Breastfeeding Consultant Course/ PCE Certified
Breastfeeding Counselor| Exams All With Complete
Solutions| 2024 Q-Bank
Medical Ethics - ANSWERStandards 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 - ANSWERbilling-related cases are based on HIPAA and False
Claims Act.
Health Insurance Portability and Accountability Act of 1996 (HIPPA) -
ANSWERCreated 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 - ANSWERTitile I: Insurance Reform
Title II: Administrative Simplification
Insurance Reform - ANSWER-Primary purpose to provide continuous insurance
coverage for workers and their dependents when they change or lose their jobs.
-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 - ANSWER-The goal is to focus on the health care
practice setting to reduce administrative cost and burdens.
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) - ANSWERFederal law that prohibits submittimg a fraudulent
claim or making statement or representation in connection with a claim.
National Correct Coding Initiative (NCCI) - ANSWERDeveloped 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 - ANSWER1. Column1/Column 2(perviously called
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 (Column 2).
2. Muttually Exclusive Edits: identifeis code pairs that, for clinical reason, are unlikely
to be performed on the same patient on the same day.
Office of Inspector General (OIG) - ANSWERInvestigates and prosecute health care
fraud and abuse.
Fraud - ANSWERKnowingly and intentionally deceiving or misrepresenting
information that may result in unauthorized benefits.
Abuse - ANSWERDefined as incidents or practices, not usually considered fradulaent
that are inconsistant with the accepted medical business or fiscal practices in the
industry.
Patient Confidentiality - ANSWERA;ll patients have the right to privacy, and all
information should remain privileged. 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 - ANSWERTreatment: 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 - ANSWERPhysicians 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 - ANSWER"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.
Medical Records - ANSWERDocumentaiton of the patient's social and medical
history, family history, physical examination findings, progress notes, radiology, and
lab results, consultation reports, and correspondence to patient.
Medical Report - ANSWERPart of the medical record and is a perment legal
document that formally states the cosequences of the patient's examination or
treatment in letter or report form.
Information needed when billing the insurance company - ANSWERDate of service
(DOS), place of service (POS), type of service (TOS), diagnosis (dx or DX), and
procedures.
, Retention of Medical Records - ANSWERGoverned by state and local laws and may
bary from state-to-state. Most physicians are required to retain records indefinitley;
deceased patient records should be kept for at least (5) years.
-algia - ANSWERpain
-emia - ANSWERblood condition
-itis - ANSWERinflammation
-megaly - ANSWERenlargement
-meter - ANSWERmeasure
-oma - ANSWERtumor, mass
-osis - ANSWERabnormal condition
-pathy - ANSWERdisease condition
-rrhagia - ANSWERbursting forth of blood
-rrhea - ANSWERdischarge, flow
-sclerosis - ANSWERhardening
-scopy - ANSWERto view
-centesis - ANSWERsurgical puncture
-ectomy - ANSWERremoval, resection, excision
-gram - ANSWERrecord
-graphy - ANSWERprocess of recording
-lysis - ANSWERsepatation, breakdown, destruction
-pexy - ANSWERsurgical fixation
-plasty - ANSWERsurgical repair
-rrhaphy - ANSWERsuture
-stomy - ANSWERopening
