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Kduvall
Health Insurance Chapter 5
| Question | Answer |
|---|---|
| Involves actions that are inconsistent with accepted, sound, medical, business, or fiscal practices | abuse |
| A legan newspaper published every business day by the national archives and records administration (NARA) | federal register |
| An intentional deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment | fraud |
| An organization that contracts with CMS to process health care claims and perform program integrity tasks for both Medicare part A and part B | medicare administative contractor |
| Is assigned to third-party payers, has 10 numeric positions, including a check digit as the tenth | national health plan id (planID) |
| Is assigned to health care providers as a 10-digit numeric identifier, including a check digit in the last position | national provider identifier (npi) |
| Funds a provider or beneficiary receives in excess amounts due and payable under medicare and medicaid statutes and regulations | overpayment |
| Document published by medicare that contains new and changed policies and/or procedures that are to be incorporated into a specific CMS program manual | program transmittal |
| The storage of documentation for an established period of time, usually mandated by federal and/or state law | record retention |
| What is the main difference between fraud and abuse? | intent |
| Name an example of fraud: | billing services not provided, unbundling codes |
| Name an example of abuse: | overcharging for services, submits claims for services not medically necessary |
| Name an example of medicare abuse: | improper billing practices that result in medicare payment when the claim is the legal responsibility of another third-party payer |
| What is the name of the document served to a physician ordering him to bring a patient's medical records to a court hearing? | subpoena duces tecum |
| The type of law passed by legislative bodies is known as_________law. | statutory |
| Which civil case document contains a list of questions that must be answered in writing? | interrogatory |
| Which federal law has regulated the conduct of any contractor submitting claims for payment to the federal government since 1863? | false claims act |
| The federal claims collection act requires medicare administrative contractors to: | attempt to recover any reimbursement funds sent as over payment to providers and beneficiaries |
| Since the creation of the Occupational Safety and Health Administration in 1971, workplace fatalities have decreased by: | 50 percent |
| The Physicians at Teaching Hospitals Hospitals (PATH) legislation was passed to: | monitor Medicare rule compliance for payment of part B services and proper coding and billing practices |
| An individual can conduct a comprehensive review of a practitioner's past actions by referring to the: | healthcare integrity and protection data bank |
| One of the provisions of HIPPA designed to improve protability and continuity of health care coverage is: | providing credit for prior health coverage |
| Which department of Health and Human Services agency is responsible for investigating a Medicare provider who is suspected of committing fraud? | office of inspector general |
| In additional to civil, criminal,and administrative penalties, those who commit health care fraud can also be tried for: | mail and wire fraud |
| The first step a physician practice can take to identify areas in the practice that are vulnerable to fraud and abuse is to: | perform periodic audits to internally monitor billing processes |
| An example of overpayment is: | duplicate processing of claim |
| Unless the case involves fraud, administrative contractors are prohibited from seeking overpayment recovery when the: | overpayment is not reopened within 48 months after payment |
| Code combinations that cannot be reported on the same claim are called: | edit pairs |
| The most controversial of the proposed unique identifiers in the administrative simplification provision of HIPAA is the: | national individual identifier |
| Claims that are considered appropriate for electronic data interchange (EDI) are_______ claims | computer tape |
| Assigning passwords to users who are authorized to access patient records is a form of: | security |
| What special handling is required to release medical information for a patient who is HIV-positive? | patient must sign an additional authorization statement for release of information |
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