Billing/coding Exam 1

Front 1

MSOs:
*Some medical practices & clinics contract with MSOs who perform a variety of business functions such as accounting, billing, coding, collections, legal advice, payroll, etc.

Back 1

management services organizations

Front 2

MSHPs:
*person cross-trained to provide more than one functions, often in more than one discipline

Back 2

multiskilled health practitioners

Front 3

CAPs:
Help pts organize, file, and negotiate health insurance claims of all types; assist the consumer in obtaining max benefits; and tell the pt how much to pay the providers to make sure no overpayments occur.

Back 3

claims assistance professionals

Front 4

Insurance claims must be promptly submitted, ideally within ___ to ___ business days, to ensure continuous cash flow

Back 4

1 to 5

Front 5

The amount of actual money available to the medical practice

Back 5

cash flow

Front 6

T or F?
Federal and state programs require the provider to submit claims for the patient. Other programs make it the patient's obligation.

Back 6

True

Front 7

Self-pay pts should be reminded that payment is due _________________.

Back 7

At the time of service

Front 8

Total amount of money owed for professional services rendered.

Back 8

accounts receivable

Front 9

AHIMA:

Back 9

American Health Information Management Association

Front 10

T or F?
The responsibilities are greater in self-employment and independent contracting

Back 10

True.

*Bcuz it demands a full-time commitment, a lot of hear work, long hours to obtain clients, and the nee to advertise and market the business.

Front 11

________ ________ has to do with how medical professionals conduct themselves.

Back 11

medical étiquette

Front 12

Rules of etiquette apply when sending email messages and placing or receiving cell phone calls under ___________.

Back 12

HIPAA

Front 13

HIPAA:

Back 13

Health Insurance Portability and Accountability Act

Front 14

Not laws, but standards of conduct generally accepted as moral guides for behavior by which an insurance billing or coding specialist may determine the propriety of his or her conduct in a relationship with patients, the physician, co-workers, the government, and insurance companies.

Back 14

medical ethics

Front 15

1. Earliest written code of ethical principles and conduct for medical profession:
2. 5th century BC, Greek physician known as the "Father of Medicine" wrote an Oath
3. In 1980, the _________ adopted a modern code of ethics, called the Principles of Medical Ethics, for the benefit of the health professional and to meet the needs of changing times.

Back 15

1. Code of Hammurabi
2. Hippocrates (Oath of Hippocrates)
3. AMA (American Medical Association)

Front 16

AMA:

Back 16

American Medical Association

Front 17

T or F?
Illegal coding practices are subject to penalties, fines, and/or imprisonment.

Back 17

True

Front 18

It is ILLEGAL to report incorrect information to __________-_________ programs, such as Medicare, Medicaid, and TRICARE

Back 18

government-funded

Front 19

Private third-party payers operate under different laws, and it is _________, but may not be illegal depending on state laws, to report incorrect information to private third-party payers.

Back 19

unethical

Front 20

T or F?
Physicians are legally responsible for their own conduct, but not any actions of their employees performed within the context of their employment.

Back 20

False

Front 21

Vicarious liability, also known as respondeat superior, literally translates to "___________________"

Back 21

"let the master answer"

*physician legally responsible for self and employees actions w/in context of their employment

Front 22

T or F?
Even with vicarious liability in place, an employee can still be sued or brought to trial.

Back 22

True

Front 23

FUN FACT!:

Back 23

*If an employee knowingly submits a fraudulent Medicare or MEdicaid claim at the direction of the employer and subsqeuently the business is audited, both the employer & employee can be brought into litigation by the stare or federal govt.

Front 24

medical professional liability insurance policy

Back 24

malpractice insurance

Front 25

True or False?
If an employee is not included in the malpractice insurance, he or she could be sued as an individual.

Back 25

True

Front 26

___________________________ is protection against loss of money caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim.

Back 26

errors and omissions insurance

Front 27

An individual who works as a ______ acts as an informal representative of pts (policyholders & Medicare beneficiaries), helping them to obtain insurance reimbursement.

Back 27

CAP

Front 28

T or F?
A CAP may interpret insurance policies but cannot act as an attorney.

Back 28

False:
*MAY NOT interpret policies, as well as cannot act as an attorney.