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Health Insurance
HI chp 5
| Question | Answer |
|---|---|
| What is a legal newspaper published every business day by the National Archives and Records Administration (NARA)? | Federal Register |
| What is reporting multiple codes for a service when a single column 1 code should be assigned? | Unbundling |
| What contains new and changed Medicare policies and/or procedures that are to be incorporated into a specific CMS program manual? | Program Transmittals |
| What "involves actions that are inconsistent with accepted, sound medical, business, or fiscal practices; it directly or indirectly results in unnecessary costs to the program through improper payments." | Abuse |
| What are procedures or services that could not reasonably be performed at the same session by the same provider on the same beneficiary? | Mutually Exclusive Codes |
| What is the measure of whether a health care procedure or service is appropriate for the diagnosis and/or treatment of a condition? | Medical Necessity |
| What column is the major procedure or service when reported with another code listed in? | One |
| What is an organization that contracts with CMS to process health care claims and perform program integrity tasks for Medicare? | MAC-Medicare Administrative Contractor |
| What are two examples of Fraud? | Billing for services not furnished; misrepresenting a diagnosis to justify payment; soliciting, offering, or receiving kickbacks; unbundling codes; falsifying certificates of medical necessity, plans of treatment, or medical records to justify payment. |
| What column is the lesser procedure or service when reported with another code listed in? | Two |
| What is the storage of documentation for an established period of time, usually mandated by federal and/or state law? | Record Retention |
| What is "an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment?" | Fraud |
| What are pairs of CPT and/or HCPCS level II codes which are not separately payable except under certain circumstances? | CCI Edits |
| What are two examples of Abuse? | Excessive charges for services, equipment, or supplies; submitting claims for items or services not medically necessary; improper billing practices; violations of par-provider agreements with insurance companies. |
| What are the unique identifiers required as part of the HIPAA administration simplification provision? | NPI, EIN, NHPID, and NII |
| What are laws passed by legislative bodies? | Statutes |
| What is the assignment of an ICD-9-CM diagnosis code that does not match patient record documentation for the purpose of illegally increasing reimbursement? | Upcoding |
| What does the acronym RAC mean? | Recovery Audit Contractor |
| What are the NCCI edits designed to detect? | Unbundling |
| What creates national standards to protect individuals' medical records and other personal health information? | HIPAA Privacy Rule |
| What adopts standards and safeguards to protect health information that is collected, maintained, used, or transmitted electronically? | HIPAA Security Rule |
Created by:
YTIMBC
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