Show:
Medicare
HIPAA
Federal Register
RBRVS
Fraud
100
What are individuals covered under Medicare called?
Beneficiaries
100
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
100
Who published the Federal Register?
The government
100
What does RVU stand for?
Relative value unit
100
This term is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes knowing that the deception could result in some unauthorized benefit.
What is fraud?
200
What does CMS stand for?
Centers for Medicare and Medicaid Services
200
Name one major change that HIPAA made to the health care industry to simplify administrative costs and duties.
Electronic transactions and code set standards Privacy requirements Security requirements National identifier requirements
200
In which month/s is the outpatient edition of the Federal Register released?
November or December
200
What three elements does the Relative Value Unit contain?
Work, Overhead, and Malpractice
200
This organization develops a workplan to idenify areas of the Medicare program that will be monitored.
What is the OIG?
300
Who handles the daily operations of the Medicare program?
Medicare Administrative Contractors
300
Name 3 code sets that were adopted under HIPAA.
CPT ICD-10-CM ICD-9-CM ICD-10-PCS HCPCS Dental Codes National Drug Classifications
300
What month is the Inpatient edition of the Federal Register released?
October
300
What is the purpose of the GPCI?
The Geographic Practice Cost Index reflects the relative costs of a practice in a given locality compared with the national average.
300
Who in the health care field may violate Medicare rules and commit fraud?
Anyone in the health care field
400
Name two services that Part A Medicare covers.
Inpatient stay, semi-private room, skilled nursing facility, skilled rehab, home health, hospice
400
What year was HIPAA created?
1996
400
The official statement of the Federal Register is called the______.
Final Rule
400
In 1989, a major change took place in Medicare with the enactment of___________.
Omnibus Reconciliation Act of 1989
400
What does OIG stand for?
The Office of Inspector General
500
What is Part C Medicare coverage?
Medicare Advantage Organizations which provide options such as HMOs, PPOs, PFFS, Special Needs Plan, Medical Savings Account, HMOPOS
500
Describe the difference between security and privacy of health records.
Privacy of protected health information (PHI) is not disclosing (revealing) a patient's health information to those who are not involved in the patient's care. Security is providing physical, administrative, and technical safeguards to protect PHI, such as passwords, firewalls, keypad entry to records room, and computer logs of patient record access.
500
The Federal Register is a document that contains only Medicare regulations. True or False
False
500
A national dollar amount that is applied to all services paid on the basis of the Medicare Fee Schedule is the ___________.
Conversion Factor
500
Name 3 forms of fraud.
Billing for services not furnished, misrepresenting a diagnosis, kickbacks, unbundling, falsifying certificates of medical necessity, up-coding, waiving the copayment