Certified Billing & Coding Specialist Exam Review
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Terms in this set (394)
Standards of conduct based on moral principle. they
What are Medical Ethics? are generally accepted as a guide for behavior
towards pt's, dr's, coworkers, the gov, and ins co's
What does acting within Carrying out one's responsibilities with integrity,
ethical behavior dignity, respect, honesty, competence, fairness, and
boundaries mean? trust
Most billing-related cases are based on HIPAA and
Compliance regulations
False Claims Act
Health Insurance Enacted in 1996, created by the Health Care Fraud &
Portability & Abuse Control Program- enacted to check for fraud
Accountability Act and abuse in the Medicare/ Medicaid Programs and
(HIPAA) private payers
What are 2 provisions of Title 1: Insurance Reform
HIPAA? Title 2: Administrative Simplification
, Insurance Reform-primary purpose is to provide
continuous coverage for workers & their dependents
when they change or lose jobs. Also Limits the use of
pre-existing conditions exclusions
Prohibits discrimination from past or present poor
health
What is Title 1 of HIPAA?
Guarantees certain employees/ individual the right to
purchase new health insurance coverage after losing
job
Allows renewal of health insurance coverage
regardless of an individuals health condition that is
covered under the particular policy
Administrative Simplification- goal is to focus on the
health care practice setting to reduce administrative
cost & burdens.
Has 2 parts
1) development and implementation of standardized
What is Title 2 of HIPAA?
health related financial & administrative activities
electronically
2) implementation of privacy & security procedures to
prevent the misuse of health info by ensuring
confidentiality
Federal law that prohibits submitting a fraudulent
What is the False Claims claim or making a false statement or representation in
Act (FCA)? connection with a claim. Also protects & rewards
whistle-blowers
Developed by CMS to promote the national correct
What is the National
coding methodologies & to control improper coding
Correct Coding Initiative
that lead to inappropriate payment of Part B health
(NCCI)?
insurance claims
2:
How many edits does 1.Column 1/ Column 2 (previously called
NCCI include? Comprehensive/ Component) Edits
2.Mutually Exclusive Edits
Questions and Answers
Save
Terms in this set (394)
Standards of conduct based on moral principle. they
What are Medical Ethics? are generally accepted as a guide for behavior
towards pt's, dr's, coworkers, the gov, and ins co's
What does acting within Carrying out one's responsibilities with integrity,
ethical behavior dignity, respect, honesty, competence, fairness, and
boundaries mean? trust
Most billing-related cases are based on HIPAA and
Compliance regulations
False Claims Act
Health Insurance Enacted in 1996, created by the Health Care Fraud &
Portability & Abuse Control Program- enacted to check for fraud
Accountability Act and abuse in the Medicare/ Medicaid Programs and
(HIPAA) private payers
What are 2 provisions of Title 1: Insurance Reform
HIPAA? Title 2: Administrative Simplification
, Insurance Reform-primary purpose is to provide
continuous coverage for workers & their dependents
when they change or lose jobs. Also Limits the use of
pre-existing conditions exclusions
Prohibits discrimination from past or present poor
health
What is Title 1 of HIPAA?
Guarantees certain employees/ individual the right to
purchase new health insurance coverage after losing
job
Allows renewal of health insurance coverage
regardless of an individuals health condition that is
covered under the particular policy
Administrative Simplification- goal is to focus on the
health care practice setting to reduce administrative
cost & burdens.
Has 2 parts
1) development and implementation of standardized
What is Title 2 of HIPAA?
health related financial & administrative activities
electronically
2) implementation of privacy & security procedures to
prevent the misuse of health info by ensuring
confidentiality
Federal law that prohibits submitting a fraudulent
What is the False Claims claim or making a false statement or representation in
Act (FCA)? connection with a claim. Also protects & rewards
whistle-blowers
Developed by CMS to promote the national correct
What is the National
coding methodologies & to control improper coding
Correct Coding Initiative
that lead to inappropriate payment of Part B health
(NCCI)?
insurance claims
2:
How many edits does 1.Column 1/ Column 2 (previously called
NCCI include? Comprehensive/ Component) Edits
2.Mutually Exclusive Edits
