Describe the difference between informed and implied consent? - ️️Informed consent is required in writing after explanation of a procedure, with time to ask questions, while implied consent is assumed
What is documentation? - ️️Documentation is a complete, accurate, up-to-date record of ...
NHA EXAM
Describe the difference between informed and implied consent? - ✔ ✔ Informed consent is required
in writing after explanation of a procedure, with time to ask questions, while implied consent is assumed
What is documentation? - ✔ ✔ Documentation is a complete, accurate, up-to-date record of the
care a patient receives at a health care facility.
Disclosure refers to the way health information is: - ✔ ✔ given to an outside person or organization.
What is the difference between consent and authorization? - ✔ ✔ **Authorization** is permission
granted by the patient or the patient's representative to release information for reasons *other than*
treatment, payment, or health care operations.
**Consent** is used only when the permission is for treatment, payment, or health care operations.
True or False: Physicians have the option to decide whether to explain privacy rules to their patients. -
✔ ✔ False
Auditing refers to which of the following?
(choose one)
*Writing claims
*Signing off on claims
*sending claims to third-party payers
*Reviews claims for accuracy and completeness - ✔ ✔ Reviews claims for accuracy and
completeness
,True or False: Fraud is intentional misrepresentation of information for the purposes of receiving higher
payments, while abuse happens unintentionally, often because of poor business practices. - ✔ ✔
true
define upcoding - ✔ ✔ Assigning a code that will deliberately result in a higher payment
The Stark Law states that:
(choose one)
*debt collection agencies can't use abusive or unfair practices to collect payments.
*the government can't be charged for substandard goods or services.
*physicians can't refer patients to practitioners with whom they have a financial relationship.
*private health information must be kept secure. - ✔ ✔ physicians can't refer patients to
practitioners with whom they have a financial relationship.
The Office of the Inspector General is responsible for: - ✔ ✔ fighting fraud.
What is a claim? - ✔ ✔ A claim is a complete record of all the services provided to a patient.
Identify two items of information that need to be on a claim. - ✔ ✔ Possible answers include the
patient's name, health record number, account number, and demographic information, the subscriber
number, group or plan number, and the provider's name.
,Which of the following describes a clean claim?
(choose one)
All the data elements are completed.
All the data elements are written on a white piece of paper.
Almost all the data elements are right.
All the necessary data elements are completed. - ✔ ✔ All the necessary data elements are
completed.
True or False: In 2012, the Administration Simplification Compliance Act (ASCA), part of HIPAA,
mandated that health care claims be submitted electronically, with some exceptions. - ✔ ✔ true
The primary insurance plan does which of the following? (choose one)
Pays for everything
Pays first
, Pays second
Has the option of paying first or second - ✔ ✔ Pays first
What is an NPI number? Where does it go on CMS-1500? - ✔ ✔ the NPI is a unique identification
number for all HIPAA-covered entities, including individuals, organizations, home health agencies,
clinics, long-term care facilities, residential treatment centers, laboratories, ambulances, group
practices, and health maintenance organizations (HMOs).
It is block 17b on the CMS-1500 form.
True or False: Misspelling a patient's name is a common processing error. - ✔ ✔ true
Nicknames and hyphenated last names can complicate the task of getting the patient's name correct.
True or False: You are allowed to use both six- and eight-digits for the date on one claim. - ✔ ✔ False
You need to pick one style and use it throughout the claim.
Describe when Medicare is the secondary insurance for a patient. - ✔ ✔ Medicare is the secondary
insurance for a patient when she has a group health insurance plan, is covered by workers'
compensation, or is on disability.
By signing block 12 on the CMS-1500 form, a patient is doing which of the following?
(choose one)
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