Health Insurance Chapter 5
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Involves actions that are inconsistent with accepted, sound, medical, business, or fiscal practices | abuse
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| A legan newspaper published every business day by the national archives and records administration (NARA) | federal register
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| An intentional deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment | fraud
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| 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
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| Is assigned to third-party payers, has 10 numeric positions, including a check digit as the tenth | national health plan id (planID)
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| Is assigned to health care providers as a 10-digit numeric identifier, including a check digit in the last position | national provider identifier (npi)
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| Funds a provider or beneficiary receives in excess amounts due and payable under medicare and medicaid statutes and regulations | overpayment
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| 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
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| The storage of documentation for an established period of time, usually mandated by federal and/or state law | record retention
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| What is the main difference between fraud and abuse? | intent
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| Name an example of fraud: | billing services not provided, unbundling codes
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| Name an example of abuse: | overcharging for services, submits claims for services not medically necessary
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| 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
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| 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
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| The type of law passed by legislative bodies is known as_________law. | statutory
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| Which civil case document contains a list of questions that must be answered in writing? | interrogatory
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| Which federal law has regulated the conduct of any contractor submitting claims for payment to the federal government since 1863? | false claims act
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| The federal claims collection act requires medicare administrative contractors to: | attempt to recover any reimbursement funds sent as over payment to providers and beneficiaries
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| Since the creation of the Occupational Safety and Health Administration in 1971, workplace fatalities have decreased by: | 50 percent
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| 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
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| An individual can conduct a comprehensive review of a practitioner's past actions by referring to the: | healthcare integrity and protection data bank
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| One of the provisions of HIPPA designed to improve protability and continuity of health care coverage is: | providing credit for prior health coverage
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| 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
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| In additional to civil, criminal,and administrative penalties, those who commit health care fraud can also be tried for: | mail and wire fraud
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| 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
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| An example of overpayment is: | duplicate processing of claim
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| Unless the case involves fraud, administrative contractors are prohibited from seeking overpayment recovery when the: | overpayment is not reopened within 48 months after payment
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| Code combinations that cannot be reported on the same claim are called: | edit pairs
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| The most controversial of the proposed unique identifiers in the administrative simplification provision of HIPAA is the: | national individual identifier
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| Claims that are considered appropriate for electronic data interchange (EDI) are_______ claims | computer tape
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| Assigning passwords to users who are authorized to access patient records is a form of: | security
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| 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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