Insurance for Medical Office

What should be your priority as a billing specialist?

What is the primary goal of a medical insurance billing specialist?

What is revenue?

What is cycle?

Two billing components exist:

What is facility billing?

What is professional billing?

What a non-physician practitioner (NNP) means?

A synonym for Non-physician practitioner(NNP)

Who can be a NNP

Payment schedules for payment of professional services are based on

Under Medicare, physicians are paid according to relative value units, which are based on

Several job title names are associated with medical billing personnel. The professional title used depend on

Some of the most popular titles include insurance billing specialist are

Cost pressures on health care providers are forcing employers to be more efficient, and hiring

What do claims assistance professionals (CAPs) do?

Administrative front office duties have gained in importance for the following reasons

Diagnostic and procedural coding must be

Cash flow is

An insurance billing specialist in a large medical practice may act as

The insurance billing specialist discusses

Insurance billing speciaist knowledge, skills and abilities

insurance billing specialist knowledge, sikill and abilities

Insurance Biling Specialist (IBS)knowledge, skills and abilities

IBS knowledge skills and abilities

IBS knowledge, skills and abilities

IBS responsabilities

IBS responsabilities

IBS responsabilities

The American Association of Medical Assistants (AAMA) developed a role delineation study in

What do the insurance billing or coding specialist accredited program offers as an additional education

For a job as a coder is necessary

A codificador medical assistance insurance billing

AHIMA

AHIMA has published diagnostic and procedure coding competencies for

IBS can receive a salary depending on

Self-Employment or Independent contracting demands

Medical etiquette has to do with

Customs, courtesy, and manners of the medical profession cam be expressed in 3 words

Principles of ethics for the insurance billing specialist:

Principles of ethics for the insurance billing specialist:

If you discover that a patient in your practice may have questionable issues of care

Never keep another physician who wants to talk about a medical case to your physician employer waiting longer than necessary in the reception room

Always connect another physician who is calling on the phone to your physician immediately asking a few questions as possible.

Follow the basic rules of etiquette with co-workers while working in the office.

Identify yourself to callers and people you call

Maintain a professional demeanor and a certain amount of formality when interacting with other.

Observe rules of etiquete when sending e-mail messages an placing or receiving cell phone calls.

Medical ethics

The earliest written code of ethical principles and conduct for the medical profession was originates in

In 1980, the American Medical Association (AMA)

Violating guidelines by using code numbers or modifiers to increase payment when the case documentation does not warrant it

Coding services or procudures that were not performed for payment.

Unbundiling services provided into separate codes when one code is available and includes all the services

Failing to code a relevant condition or complication when it is documented in the health record, or viceversa, assigning a code without documentation from the provider.

Coding a service in such a way that it is paid when usually it is not covered

Coding another condition as the principal or primary diagnosis when most of the patient's treatment is for the preexisting condition.

Physicians are legally responsible for their own conduct and any actions of their emplyees performed within the context fo their employment.

An insurance biller always should check with his or her physician-employer to determine whether he or she is included in the medical professional liability insurance policy otherwise

Future goals for a insurance IBS

goals for an IBS

If IBS change the date of service for get into insurance policy to bill charge

Hay una exclusion para el derecho de privacidad

Best practice when you call a patient

Who handles the code of ethics for IBS?

AAMA

ACA

AHIMA

AMA

ASHD

CAP

GED

HIPAA

listserv

MSHP

MSO

NPP

ARRA

CERT

CLIA

CMP

CMS

DHHS

DOJ

FBI

FCA

FDIC

FTP

HCFAP

HEAT

HIPAA

HITECH

IIHI

MIP

npp

OCR

OIG

ORT

OSHA

P&P

PHI

PO

RAC

SDP

TPO

ZPIC

COMPLIANCE in the health care industry

Title of HIPAA (Health Insurance Portability and Accountability Act) focuses on the health care practice setting and aim to reduce administrative costs and burdens

The HIPAA Title that provede continuous insurance coverage for workers and their insured dependents when they change or lose jobs.

What is a clearinghoue?

What a covered entity may be?

Who is a business associate?

A health care provider is

Is designated to help the provider remain in compliance by setting policies and procudures (P&P) and by training and managing the staff regarding HIPAA

OCR (Official of Civil Rights)

Confidentiality

PHI (Protected health information)

Under the HIPAA (Health Information Portability and Accountability Act) what is authorization

Authorizatin form is necessary for

Confidentiality between the physician and patient is automatically waived in the following situations:

Confidentiality is waived in the following situations:

Confidentially physician and patiente is waived in

Confidiantelly between physician patients waived if

Confidential Communicatios is

Everything you see, hear, or read about patients remains

Privileged information is related to

Nonprivileged information

What do yo have to do if a relative telephones asking about a patient?

