revenue cycle and regulatory compliance Flashcards
What is an effective tool for collecting a patient’s payment for health care services?a. Eligibility verification
b. Communication
c. Precertification
d. Copayment
Communication
A billing and coding specialist is speaking with a patient on the phone about their plan benefits. What action should the specialist take when communicating with the patient?
a. Use slang terminology.
b. Explain patient financial responsibility.
c. Demand payment for services.
d. Use specific coding convention terms.
Explain patient financial responsibility
What describes the practice of routinely submitting claims that have the same coding or modifier errors?
a. Upcoding
b. Overpayment
c. Abusive billing pattern
d. Billing for services not rendered
Abusive Billing Pattern
A billing and coding specialist should identify that a Medicare Recovery Audit Contractor(RAC) can review medical records for what reason?
a. To investigate if a patient was denied Medicare coverage
b. To investigate whether a provider is self-referring for ancillary services
c. To investigate potential improper Medicare payments
d. To investigate whether a Medicare beneficiary was subject to a HIPAA violation
To investigate potential improper Medicare payments
What document assists providers in determining whether there are any outstanding claims?
a. Charge description master
b. Aging report
c. Credit report
d. Preauthorization
Aging Report
What is a claim called when it is possible to adjudicate and includes all required data elements?
a. Pending claim
b. Clean claim
c. Delinquent claim
d. Open claim
Clean Claim
What requires a patient’s authorization prior to disclosure?
a. Protected health information (PHI)
b. Workers’ compensation claim
c. Release of information log
d. Treatment, payment, and health care operations (TPO)
Protected Health Information(PHI)
What is the role of the Office of Inspector General(OIG)?
a. To investigate disclosure of protected health information
b. To evaluate workplace safety standards
c. To administer the Patient Protection and Affordable Care Act
d. To identify Medicare fraud and abuse
To identify Medicare fraud & abuse
A billing and coding specialist is preparing to code an anesthesiologist’s portion of a procedure. The specialist must be able to identify the correct start/stop times to code the claim correctly. What regulates this activity?
a. ICD-10-CM Official Guidelines
b. Federal Claims Collection Act (FCCA)
c. CPT® guidelines
d. Stark Law
CPT Guidelines
What term describes a patient’s right to have their Protected Health Information(PHI) safeguarded and not disclosed to others without their permission?
a. Privacy
b. Security
c. Confidentiality
d. Authorization
Privacy
What action by a billing and coding specialist would represent a breach in confidentiality?
a. Protecting passwords and keeping them in a secured location
b. Never leaving the computer screen unattended
c. Discussing patient information in the elevator where other patients are present
d. Communicating patient information to family members with the patient’s consent
Discussing patient information in a public space while other patients are present.
When does effective communication begin in the Revenue Cycle?
a. Utilization management review
b. Health care encounter and documentation
c. Billing
d. Registration and scheduling
Registration and Scheduling
A billing and coding specialist notices that a provider is reporting the same code for all new patient visits to get higher reimbursement. What should the specialist identify this as?
a. Fraud
b. Waste
c. Abuse
d. Overpayment
Fraud
A billing and coding specialist is processing claims. what should the specialist identify as fraud?
a. Billing non-covered services
b. Charging excessively for services in error
c. Mistakenly reporting duplicate charges
d. Upcoding for increased reimbursement
Upcoding for increased reimbursement
What refers to the act of controlling access to records, protecting patient health information from destruction or loss, and providing employee training?
a. Security
b. Confidentiality
c. Privacy
d. Authorization
Security
