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NHA credential exam

Certification for Medical B/C

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.
Created by: Successfull