Mod-D Chp-5

Front 1

A commercial insurance company sends a letter to the physician requesting a copy of a patient's entire medical record in order to process payment. No other documents accompany the letter. The insurance specialist should

Back 1

require a signed patient authorization from the insurance company.

Front 2

An attorney calls the physician's office and requests that a copy of his client's medical record be immediately faxed to the attorney's office. The insurance specialist should

Back 2

instruct the attorney to obtain the patient's signed authorization.

Front 3

An insurance company calls the office to request information about a claim. The insurance specialist confirms the patient's dates of service and the patient's negative HIV status. The insurance specialist

Back 3

appropriately released the dates of service, but not the negative HIV status

Front 4

A patient's spouse comes to the office and requests diagnostic and treatment information about his wife. The spouse is the primary policyholder on a policy for which his wife is named as a dependent. The insurance specialist should

Back 4

obtain a signed patient authorization from the wife before releasing patient information.

Front 5

Which is considered Medicare fraud?

Back 5

billing for services that were not furnished and misrepresenting diagnoses to justify payment

Front 6

Which is considered Medicare abuse?

Back 6

improper billing practices that result in Medicare payment when the claim is the legal responsibility of another third-party payer

Front 7

The 66-year-old patient was treated in the emergency department (ED) for a fractured arm. The patient said, “I was moving a file cabinet for my boss when it tipped over and fell on my arm.” The facility billed Medicare and received reimbursement of $550. The facility later determined that Medicare was not the payer because this was a workers' compensation case. Therefore, the facility

Back 7

should have billed the employer's workers' compensation payer for the ED visit.

Front 8

A provider was ordered by a judge to bring a patient's medical record to court hearing. Which document was served on the provider instructing him to comply?

Back 8

Subpoena duces tecum

Front 9

The type of law passed by legislative bodies is known as ,_____________law.

Back 9

Statuory

Front 10

Which civil case document contains a list of questions that must be answered in writing?

Back 10

Interrogatory

Front 11

Which federal law has regulated the conduct of any contractor submitting claims for payment to the federal government since 1863?

Back 11

False Claims Act

Front 12

The federal Claims Collection Act requires Medicare administrative contractors to.

Back 12

attempt to recover any reimbursement funds sent as over payment to providers and beneficiaries.

Front 13

The Hospital IQR program equips consumers with, _________ Information so they can make more informed decisions about health care options.

Back 13

quality of care.

Front 14

The Physicians at Teaching Hospitals (PATH) legislation was passed to.

Back 14

monitor Medicare rule compliance of Part B services and proper coding and billing practices.

Front 15

The ,______ , Combats fraud and abuse in health insurance and health care delivery by alerting users to conduct a comprehensive review of a practitioner's, provider's, or supplier's past actions.

Back 15

Health care Integrity and Protection Data Bank

Front 16

One of the provisions of HIPAA Title I designed to improve portability and continuity of health care coverage is.

Back 16

Providing credit for prior health coverage

Front 17

Which act protects whisleblowers---individuals who make specified disclosures relating to funds covered by the act?

Back 17

ARRA

Front 18

In addition to civil, criminal , and administrative penalties, those who commit health care fraud can also be tried for.

Back 18

mail and wire fraud

Front 19

The first step a physician practice can take to identify areas in the practice that are vulnerable to fraud and abuse is to.

Back 19

perform periodic audits to internally monitor billing processes.

Front 20

An example of an over payment is

Back 20

duplicate processing of a claim

Front 21

Unless the case involves fraud, administrative contractors are prohibited from seeking over payment recovery when the-

Back 21

Over payment is not reopened within 48 months after payment.

Front 22

CMS is authorized to enter into contracts with entities to perform cost report auditing, medical review, and anti-fraud activities by the, ______ , program.

Back 22

Medicare integrity

Front 23

Which government agency is responsible for investigating a Medicare provider who is suspected of committing fraud?

Back 23

Office of Inspector General

Front 24

The agency that assigns the National Standard Employer Identification Number (EIN) is the

Back 24

Internal Revenue service.

Front 25

PSCs were replaced by the Zone Program Integrity Contractor in.

Back 25

2009

Front 26

Assigning passwords to users who are authorized to access patient records is a form of

Back 26

Security

Front 27

What special handling is required to release medical information for a patient who is HIV-Positive?

Back 27

The patient should sign an additional authorization unless subpoenaed.