Health Maintenance Organization (HMO) Act

Play an AI-generated podcast conversation about this lesson

What is the primary purpose of the Security Rule established by HIPAA of 1996?

To provide national standards for requesting payment for medical services

To establish codes for dental services

To provide national standards for protecting and transmitting patient data (correct)

To maintain codes for medical procedures and physician services

Which code set is used to report procedures for inpatient hospital services?

ICD-10-PCS (correct)

ICD-10-CM

CPT

NDC

Which organization maintains the National Drug Codes (NDC)?

HHS (correct)

CMS

ADA

AMA

What is the purpose of Place of Service Codes?

To denote the setting in which the service was provided Signup and view all the answers

Which code set is used for dental services?

CDT Signup and view all the answers

Which of the following is NOT maintained by the Centers for Medicare and Medicaid Services (CMS)?

CPT Signup and view all the answers

What was the outcome of the Act in terms of HMO enrollment?

An increase from 3 million to over 80 million Signup and view all the answers

What is a characteristic of Preferred Provider Organizations (PPOs)?

Offering members more flexible options for healthcare Signup and view all the answers

Why have hospitals, clinics, and private physician practices had to adapt?

Due to the complexity in the business of medicine Signup and view all the answers

What is a key challenge for medical billers?

Distinguishing between different regulatory requirements Signup and view all the answers

What is a consequence of the Act overriding state laws?

Employers with 25 or more employees had to offer an HMO option Signup and view all the answers

What has contributed to the growth of medical professionals with business skills?

The expansion of healthcare plans Signup and view all the answers

What is required for knowledge of existence of a fact to be established in an offense?

Awareness of a high probability of its existence Signup and view all the answers

What is the penalty range per claim for violating the FCA?

$5,500 to $11,000 Signup and view all the answers

What is the term for a person who brings a civil action on behalf of themselves and the U.S. government?

Relator Signup and view all the answers

What is the primary responsibility of the government in a Qui Tam action?

Prosecuting the action Signup and view all the answers

What is a requirement for reduced penalties (mitigation) under the FCA?

Self-disclosure and meeting other requirements Signup and view all the answers

What is the term for intentionally ignoring a fact when one has every reason to believe about its existence?

Deliberate ignorance Signup and view all the answers

What is the primary purpose of the Consumer Credit Protection Act of 1968?

To protect consumers in their dealings with lenders or creditors Signup and view all the answers

What is the condition for a practice to be considered a creditor under the TILA?

If the practice regularly extends credit which is payable by agreement in more than four installments Signup and view all the answers

What is the requirement for disclosing finance charges on statements?

The finance charge must be disclosed as an annual percentage rate Signup and view all the answers

What is an example of a deceptive practice related to billing services?

Biling for services that were not provided Signup and view all the answers

What is the main purpose of assessing finance charges on statements?

To inform consumers of the total cost of credit Signup and view all the answers

What is the primary goal of the Health Insurance Portability and Accountability Act of 1996?

To make it easier for people to keep health insurance Signup and view all the answers

What is the main characteristic of a Preferred Provider Organization (PPO)?

It is a network of healthcare providers who agree to provide healthcare at reduced rates Signup and view all the answers

What is included in Protected Health Information (PHI)?

Individually identifiable health information, including demographic data, medical history, and payment information Signup and view all the answers