Fordneys Medical Insurance Chapters 1 - 9 true or false

Individually identifiable health information is any part of a person's health data obtained from the patient that is created or received by a covered entity

True

Referrals are not required for the TRICARE Select program

True

A Medicare/Medigap claim is not called a crossover claim

false

A Non availability Statement is for individuals who are seeking any type of emergency care service

false

A claims assistant professional (CAP) can interpret insurance policies for patients

false

A group policy usually provides better benefits; however, the premiums are generally higher than an individual contract would be.

false

A roofer takes his girlfriend to a roofing job and she is injured. She is covered under workers' compensation insurance

false

A signature stamp is acceptable by all insurances as proof of the provider's signature on a CMS 1500 claim form.

false

A stamped physician's signature is acceptable on the Doctors First Report of Occupational Injury or Illness form

false

All managed care plans are alike

false

All patients who have a Medicare health insurance card have Part A hospital and Part B medical coverage.

false

All states have a Medicaid time limit of 12 months from the date of service for filing claims

false

An independent contractor is injured while working for a local construction company. The construction company's workers' compensation would cover the related medical bills

false

Beneficiaries of the Veterans Health Administration CHAMPVA program does not need preauthorization for hospice services

false

CHAMPVA is considered primary to Medicare for persons younger than age 65 who are enrolled in Medicare parts A and B

false

Consumer driven health plans are referred to as low deductible plans

false

Deleting files for formatting the hard drive is sufficient to keep electronic protected information from being accessed

false

Glaucoma screening is a covered screening for Medicare patients when performed every 6 months

false

HIPPA requirements protect disclosure of PHI outside of the organization but do not protect against internal use of health information

false

Hospital acquired conditions are payable by the Medicaid program

false

If a Medicaid managed care patient requires medical care, the claim for services should be filed with the state Medicaid's fiscal agent

false

If a health care organization belongs to a preferred provider organization and does not follow his or her contract with the PPO the patient is liable for the bill

false

Independent contractors are covered under the health care organization's professional liability insurance whom the provide services to.

false

It is not necessary to turn documents over to lock them in a secure drawer if you are only leaving your desk for a few moments

false

Medicaid spend down eligibility is determined annually to find out the patient's monthly copayment amount.

false

Medicare patients must pay for diabetes screening

false

Obtaining preapproval for services always ensures payment of a claim by the insurance company

false

Pneumococcal pneumonia vaccine may ben administered annually to Medicare patients

false

Private health insurances are government sponsored programs

false

TRICARE Prime Remote is a program designed for military retirees and their families

false

TRICARE is considered primary to Medicare for persons younger than age 65 who have Medicare Part A as a result of a disability and who have enrolled in Medicare Part B.

false

TRICARE is considered primary to Worker's Compensation if the beneficiary is injured on the job or becomes ill because of his or her work

false

TRICARE is funded by both the state and federal governments

false

The TRICARE Select program became effective January 1, 2017

false

There is only one type of copayment requirement in the Medicaid program

false

Under HITECH civil penalties for HIPAA violations are $100 for each violation with a maximum penalty for $25,000 for all violations of the same provision in a calendar year

false

When a health care organization agrees to accept a single negotiated fee to deliver al medical services related a patient's hip replacement surgery it is referred to a pay for performance

false

A Department of Energy subcontractor diagnosed with a disease resulting from exposure to radiation is covered under workers' compensation

true

A Medicare preventative health benefit is an annual mammogram screening

true

A private duty nurse employed with the XYZ homecare service is injured while moving a patient. She is covered under workers' compensation insurance

true

A provider sponsored organization is a managed care plan that can be owned and operated by a hospital rather than an insurance company

true

A state agency that investigates complaints of mistreatment in long term care facilities is the Medicaid Fraud Control Unit

true

Blue Cross plans provide health care coverage for hospital expenses

true

If a Medicaid patient requires medical care while out of state, the claim for services should be filed with the patient's home state Medicaid program

true

If a provider participates with TRICARE, accepts assignment, and receives payment directly from the regional contractor, the patient will receive a copy of the voucher

true

If an individual seeks medical care for a workers' compensation injury from another state, the state's regulations are followed in which the injured person's claim was originally filed

true

If you knowingly submit a false claim or allow such a claim to be submitted, you can be liable for a civil violation

true

In some states the phrase prior approval may be referred to as prior authorization

true

Insurance billing specialists have a well defined scope of practice

true

It is the coders responsibility to inform administration or his or her immediate supervisor if unethical or illegal coding practices are occurring

true

Medicare's Correct Coding Initiative was implemented by the Centers for Medicare and Medicaid Services to identify procedures that are usually described by a single code or are inherent to another procedure

true

Nonparticipating physicians may decide on a case by case basis whether to accept assignment when providing medical services to Medicare patients

true

Obesity screening and counseling are Medicare preventive health benefits

true

Prescription drug plans refer to the drugs in their formularies by tier numbers

true

Providers must enroll for participation in the Medicaid program with the fiscal agent for their region

true

Service members move often, so it is prudent to ask beneficiaries enrolled in TRICARE to update their information during each office visit

true

TRICARE beneficiaries who use non authorized providers and receive medical services may be responsible for their entire bill

true

The Consolidate Omnibus Reconciliation Act of 1985 mandates that when an employee is laid off from a company, the group health insurance coverage must continue at group rates for up to 18 months

true

The Quality Improvement System for Managed Care provides oversight and ensures accountability of managed care programs

true

The catastrophic cap does not apply to noncovered TRICARE services

true

Under HIPAA patients may request confidential communications and may restrict certain disclosures of PHI

true

Under HIPAA privacy regulations patients do not have the right to access psychotherapy notes

true

Value based reimbursement programs reward health care providers with incentive payments for the quality of care they provide

true

When a patient arrives at a medical office and says he or she was hurt at work, you should verify insurance information with the benefits coordinator for the employer

true

When transmitting a TRICARE claim, always send it to the TRICARE claims office nearest to the residence of the military sponsor

true

When working for the ABC Machining Company, an employee cuts his finger off while using a lathe. He is covered under worker's compensation

true

the HITECH Act requires that business associates comply with the HIPAA Security Rule in the same manner that a covered entity would

true

the birthday rule is a change in the order of determination of COB regarding primary and secondary insurance carriers for dependent children

true

the federal register publishes regulations pertaining to health care regulations

true

the penalty for violating HIPAA and HITECH can be $100 to $50,000 or more per violation

true