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chapter 2,3,4
Insurance handbook for the medical office
| Question | Answer |
|---|---|
| One of the agencies charged with enforcing laws that regulate the health care industry is | Office of Inspector General (OIG) |
| HIPAA transaction standards apply to the following | health care third-party payers, health care providers, health care clearinghouses |
| Enforcement of the privacy standards of HIPAA is the responsibility of the | Office for Civil Rights (OCR) |
| Verbal or written agreement that gives approval to some action, situation, or statement is called | consent |
| An individual's formal written permission to use or disclose his or her personally identifiable health information for purposes other than treatment, payment, or health care operations is called | authorization |
| The Notice of Privacy Practices (NPP) document is given to patients | at the first visit to the practice |
| Privacy regulations allow patients the right to obtain a copy of PHI | only if the health care provider has determined that it would be appropriate and would not endanger the patient or any other person |
| Under HIPAA, patient sign-in sheets | are permissible but limit the information that is requested |
| Under HITECH, if a breach occurs, the covered entity | must notify the affected party no later than 60 calendar days after the discovery of the breach |
| The HIPAA Omnibus Rule enhanced | patients privacy rights |
| Measurable solutions that have been taken, based on accepted standards, and are periodically monitored to demonstrate that an office is in compliance with HIPAA privacy rules are referred to as | reasonable safeguards |
| Stealing money that has been entrusted into one's care is known as | embezzlement |
| Under the Criminal False Claim Act, fines and imprisonment penalties for making a false claim in connection with payment for health care benefits can be imposed on | anyone who knowingly and willfully participated in the scheme |
| The FCA provision that allows a private citizen to bring civil action for a violation on behalf of the federal government and share in any money recovered is referred to as | qui tam |
| The initiative that established hotlines for the public to report issues that might indicate fraud, abuse, or waste is | Operation Restore Trust (ORT) |
| Health care providers who determine that they have submitted false claims should resolve the issue by seeking the Department of Health and Human Services (HHS) and OIG guidance established in 2006 and referred to as | Self-Disclosure Protocol |
| The OIG recommends that health care staff should attend trainings in "general" compliance | at least annually |
| When faced with the discovery of an offense or an error, health insurance specialists should immediately report concerns | using the established chain of command outlined in their compliance plan |
| When a patient goes to a physicians office seeking medical services, the physician accepts the patient and agrees to render treatment, ad both parties agree. This contract is known as a/an | implied contract |
| The process of checking and confirming that a patient is covered under an insurance plan is known as | eligibility verification |
| A provision that allows the policyholder the right to refuse to renew the insurance policy on a premium due date is called | optionally renewable |
| A provision in a health insurance policy in which two insurance carriers work together for payment so that there is no duplication of benefits paid between the primary insurance carrier and the secondary insurance carrier is called | COB |
| A type of tax-free savings account that allows individuals and their employers to set aside money to pay for health care expenses is known as | health savings account, medical savings account, flexible spending account |
| Time Limits for filing insurance claims to a commercial carrier may have a range of | 30 days from the date of service to 1 and a half years |
| Renders a service to a patient | Treating or performing physician |
| Directs selection, preparation, and administration of tests, medication, or treatment | Ordering physician |
| Legally responsible for the care and treatment given to a patient | Attending physician |
| Gives an opinion regarding a specific problem that is requested by another doctor | Consulting physician |
| Sends the patient for tests or treatment or to another doctor for consultation | Referring physician |
| Oversees care of patients in managed care plans and refers patients to see specialists when needed | Primary care physician |
| Responsible for training and supervising medical students | Teaching physician |
| Clinical nurse specialist or licensed social worker who treats a patient for a specific medical problem and uses the results of a diagnostic test in managing a patient's medical problem | Non-physician practitioner |
| Performs one or more years of training in a specialty area while working at a hospital (medical center) | Resident physician |
Created by:
pgran