medical insurance ch. 1 and 2

What does the abbreviation MSHP designate?
Multiskilled health practitioner
Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring
multiskilled health care practitioners
administrative medical office responsibilities include
claims submission
A claims assistance professional
works for the consumer and helps patients file insurance claims
What is “cash flow” in a medical practice?
The actual money available to a medical practice
Front office medical duties have become increasingly important because
diagnostic and procedure coding must be reviewed for it correctness and completeness
Which level of education is generally required for one who seeks employment as an insurance coder?
Completion of an accredited program for coding certification
Which organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing?
American Health Information Management Association (AHIMA)
The amount of money an insurance billing specialist earns is dependent on which of the following factors?
Knowledge, Experience, and size of employing institution
A billing specialist is entrusted with?
holding patients’ medical information in confidence, collecting money, and being a reliable resource for co-workers
medical etiquette
consideration for others
medical ethics include
standards of conducts
The earliest written code of ethical principles for the medical profession is the
code of hammurabi
What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?
The Principles of Medical Ethics
What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment?
Notify your physician
Reporting incorrect information to private insurance carriers is considered
unethical
The Internet Healthcare Coalition has developed the ________ Code of Ethics
eHealth
Reporting incorrect information to government-funded programs is
illegal
Insurance specialist certificate programs include
anatomy, diagnostic coding, computer technology
The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as
respondeat superior, let the master answer, and vicarious liability
The AHIMA Code of Ethics is appropriate for
health information specialists, coders, and insurance billing specialists.
Why are multiskilled health practitioners (MSHPs) in demand?
They are cross-trained to provide more than one function, often competent in more than one discipline offer more flexibility to their employer
Which code of ethics is most appropriate for an insurance billing specialist who handles medical records?
The american Health Information Management Association (AHIMA) code of ethics
AHIMA publishes
diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements
A self-employed medical insurance biller who does independent contracting is responsible for
advertising, billing, accounting
Using code number to increase payment when case documentation does not warrant it
both illegal and unethical
Reporting incorrect information to medicare
illegal
coding services that were not performed for payment
both illegal and unethical
reporting incorrect information to a private insurance carrier
unethical
unbundling services when an available single code includes all services
both illegal and unethical
assigning a code without documentation from the provider
both illegal and unethical
health care provider
individual who renders medical services, furnishes bills, or is paid for health care in the normal course of business
clearinghouse
Third-party administrator who receives insurance claims from the physicians office performs edits, and redistributes the claims electronically to various insurance carriers
covered entity
A health care coverage carrier clearinghouse or physician who transmits health information in electronic form in connection with a transaction covered by HIPAA
business associate
individual who is hired by a medical practice to process claims to a third-party payer
privacy officer, privacy official
Individual who is designated to help a provider remain in compliance by setting policies and procedures in place training staff regarding HIPAA Privacy guidelines and acting as the contact person for questions and complaints
The process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry is known as eHealth information management
False
Under HIPAA guidelines, an outside billing company that manages claims and accounts for a medical clinic is known as a covered entity
False
to give, release, or transfer information to another entity is called consent
false
A HIPAA compliance exception to the right of privacy and privileged communication is a patients records pertaining to his or her industrial accident case.
true
Confidentiality between the physician and the patient is automatically waived when the patient is being treated in a workers compensation case
true
Notes, papers, and memos regarding patient information should be disposed of using a shredding device
True
A patient has the right to obtain a copy of his or her confidential health information
true
The HITECH Act replaced the HIPAA privacy laws
False
Disclosing PHI as authorized by the laws relating to workers’ compensation does not require a signed authorization
true
Confidential information includes everything that is _______ a patient.
heard about, read about, seen regarding
What is the correct response when a relative calls asking about a patient?
Have the physician return the phone call
Forgiving the deductible or copayment for a Medicare patient
fraud
Filing insurance claims for services not medically necessary
abuse
billing medicare beneficiaries at a higher rate than other patients
abuse
changing the date of service
fraud