HRA - ANSWERSHealth Reimbursement Account
What part of Medicare pays for prescriptions - ANSWERSPart D
What type of plan allows an insurer to administer straight indemnity insurance, an HMO, or a PPO insurance plans to its members? - ANSWERSTriple Option Plan
HIPAA - ANSWERSHealth Insuranc...
What part of Medicare pays for prescriptions - ANSWERSPart D
What type of plan allows an insurer to administer straight indemnity insurance, an HMO,
or a PPO insurance plans to its members? - ANSWERSTriple Option Plan
HIPAA - ANSWERSHealth Insurance Portability and Accountability Act of 1996
Fraud (CMS defines) - ANSWERSMaking false stmts or misrepresenting facts to obtain
an undeserved benefit or payment from a federal healthcare program. Ie. misusing
codes on claims, billing for services not medically necessary, higher fees charged, etc
Penalties for fraud - ANSWERSMonetary penalties, exclusion from Federal healthcare
program, imprisonments
Fraud Claimsexample Acct - ANSWERSBilling a code that is not performed is a
violation
HMO plans require - ANSWERSA referral from PCP to see a specialist
CMS Abuse - ANSWERSCharge unnecessary cost to federal healthcare program
What is the standard time frame established for record retention? - ANSWERSThere is
no standardretention requirement, it varies by state and federal regulations. CMS 5 year
time line for providers to submit cost reports. 7 years is the length of time that false
claims can be investigated.
Federal Fraud and abuse laws are enforced by - ANSWERSDept of Justice (DOJ), Dept
oh Health & Human Srvc Officer of Inspector's General (OIG), and the Centers for
Medicare and Medicaid
Truth in Lending Act requires full disclosure of... - ANSWERSCash price, annual
percentage rate, down payment, resulting unpaid balance,
Privacy Rule Purpose - ANSWERSIs to protect individual privacy, while promoting high
quality healthcare and public health and well being
What entities are exempt from HIPAA Andy are not considered to be covered entities -
ANSWERSHIPAA allows exemption for entities providing only worker's compensation
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