Health Ins Chapter 5 Test

Fraud “involves actions that are inconsistent with accepted, sound medical,
business, or fiscal practices. Abuse directly or indirectly results in unnecessary costs to the program through improper payments.”

Medicare Conditions of Participation mandate the retention of patient records in their original or legally reproduced form (e.g., microfilm) for a period of at least ______ years.

A _________ requires documents (e.g., patient record) to be produced.

Privacy is an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment.

The ____ mandates the retention of patient records and health insurance claims for a minimum of six years, unless state law specifies a longer period.

____ is the storage of documentation for an established period of time, usually mandated by federal and/or state law.

Act that authorized the federal government to monitor the purity of foods and the safety of medicines, now a responsibility of the Food and Drug Administration.

The Health Insurance Portability and Accountability Act mandates that patient records and health insurance claims be retained for a minimum of ______ years after a patient’s death.

Fraud involves actions that are inconsistent with accepted, sound medical, business, or fiscal practices.

The National Correct Coding Initiative was developed to reduce Medicare program expenditures by detecting inappropriate codes submitted on claims and denying payment.

Conditions of Participation (CoP) → Medicare - requires providers to keep copies of any government insurance claims and copies of all attachments filed by the provider for a period of five years, unless state law specifies a longer period.

Which of the following is not an example of abuse?

Subpoena duces tecum requires documents (e.g., patient record) to be produced.

Medicare program that was developed by CMS to reduce inappropriate expenditures.

National Standard Employer Identification Number (EIN) is Assigned to employers who, as sponsors of health insurance for their employees, must be identified in health care transactions. It is the federal employer identification number (EIN) assigned by the Internal Revenue Service (IRS) and has nine digits with a hypen.

_____________ numbers are assigned to employers who, as sponsors of health insurance for their employees, must be identified in health care transactions.

HIPAA mandates that health insurance claims be retained for a minimum of two years after a patient’s death.

__________ means testimony under oath taken outside
of court (e.g., at the provider’s office).

Which of the following is not an example of abuse?

In 1996, Congress passed the ____ because of concerns about fraud and abuse.

______________ is information that is identifiable to an individual (individual identifiers) such as name, address, telephone numbers, social security number, and name of employer.

Abuse is “an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment.” The attempt itself is considered fraud, regardless of whether it is successful.

The difference between fraud and abuse is the individual’s intent; however, both have the same impact in that they steal valuable resources from the healthcare industry.

HIPAA mandates that health insurance claims be retained for a minimum of seven years after a patient’s death.

The most common form of Medicare fraud is

A ____________ is an order of the court requiring a witness to appear at a particular time and place to testify.

Participants maintain, at their own expense and at the same rate, health care plan coverage that would have been lost due to a triggering event (e.g., termination of employment).

A dated, signed special release form is generally considered valid as long as the patient sees the physician.

HIPAA Privacy Rule is a document containing a list of questions that must be answered in writing.

Electronic transaction standards or (transactions rule) is a uniform language for electronic data interchange.

Protected health information (PHI) is information that is identifiable to an individual, such as name, address, telephone number, date of birth, and social security number.

The Health Insurance Portability and Accountability Act (HIPAA) mandates
the retention of patient records and health insurance claims for a minimum of ______ years, unless state law specifies a longer period.

____________ is public law (statute or ordinance) that defines crimes and their prosecution.

Civil law is public law (statute or ordinance) that defines crimes and their prosecution.