Tentamen (uitwerkingen)
CBCS EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS
- Vak
- Instelling
CBCS EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS
[Meer zien]Voorbeeld 4 van de 67 pagina's
Voorbeeld 4 van de 67 pagina's
In winkelwagen
In winkelwagen
gesponsord bericht van onze partner
Verkoper
Volgen
YANCHY
Ontvangen beoordelingen
Voorbeeld van de inhoud
CBCS EXAM 2024/2025 WITH 100%ACCURATE SOLUTIONS
Medical Billing & Coding as a Career - Precise Answer ✔✔*Claims
assistant professional or claims manager, *Coding Specialist, *
Collection Manager, *Electronic Claims Processor, *Insurance Billing
Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical
Biller, *Medical & Financial Records Manager, * Billing & Coding
Specialist
What are Medical Ethics? - Precise Answer ✔✔Standards of conduct
based on moral principle. They are generally accepted as a guide for
behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - Precise
Answer ✔✔carrying out one's responsibilities w/ integrity, dignity,
respect, honesty, competence, fairness, & trust.
Legal Aspects of of Medical Billing & Coding: - Precise Answer ✔✔...
Compliance regulations: - Precise Answer ✔✔Most billing-related cases
are based on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) - Precise
Answer ✔✔Enacted in 1996, created by the Health Care Fraud & Abuse
,Control Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - Precise Answer ✔✔Title I:
Insurance Reform
Title II: Administrative Simplification
What is Title I of HIPPA? - Precise Answer ✔✔Insurance Reform-
primary purpose is to provide continuous ins coverage for worker &
their dependents when they change or lose jobs. Also *Limits the use of
preexisting conditions exclusions *Prohibits discrimination from past or
present poor health *Guarantees certain employees/indv the right to
purchase new health ins coverage after losing job *Allows renewal of
health ins cov regardless of an indv's health cond. that is covered under
the particular policy.
What is Title II of HIPPA? - Precise Answer ✔✔Administrative
Simplification-goal is to focus on the health care practice setting to
reduce administrative cost & burdens. Has 2 parts- 1) development and
implementation of standardized health-related financial & administrative
activities electronically 2) Implementation of privacy & security
procedures to prevent the misuse of health info by ensuring
confidentiality
What is the False Claims Act (FCA)? - Precise Answer ✔✔Federal law
that prohibits submitting a fraudulent claim or making a false statement
or representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
,What is the National Correct Coding Initiative (NCCI)? - Precise
Answer ✔✔Developed by CMS to promote the national correct coding
methodologies & to control improper coding that lead to inappropriate
payment of Part B health ins claims.
How many edits does NCCI include? - Precise Answer ✔✔2: 1)Column
1/Column 2 (prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
Column 1/Column 2 edits (NCCI) - Precise Answer ✔✔Identifies code
pairs that should not be billed together b/c 1 code (Column 1) includes
all the services described by another code (Column 2)
Mutually Exclusive Edits (NCCI) - Precise Answer ✔✔ID's code pairs
that, for clinical reasons, are unlikely to be performed on the same pt on
the same day
What are the possible consequences of inaccurate coding and incorrect
billing? - Precise Answer ✔✔*delayed processing & payment of claims
*reduced payments, denied claims *fine and/or imprisonment
*exclusion from payer's programs, loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud &
abuse? - Precise Answer ✔✔The Office of Inspector General (OIG)
, Fraud - Precise Answer ✔✔knowingly & intentionally deceiving or
misrepresenting info that may result in unauthorized benefits. It is a
felony and can result in fines and/or prison.
Who audits claims? - Precise Answer ✔✔State & federal agencies as
well as private ins co's
What are common forms of fraud? - Precise Answer ✔✔billing for
services not furnished, unbundling, & misrepresenting diagnosis to
justify payment
Abuse - Precise Answer ✔✔incidences or practices, not usually
considered fraudulent, that are inconsistent w/ the accepted medical
business or fiscal practices in the industry.
What are examples of Abuse? - Precise Answer ✔✔submitting a claim
for services/procedures performed that is not medically necessary, and
excessive charges for services, equipment or supplies.
What is a method use to minimize danger, hazards, & liabilities
associated w/ abuse? - Precise Answer ✔✔Risk Management
Patient Confidentiality - Precise Answer ✔✔All pt's have right to
privacy & all info should remain privileged. Only discuss pt info when
necessary to do job. Obtain a signed consent form to release medical
info to ins co or other individual.
Voordelen van het kopen van samenvattingen bij Stuvia op een rij:
Verzekerd van kwaliteit door reviews
Stuvia-klanten hebben meer dan 700.000 samenvattingen beoordeeld. Zo weet je zeker dat je de beste documenten koopt!
Snel en makkelijk kopen
Je betaalt supersnel en eenmalig met iDeal, creditcard of Stuvia-tegoed voor de samenvatting. Zonder lidmaatschap.
Focus op de essentie
Samenvattingen worden geschreven voor en door anderen. Daarom zijn de samenvattingen altijd betrouwbaar en actueel. Zo kom je snel tot de kern!
Veelgestelde vragen
Wat krijg ik als ik dit document koop?
Je krijgt een PDF, die direct beschikbaar is na je aankoop. Het gekochte document is altijd, overal en oneindig toegankelijk via je profiel.
Tevredenheidsgarantie: hoe werkt dat?
Onze tevredenheidsgarantie zorgt ervoor dat je altijd een studiedocument vindt dat goed bij je past. Je vult een formulier in en onze klantenservice regelt de rest.
Van wie koop ik deze samenvatting?
Stuvia is een marktplaats, je koop dit document dus niet van ons, maar van verkoper YANCHY. Stuvia faciliteert de betaling aan de verkoper.
Zit ik meteen vast aan een abonnement?
Nee, je koopt alleen deze samenvatting voor €15,39. Je zit daarna nergens aan vast.
Is Stuvia te vertrouwen?
4,6 sterren op Google & Trustpilot (+1000 reviews)
Afgelopen 30 dagen zijn er 79751 samenvattingen verkocht
Opgericht in 2010, al 14 jaar dé plek om samenvattingen te kopen