Reimbursement and HIPAA
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| show | False. Next business day.
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| show | False. Clearinghouses, Providers and Third party payers are "Covered Entities".
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| Insurance companies are rated according to the number of complaints received about them. | show 🗑
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| When a physician offers a discount, it must apply to the total bill, not just the portion that is paid by the patient. | show 🗑
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| show | False.
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| Standard policy should be to reduce fees of any patient who dies after receiving medical care. | show 🗑
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| In the UCR system of payment, "Usual" is the fee that the physician usually charges for a given serive to a private patient. | show 🗑
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| Ambulatory Payment Classifications are based on diagnoses. | show 🗑
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| A patient always has the right to obtain a copy of his/her confidential health information. | show 🗑
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| A collection rate of 80-85% should be a goal for the practise administrator in charge of collections in the physician's office. | show 🗑
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| show | True.
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| show | True.
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| show | True.
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| show | True.
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| The cash factor is used to translate the abstract units (RVUs) in the scale to dollar fees for each serivce or procedure. | show 🗑
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| Confidential data should be stored only in the computer's hard drive. | show 🗑
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| Appeal decisions on Medicare unassigned insurance claims are sent to the patient. | show 🗑
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| show | True.
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| When a physician continues to treat an established patient with an overdue account, patients who fall into this delinquent status should be referred elsewhere. | show 🗑
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| show | False. Volume 1 and 2 only in the private office.
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| show | All the above.
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| show | UB-04
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| M/C: A group of insurance claims sent at the same time from one facility is known as a: | show 🗑
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| The most important function of a practise management system is: | show 🗑
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| M/C: A clearinghouse performs:1. Transmits claims to the insurance payer.2. Performs software edits.3. Separates claims by carrier.4. All of the above. | show 🗑
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| show | Carrier-direct
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| The significant reason for which a patient is admitted to the hospital is coded using the: | show 🗑
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| The form that accompanies the billing claim for inpatient hospital services is called a/an: | show 🗑
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| Nonprivilged information about a patient consists of the patient's: | show 🗑
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| The focus on the health care practise setting and reducing administrative costs and burdens are the goals of which HIPAA Title: | show 🗑
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| What is the correct response when a relative calls asking about a patient? | show 🗑
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| The rule stating that when a patient receives outpatient services within 72 hours of admission, then all outpatient services are combined with inpatient services and become part of the diagnostic-related group for the admission, is called the____? | show 🗑
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| show | Hospital consultations; Hospital visits; Emergency department visits.
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| Pending or resubmitted insurance claims may be tracked through a_______? | show 🗑
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| The document togethar with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as a/an? | show 🗑
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| show | Duplicate dates of service; Transposed numbers; Missing "Place of service" codes.
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| The correct method to send documents for a Medicare reconsideration (Level 2) is by what method? | show 🗑
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| The average amount of accounts receivable should be? | show 🗑
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| What is the name of the Act designed to address the collection practises of third party debt collectors and attorneys who regularly collect debts from others? | show 🗑
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| show | Relative Value Unit
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| What does PAT stand for? | show 🗑
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| show | Correct Coding Initiative.
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| What does DRG stand for? | show 🗑
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| What does APC stand for? | show 🗑
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| show | Resource Based Relative Value Scale(System)
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| show | Geographic Adjustment Factor
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| show | Usual, Customary and Reasonable
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| What does HL7 stand for? | show 🗑
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| What does EIN stand for? | show 🗑
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| Assigning a code to represent data is known as? | show 🗑
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| show | Back-up
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| If the medical practise receives payment from an insurance company that is more than the contracted rate, it is called a/an ____? | show 🗑
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| show | Appeal
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| show | Collection Ratio
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| How the physician's office handles the retention, removal, and disposal of paper records is a/an _________ safeguard. | show 🗑
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| show | Utilization Review.
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| show | Revenue Code
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| show | Diagnosis and Treatment
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| The range of usual fees charged by providers of similar training and experience in a geographic area is called? | show 🗑
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| Stealing money that has been entrusted to one's care is known as? | show 🗑
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| show | Fraud
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| A billing practise such as excessive referrals to other providers for unnecessary services is considered? | show 🗑
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| The procedure of systematically arranging the accounts receivable by age from the date of service is called? | show 🗑
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| The statement "This bill is now 30 days past due. Please remit payment." This is known as what kind of message? | show 🗑
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| A formal regulation of law setting time limits on legal action is known as what? | show 🗑
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| show | Executor
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| show | Lien
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| show | Annually
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| show | Statue of Limitation
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| What are the three names for the form used by inpatient billing services? | show 🗑
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| Explain the following formula. Not only what the abbrevations stand for, but also their meaning: RVU X GAF X CF= MEDICARE REIMBURSEMENT | show 🗑
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| show | Verbal warning; Written warning; Written reprimand; Suspension or probation; Demotion; Termination; Restitution of damages; Referral for prosecution.
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| show | Health Insurance Portability and Accountablity Act. (1996 signed into law by Pres. Clinton)
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