NHA CBCS EXAM FLASHCARDS//WITH QUESTIONS AND
CORRECT ANSWERS GRADED A+
When does communication with the
patient begin?
A. Patient check-in
B. Registration and scheduling
C. Health care encounter
D. Patient Check Out - CORRECT ANSWER: B. Registration and
scheduling.
Explanation: Communication starts at the
point of service, during registration and
scheduling, where the information is gathered
from the patient to create an account
What is a third-party payer? - CORRECT ANSWER: Healthcare insurance
company
that reimburses services
provided by providers and/
,or health care organizations.
Terminology - CORRECT ANSWER: As health care changes, so do the
terms
we use. It is important to know and use
current health care terminology. For
example, the CMS-1500 (paper) form was
previously called the HCFA-1500 form.
What is a provider? - CORRECT ANSWER: A provider is a licensed
professional
who can submit claims to a third-
party payer. This individual can be a
physician, nurse practitioner, physical or
occupational therapist, hospital, or any
qualified professional who is licensed
to provide health care services
What are the Office of Inspector General responsible for? - CORRECT
ANSWER: The OIG is a division of the Department of Health and Human
Services (HHS) and is responsible for investigating insurance fraud and
abuse related to Medicare, Medicaid, and other federally funded
programs.
What is the intent of the Office of the
, Inspector General? - CORRECT ANSWER: Identify and eliminate fraud,
abuse, and waste
Covered entity. - CORRECT ANSWER: Entity that transmits health
information in electronic form (e.g., providers, health plans,
clearinghouses)
Electronic Data Interchange. - CORRECT ANSWER: Computer technology
that contains the exchange of data between the health care provider and
payer
Fraud - CORRECT ANSWER: Intentionally billing for services not
performed, reporting fraudulent diagnosis, or medical coding errors.
Abuse - CORRECT ANSWER: Billing patterns and practices that are
excessive or unnecessary but not fraudulent.
HIPAA - CORRECT ANSWER: HIPAA not only protects protected health
information (PHI) in electronic or paper
records, but PHI is also protected in the
verbal form. A conversation with another staff
member can violate PHI depending on where
and how the conversation takes place.
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