Busy. Please wait.
Log in with Clever

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever

Username is available taken
show password

Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Didn't know it?
click below
Knew it?
click below
Don't Know
Remaining cards (0)
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Health Insurance

HI chp 5

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
Popular Insurance sets




Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!
"Know" box contains:
Time elapsed:
restart all cards