Which of the following accurately describes the difference between an informed and implied private

The stark law states that

Physicians can't refer patients to practitioners with whom they have a financial relationship.

What is an NPI number? Where does it go on CMS-1500?

The NPI number is the National Provider Identifier and it goes on line 33A

What is a claim?

A claim is a complete record of all the services provided to a patient.

The primary insurance plan does which of the following

pays first

Which of the following accurately describes the difference between informed and implied consent

Informed consent is required in writing after explanation of a procedure, with time to ask questions, while implied consent is assumed.

Which of the following accurately defined pre-authorization

A health plan to give approval of an inpatient hospital stay for a surgical procedure

Which of the following describes a clean claim

All the necessary data elements are completed.

List three purposes of ICD-10-CM

Among the correct response are classifying morbidity and mortality, indexing hospital records by disease and operation reporting diagnosis by physician, storing and retrieving data, national morbidly and mortality data, serving as the basis of diagnosis-related group assignment for hospital reimbursement, reporting and compiling health care data, determining patterns of care among provider analyzing payment for health services and conducting epidemiological and clinical research

What are two kinds of information the CDM stores

Among the correct responses are description of service, CPT/HCPCS code, revenue code, charge amount, charge or service code, general ledger key, and activity/status date.

Name three kinds of insurance information that needs to be collected from the patient

Among the correct responses are the correct policy number and group number, if applicable; policy effective dates; and type of policy.

Which of the following accurately describe deductible

Amount the patient must pay before the insurance company will start to provide a benefit

The allowable charge in which of the following

Amount the whole insurance company will pay for providers

Which of the following accurately defines up coding

Assigning a code that will deliberately result in a higher payment

what is the difference between consent and authorization

Authorization is permission granted by the patient or the patient's representative to release information for reasons other than treatment, payment, or health care operations. Consent is used only when the permission is for treatment, payment, or health care operations.

By signing block 12 on the CMS-1500 form, a patient is doing which of the following?

Authorizing the release of medical information needed to process a claim

The term reconciliation mean which of the following

Determining how much the provider has been reimbursed and how much patient owe

coordination of benefits involves which of the following

Determining which insurance is primary and which is secondary.

Which of the following is not a charge the patient is expected to pay

Difference between a provider's charges and what the insurance company will pay

What is the advantage of employer-based self-insurance health plans

Due to economies of scale, employer based self-insured health plans are more reasonably priced than private insurance

True or false. An RA is sent to policyholder

False. An RA And sent to the provider not to policyholders

True or false a co-pay is the patient share of the insurance premium

False. Insurance premium is a weekly monthly or annual cost for the plan for insurance coverage. Copayment is no out-of-pocket cost

True or false. Physicians have the option to decide whether to explain privacy rules to their patient

False. Physicians are legally obligated to explain privacy rules to their patient

The birthday rule is a way to mark how long a patient has had his insurance policy

False. The birthday rule is a way to determine primary insurance if both parents have insurance list their child as dependent. The insurance of the parent whose birthday is first in kids the Calendar year is considered the primary insurance

You are allowed to use both six and eight digit for a date on one claim

False. you me to pick one style and use it throughout the claim

The office of the inspector general is responsible for

Fighting fraud (HIPAA established a comprehensive program to combat fraud called the Health Care Fraud and Abuse Control (HCFAC) Program, which is run by the OIG)

What are HCPCS Level II codes used for?

HCPCS Level II codes were established to report services, supplies, and procedures not represented in CPT.

What is the difference between Medicare and Medicaid?

Medicare is a government-based insurance Plan that covers people order than 65, those younger than 65 with disabilities and those with end-stage kidney disease. Medicaid cover low income families and individuals

Describe when Medicare is the secondary insurance for a patient.

Medicare is the secondary insurance for a patient when she has a group health insurance plan, is covered by workers' compensation, or is on disability.

What is the purpose for using modifiers

Modifiers provide the means to report or indicate a service or procedure that has been altered by some specific circumstance but not changed in its definition or code.

What character I see the current PC air for medical or surgical procedure which identify the medical/surgical section body part

Or identify the body part

Name one advantage and one disadvantage of a PPO.

PPOs generally provide greater choice in the health care professionals patients can choose to see. Patients do not need a referral from the provider to see a specialist. A disadvantage is that cost-control measures, such as coinsurance and copayments, are usually in place.

CPT Codes are used to describe which of the following

Physicians use CPT code for hospital inpatient and outpatient services and for those preformed in other facilities

Identify two items of information that need to be on a claim

Possible answers include the patient's name, health record number, account number, and demographic information, the subscriber number, group or plan number, and the provider's name.

Auditing refers to which of the following?

Reviewing claims for accuracy and completeness

Abstracting involves which of the following?

Selecting relevant information from the health record.

What is the role of the accounts receivable department

The accounts receivable department manages follow-up to the billing process for a provider's office.

An aging report refers to which of the following?

The claims that are outstanding.

what is the total insurance percentage

The coinsurance percentage is the amount the provider is allowed for the service and the amount he was paid. The patient has coinsurance responsibility to what provider was allow a common percentage split is 80% for the insurance carrier and 20% for the patient

What are the goal of ICD-10-PCS

The goal of ICD-10-PCS to improve accuracy and efficiency of coding reduce training effort and improve communication with physicians

Who benefit from the new appeal process and why

The patient benefit because the new process play so bad insurance company my follow up and make sure that the task get done in a timely fashion

When can a patient request an external independent review?

The patient can request an external independent review after an internal appeal has been denied.

In 2012, the Administration Simplification Compliance Act ASCA, part of HIPPA mandated that health care claims be submitted electronically, with some exceptions

True

T/T fraud is intentional misrepresentation of information for the purpose of receiving higher payments, while abuse happens unintentionally, often because of poor business practices.

True

What are the four types of non medical codes used by Medicare to explain claim?

True coding claim adjustment reason code CARC's, remittance advice remark code RARC's and provider level adjustment reason codes are not related to specific claim. Their adjustments are made by the provider office

True or false. the following represents a disease coded under ICD 10 DM E 10.2

True. For ICD-10-CM codes, the first Character is a letter followed by digit character three through seven and being number or letter

Misspelling a patient name is a common processing error

True. Nickname and hyphenated last name can complicate the task of getting the patients name correct based on 2011 resolved the average claim process error rate was 19.3%

Abstracted information is which of the following?

coded. Abstract information and children often use their calculator assisted coding to generate code for each episode of care

What is documentation?

complete, accurate, up-to-date record of the care a patient receives at a health care facility.

Disclosure refers to the way health information is

given to an outside person or organization.