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.
Help!
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| Involves actions that are inconsistent with accepted, sound, medical, business, or fiscal practices | show 🗑
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| show | 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 | show 🗑
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| show | medicare administative contractor
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| show | 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 | show 🗑
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| show | 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 | show 🗑
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| The storage of documentation for an established period of time, usually mandated by federal and/or state law | show 🗑
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| What is the main difference between fraud and abuse? | show 🗑
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| show | billing services not provided, unbundling codes
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| show | overcharging for services, submits claims for services not medically necessary
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| Name an example of medicare abuse: | show 🗑
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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? | show 🗑
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| show | statutory
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| Which civil case document contains a list of questions that must be answered in writing? | show 🗑
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| Which federal law has regulated the conduct of any contractor submitting claims for payment to the federal government since 1863? | show 🗑
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| show | 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: | show 🗑
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| show | 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: | show 🗑
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| show | 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? | show 🗑
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| show | 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: | show 🗑
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| show | duplicate processing of claim
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| show | 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: | show 🗑
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| show | national individual identifier
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| show | computer tape
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| show | security
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| What special handling is required to release medical information for a patient who is HIV-positive? | show 🗑
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