Unathorized release of information is called

Telephone conversations by provides in front of patients

The Security Rule comrises regulations related to the

The Health Information Technology for Economic and Clinical Health Act (HITECH) was a provision of

HITECH brought significant compliance changes to three very especific areas

HIPAA established

What AAMA (American Association of Medical Assitance) handle?

Do's of Confidentiality

Don't of Confidentiaity:

The HITECH defines a breach as the

Claim submission is the responsibility fo

Medical Ethics include

Report incorrect information to third-party

If physician charge for innecesary visits is

Report false information is

The OCR (Office of Civil Rights), oversees

The OIG (Office of Inspector General) provides

The mission of OIG (Office of Inspector General) is

The OIG (Office of Inspector General) was established to

Billing for services or supplies not provided (phantom billing or invoice ghosting)

Bill for an office visit if a patient fails to keep an appointment and is not notified ahead of time that this is office policy

Alter fees on a claim for to obtain higher payment

Forgive the deductible or copayment

Alter medical records to generate fraudulent payments

Leave relevant information off a claim, as failing to reveal whether a spouse has health insurance coverage through an employer

Upcode. Submitte a code for a complex fracture when the patient had a simple fracture.

Shorte. Dispensing less medication than billed for

Split billing schemes. Billing procedures over a period of days when all treatment occurred during one visit

Use another person's insurance card in obtaining medical care

Change a date of Service

Post adjustments to generate fraudulent payments

Solicit, offer or receive a kickback, bribe or rebate in return for refering a patient to a physician or NPP

Referring a patient to obtain any item or service that may be paid for in full or in part by Medicare or Madicaid

Restate the diagnosis to obtain insurance benefits or better payment

Apply deliberately for duplicate payment. Billing Medicare twice, billing Medicare and the beneficiary for the same service or billing Medicare and another insurer in an attmpt to get paid twice

Unbundle or explode charge. Billing a multichannel laboratory test as if individual tests were performed

Collusion between a physician and an employee of a third-party payer when the claim is assigned

Physician deliberately overbilled for services, overpayments could be generated with little awareness on the part of the Medicare beneficiary

Refer excessively to other providers for unnecessary services

Charge excessively for services or supplies

Perform a baterry of diagnostic test when only a few are required for services

Violate Medicare's physician participating agreement

Call patients for repeatd and unnecessary follow-up visits

Bill Medicare beneficiaries at a higher rate than other patients

Submit bills to Medicare instead of to third-parthy payers, like claims for injury from an automobile accident, in store, or the workplace.

Breach assignment agreement

Fail to make required refunds when services are not reasonable and necessary

Require patients to contract to pay their physician's full charges, in excess of the Medicare charge limits

Require a patient to waive rights to have the physician submit claims to Medicare and obligate a patient to pay privately for medicare-covered services

Require a patients to pay for services not previously billed, including telephone calls with the physician, prescription refills, and medical conferences with other professionals

Require patients to sign a global waiver agreeing to pay privately for all services that Medicare will not cover, and using these waivers to obligate patients to pay separately for a service that Medicare covers a part of a package or related procedures

Published the Compliance Program for Individual and Small Group Physician Practices in September, 2000

The Compliance Program for Individual and Small Group Physician Practices was provided as

A well-designed compliance program can

Is the key individual overseeing your organization's compliance program monitoring with the support of the Compliance Committe

"Open door" policies ensure

The insurance industry is

Contract

The physician-patient contract begins when

Implied contract

An expressed contract

For a patient who carries private medical insurance, the contract FOR TREATMENT is

PPO

The patients who belong to a PPO (preferred provider organization)

Guarantor

An emancipated minor is

Workers' Compensation (WC) cases

Major medical or extended benefits contracts are

The insured is known as a

Eligibility verification means

In private health insurance, there are five classifications:

Canceleable policy

Optionally renewable policy,

Conditionally renewable polices

Noncancelable policy

coinsurance or cost-sharing requirement means

copayment (copay)

COB

A COB is

Birthday law

In the birthday law, if mother and father have the same birthday, who is the primary

In cases of divorce, consider that you are not an enforcer of court laws

Health insurance policies contain exclusions

Preexisting conditions

Precertification refers

Preauthorization relates

Predetermination means

Blanket contract

What is conversion privilege

Usually conversion from a group adventage

Veterans' Health Administration (CHAMPVA) "Civilian Health and Medical Program of the Department of Veterans Affairs.

If the person has a condition that would make him or her ineligible for coverage is a case considered