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NHA credential exam
Certification for Medical B/C
Question | Answer |
---|---|
How is the patients DOB entered on the claim form? | MM/DD/YY |
What is an assignment of benefits? | Reimbursement is sent directly from payer to the provider. |
What is Fiscal Intermediary? | An insurance company that bids for a contract with CMS to handle the Medicare program in a specific area. |
What is a Qualified Diagnosis? | A working diagnosis that has not yet been established. |
What is the Civil Monetary Penalties Law (CMPL)? | A law passed by the Federal Government to prosecute cases of Medicaid fraud. |
When was the Health Information and Accountability Act (HIPAA) created? | 1996 |
What are Medical Ethics? | Standards of conduct based on moral principals. |
What are two provisions of HIPPA? | 1. Insurance Reform 2. Administrative Simplification |
What is the False claims Act (FCA)? | A Federal law that prohibits submitting a false claim or making a false statement or representation in connection with a claim. |
What is the national Correct Coding Initiative (NCCI)? | Initiative developed by CMS to promote national correct coding methods and control improper coding that leads to wrong payments of Part B health claims. |
What are the two types of edits that the NCCI implements? | 1. Column 1/Column 2; identified unbundled codes. 2, Mutually Exclusive Edits: Codes that are unlikely to be performed on the same patient in the same day. |
Who investigates and prosecutes Health Care fraud? | Office of Inspector General (OIG) |
When can a provider share PHI without specific permission from th4e patient? | 1. For treatment (discussing the case with another professional). 2. Payment (When providers submit claims on the patient's behalf). 3. Operations: Staff training and Quality Improvement. |
What is Employer Liability? | Physicians are legally responsible for their actions and their employee's actions, aka Respondant Superior. (Let the master answer.) |
What is Employee Liability Insurance? | Protection against loss of money caused by failure through error or unintentional omission of the individual or service submitting the claim. |
What is in a Medical Record? | -Social and Medical History -Family History -Physical Exam Findings -Progress Notes -Lab/rad Results -Consultation Reports -Correspondence to the patient |
When billing an insurance company, what information must be included? | Date of Service (DOS) Place of Service (POS) Type of Service (TOS) Diagnosis Procedure(s) |
How long should Medical Records be retained? | Governed by State and Local laws; should retained indefinitely. For deceased patients, they should be kept at least 5 years. |