Medical Billing and Compliance Terms Quiz

More accurate payment of claims, fewer billing mistakes, improved documentation and more accurate coding, less chance of violating self-referral and anti-kickback status.

An entity that processes nonstandard health information they receive from another entity into a standard format.

<p>Only the minimum necessary protected health information should be shared to satisfy a particular purpose.</p> Signup and view all the answers

<p>The least radical service/procedure that allows for effective treatment of the patient's complaint or condition.</p> Signup and view all the answers

<p>Leg</p> Signup and view all the answers

<p>Ambulatory Payment Classification</p> Signup and view all the answers

<p>American Recovery and Reinvestment Act (of 2009)</p> Signup and view all the answers

<p>Ambulatory Surgical Centers</p> Signup and view all the answers

<p>Payment for items or services that are billed by providers in error that should not be paid for by Medicare.</p> Signup and view all the answers

<p>Advance Beneficiary Notice protects the provider's financial interest by creating a paper trail that CMS requires before a provider can bill the patient if Medicare denies coverage.</p> Signup and view all the answers

<p>The Affordable Care Act amended the definition of fraud to remove the intent requirement.</p> Signup and view all the answers

<p>Every 5 years</p> Signup and view all the answers

<p>A fixed dollar amount used to translate the RVUs into fees.</p> Signup and view all the answers

<p>Centers for Medicare and Medicaid Services</p> Signup and view all the answers

<p>Social Security Act, specifically title XVIII, $1862(a)</p> Signup and view all the answers

<p>CMS-R-131 is the ABN form used for informing patients about potentially non-covered services.</p> Signup and view all the answers

<p>Current Procedural Terminology</p> Signup and view all the answers

<p>CY 2013</p> Signup and view all the answers

<p>Private contracts between the payer and practice or provider.</p> Signup and view all the answers

<p>Diagnosis Related Group</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>Evaluation and Management</p> Signup and view all the answers

<p>Electronic Health Record</p> Signup and view all the answers

<p>[(Work RVU * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF</p> Signup and view all the answers

<p>[(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)</p> Signup and view all the answers

<p>Geographic Practice Cost Index</p> Signup and view all the answers

<p>To realize the varying cost based on geographic location.</p> Signup and view all the answers

<p>Healthcare Common Procedure Coding System</p> Signup and view all the answers

<p>Department of Health and Human Services</p> Signup and view all the answers

<p>Federal protections for personal health information when held by covered entities.</p> Signup and view all the answers

<p>Health Insurance Portability and Accountability Act of 1996</p> Signup and view all the answers

<p>The Health Information Technology for Economic and Clinical Health Act.</p> Signup and view all the answers

<p>An audit trail showing all disclosures of their health information made through an electronic record.</p> Signup and view all the answers

<p>That an individual is notified.</p> Signup and view all the answers

<p>The American Recovery and Reinvestment Act of 2009 (ARRA).</p> Signup and view all the answers

<p>Health Maintenance Organization</p> Signup and view all the answers

<p>Nervous system</p> Signup and view all the answers

<p>International Classification of Diseases, 9th Clinical Modification</p> Signup and view all the answers

<p>$39.51 Non-facility pricing amount</p> Signup and view all the answers

<p>Advance Beneficiary Notice of Non-Coverage (ABN)</p> Signup and view all the answers

<p>MAC (Medicare Administrative Contractor)</p> Signup and view all the answers

<p>Part D</p> Signup and view all the answers

<p>Malleus</p> Signup and view all the answers

<p>Fraud</p> Signup and view all the answers

<p>Local Coverage Determinations</p> Signup and view all the answers

<p>Their regional area.</p> Signup and view all the answers

<p>When a service is indicated or necessary, coverage limitations, specific CPT codes applicable, and related ICD-9-CM codes.</p> Signup and view all the answers

<p>Malpractice</p> Signup and view all the answers

<p>Medical Severity-Diagnosis Related Group</p> Signup and view all the answers

<p>A health insurance assistance program for some low-income people.</p> Signup and view all the answers

<p>State by state basis adhering to certain federal guidelines.</p> Signup and view all the answers

<p>Medically necessary physicians' services, outpatient care, and other medical services not covered under Part A.</p> Signup and view all the answers

<p>The patient</p> Signup and view all the answers

<p>The benefits of Part A and Part B and sometimes Part D.</p> Signup and view all the answers

<p>Medicare Advantage</p> Signup and view all the answers

<p>Private insurers approved by Medicare.</p> Signup and view all the answers

<p>A prescription drug coverage program.</p> Signup and view all the answers

<p>Private companies approved by Medicare.</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>Inpatient hospital care, care provided in skilled nursing facilities, hospice care, home health care.</p> Signup and view all the answers

<p>Using a resource-based relative value scale (RBRVS).</p> Signup and view all the answers

<p>National Coverage Determinations</p> Signup and view all the answers

<p>When Medicare will pay for items or services.</p> Signup and view all the answers

<p>Nurse Practitioner</p> Signup and view all the answers

<p>Office of Civil Rights</p> Signup and view all the answers

<p>Office of the Inspector General</p> Signup and view all the answers

<p>Implement standards, designate compliance officer, train staff, conduct audits, respond to violations, develop communication channels, enforce disciplinary standards.</p> Signup and view all the answers

<p>Physician Assistant</p> Signup and view all the answers

<p>Physician Expense</p> Signup and view all the answers

<p>Physician Fee Schedule</p> Signup and view all the answers

<p>Protected Health Information</p> Signup and view all the answers

<p>Professional Liability Insurance</p> Signup and view all the answers

<p>$34.0376</p> Signup and view all the answers

<p>$33.9764</p> Signup and view all the answers

<p>Resource Based Relative Value System</p> Signup and view all the answers

<p>Relative Value Update Committee</p> Signup and view all the answers

<p>Physician work, practice expense, professional liability insurance.</p> Signup and view all the answers

<p>Integumentary system</p> Signup and view all the answers

<p>Revised ABN CMS-R-131.</p> Signup and view all the answers

<p>The ABN standardizes communication regarding why Medicare may deny particular services.</p> Signup and view all the answers

<p>The efficiency and economy of government programs, including health care fraud investigation.</p> Signup and view all the answers

<p>$100 or 25% of cost</p> Signup and view all the answers

<p>Left ventricle</p> Signup and view all the answers

<p>Whether a procedure or service is considered appropriate in a given circumstance.</p> Signup and view all the answers

<p>Male reproductive system</p> Signup and view all the answers

<p>Disclosures for treatment, disclosures to the individual, and certain compliance disclosures.</p> Signup and view all the answers

<p>OIG work plan</p> Signup and view all the answers

<p>LCD (Local Coverage Determination)</p> Signup and view all the answers

<p>Urine will not be able to flow from the kidney to the bladder.</p> Signup and view all the answers

<p>October</p> Signup and view all the answers

<p>When a service is not expected to be covered by Medicare.</p> Signup and view all the answers

<p>Lens</p> Signup and view all the answers

<p>Supplies digestive enzymes</p> Signup and view all the answers

<p>Nephrolithiasis</p> Signup and view all the answers

<p>Each MAC (Medicare Administrative Contractor)</p> Signup and view all the answers

<p>The entity covered by HIPAA.</p> Signup and view all the answers

<p>The relative levels of time and intensity associated with furnishing a Medicare PFS service and account for approximately 50% of the total payment.</p> Signup and view all the answers