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Confidential information about patients should never be discussed with   show
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when Criterion are used by the review agency for admission screening, this is referred to as   show
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show active, uncontrolled bleeding  
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One criterion that needs to be met for intensity of service (IS) in an admission is   show
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a patient is considered an inpatient to the hospital on admission   show
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when a patient is admitted who has a managed care contract for an emergency to a hospital, the managed care program needs to be notified within   show
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show 72 hour rule  
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show PRO  
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show 7 days of discharge  
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show day outlier review  
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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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show ICD-9-CM Volume 3  
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show at least two digits, and two to four digits  
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The code book used to list procedures on outpatient hospital claims is   show
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the person who interviews the patient and obtains personal and insurance information and the admitting diagnosis is a   show
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show nurse  
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the claim form sent to the insurance carrier for reimbursement for inpatient hospital services is called the   show
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the form that accompanies the billing claim form for inpatient hospital services is called a   show
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show insurance billing editor  
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show hospital consultations, hospital visits and emergency department visits  
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show double billing  
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show admission diagnosis, scheduled procedures, age, an secondary diagnosis  
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how many major diagnostic categories (MDCs) are there in the DRG- based system   show
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On the UB-92 claim form, code 6 (transfer from another health care facility) in block 20 is used to indicate   show
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show UB-92 claim form  
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PAT is an abbreviation for   show
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show utilization review  
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show Healthcare Common Procedures  
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The _____ is the clinical resume for final progress note   show
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The Uniform bill claim form is considered a _____ statement   show
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show outliers  
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The abbreviation of the phrase that indicates when claims are submitted electronically is   show
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On the UB-92 claim form, the first digit of the three-digit bill code in block 4 indicates the type of _____   show
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On the UB-92 claim form, 15:53 listed as the hour of admission indicates that the patient was admitted at   show
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On the UB-92 claim form, the number of inpatient days is indicated in block 7; these are referred to as _____ days   show
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A three- or four-digit code corresponding to each narrative description or standard abbreviation that identifies a specific accomodation, ancillary service, or billing calculation related to services billed is called a ____ code   show
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show Diagnosis  
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show cost outliers  
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show DRG creep  
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show Comorbidity  
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What is the Outpatient Prospective Payment System pricing unit that is comparable to DRGs for inpatient services   show
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show Column1/Column 2 code pair edits mutually exclusive edits medically unlikely edits  
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show fraud is an intentional act of deception to take advantage of another person. Abuse is an action of misusing government allocated money; it is not necessarily intentional  
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what is a compliance plan   show
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show major diagnostic categories  
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A software program used to assign DRGs   show
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show complications  
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show case mix index (CMI)  
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MCE is the abbreviation for   show
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show Correct Coding Initiative (CCI)  
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Identification of services that could not have reasonably been done during a single patient encounter   show
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Programs that align financial incentives with the delivery of high-quality care   show
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show False: Next Busines day  
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T/F: Under HIPAA guidelines, an outside billing company that manages claims and accounts for a medical clinic is known as a covered entity   show
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show True: Remember, the state Insurance Commissioner tracts this data and is published in the public domain.  
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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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A personal check is a guarantee of payment   show
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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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show True  
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Ambulatory Payment Classifications are based on diagnosis   show
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A patient always has the right to obatin a copy of his or 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 physicians office   show
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show True  
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show True  
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The purpose of the DRG based system is to hold down rising health care costs   show
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Confidentiality between the physician and the patient is automatically waived when the patient is being treated in a workers com case   show
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show False. It is the converstion factor  
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Confidential data should be stored only in the computer's hard drive   show
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show True  
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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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The physician's office uses ICD-9-CM Volumes 1,2, and 3 to code diagnoses and procedures   show
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M/C: Confidential information includes: A.) everthing heard about a patient, B.) Everything that is read about a patient, C.) Everything tha tis seen regarding the patient, D.) All the above   show
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M/C: The claim form transmitted to the insurance carrier for reimbursement for inpatient hospital services is called?   show
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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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show Accounts receivable  
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show D.) all the above  
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When a medical practise has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as   show
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show Principle diagnosis  
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The form that accompanies the billing claim for inpatient hospital services is called   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 administration costs and burdens are hte goals of which HIPAA title   show
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show Have the physican return the phone call  
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show 72 hour rule  
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show hospital consultation, hospital visits, emergency department visits  
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show tickler file  
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the document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as a   show
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An example of a technical error on an insurance claim is   show
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The correct method to send documents for a Meedicare reconsideration (Level 2) is by what method   show
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show 1.5 to 2.0 times the charges for 1 month of services  
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show fair debt collection practices act (FDCPA)  
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RVU is   show
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PAT is   show
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show Correct Coding Initiative  
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show Diagnosis related group  
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APC is   show
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show Resource based relative value scale (system)  
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GAF is   show
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show Usual, ustomary and reasonable  
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HL7 is   show
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EIN is   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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show Overpayment  
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show Appeal  
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show collection ratio  
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show Physical  
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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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show Customary (UCR)  
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show embezzelment  
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Billing for services for supplies not provided is   show
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A billing practice such as exccessive 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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show Dun  
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show Statue of limitations  
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in dealing with an estate claim, a call to the _____ can be made periodically to check on the status of the estate   show
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A ____ is a claim on the property of anoher as seurity for a debt   show
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show annually  
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the maximum time during which a legale collection suit may be rendered against a debtor is referred to as a   show
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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 abbreviations 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; suspenstion or probation; demotion; termination; restitution of damages; referral for procecution  
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show health insurance portability and accountability act.  
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Kaiser Permanente's Medical plan is a closed panel program, which means: A.) limits the patients choice of a PCP, B.) Limits the patient choise of a hospital for ER care, C.) Services are provided on a FFS basis, D.) Only Certain illnesses are covered   show
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show D.) Capitation  
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Created by: Lea99