Who is the person that is ultimately responsible for paying the patient's bill
100
A fixed amount the beneficiary pays for health care services, regardless of the actual charge; the amount is designated as the patient's responsibility.
What is a co-pay
100
Fraud and abuse, billing practices, Antitrust, quality of care, managed care, bribes and improper payments, conflicts of interest, environmental concerns, and copyright and software licensing
What are compliance issues
100
high, execsivse excessive, beyond normal
hyper
100
ABN
What is the Advanced Beneficiary Notice
200
Subscriber
Who is the individual who carries the insurance coverage
200
A fixed sum that a beneficiary must contribute towards the cost of their health care before insurance benefits begin.
What is a Deductible
200
Corporate Integrity
What is the act of complying with a request, demand, or regulation
200
An x-ray of the breast in a device that compresses and flattens it
What is a mammogram
200
EMTALA
What is the Emergency Medical Treatment and Active Labor Act
300
Consent given in writing or verbally by patient or guardian
What is actual or explicitly expressed consent
300
To inform the patient that Medicare may not consider the health services being provided as medically necessary and that there is a good possibility that Medicare will not pay for the services provided and the patient may be billed for the services
What is the purpose of the Advanced Beneficiary Notice?
300
Fraud committed or attempted using identifying information of another person without authority
What is identity theft
300
A non-invasive test that is used to reflect underlying heart conditions by measuring the electrical activity of the heart
What is an Electrocardiogram
300
Intended to prevent duplication of payments when a patient is covered by multiple group health plans for the same medical service
What is COB
400
Treatment received by a patient in a hospital or clinic. The patient does not require hospitalization
What is Out Patient Care
400
Written authorization from a policy holder for their insurance company that allows a payer to pay benefits directly to the provider
What is an Assignment of Benefits
400
The obligation of an employee to let management know of suspected violations in organizational policies, or federal or state laws
What is the duty to report wrong doing
400
Part od a medical procedure, typically to withdraw a blood sample or for an intravenous injection
What is a venipuncture
400
IMM
What is the Important Message from Medicare
500
In addition to accurately identifying the patient, patient access staff should follow the facility directed guidelines to secure the patient's ________ and ________ information. Doing so helps prevent ______ ______ and _______ ________
What is Demographic, Financial, Identity theft, and Insurance fraud
500
An 8 year old patient is registering for a Radiology appointment. His mother and father each have separate insurance coverage through their employers. The child is covered under both policies. Mother: BCBS, DOB 04/10/1970, employed by Pepsico which has over 100 employees. Father: Oxford, DOB 01/17/1969, employed by a local pharmacy and has 9 employees. Who's policy would be primary and why?
What is known as the Birthday Rule. The father's insurance would be primary because he is the older parent.
500
Falsifying insurance eligibility is an example of:
What is fraud
500
Partial or complete loss of consciousness
What is syncope
500
Federal agency within the United States Department of Health and Human Services (HHS) that administers the medicare program and works in partnership with state governments to administer Medicaid
What is CMS (Centers for Medicare and Medicaid Services)