Exam 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed. -Forgiving the deductible or copayment for a Medicare patient.

Confidentiality between the physician and the patient is automatically waived when the patient is being treated in a workers' compensation case.

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed. -Altering medical records to generate more in payment.

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed. -Failure to make a refund when services are not reasonable or necessary.

What action could happen if an employee knowingly submits a fraudulent Medicare or Medicaid claim at the direction of the employer and subsequently the medical practice is audited?

Confidentiality is automatically waived in cases of

Match the positions below with the description of that person or entity. -Third-party administrator who receives insurance claims from the physician's office, performs edits, and redistributes the claims electronically to various insurance carriers.

When an insurance billing specialist bills for a physician and completes a Medicare claim form with information that does not reflect the true situation,

A patient has the right to obtain a copy of his or her confidential health information.

Identify which of the following would NOT typically be considered as a form of discipline for situations that involve fraudulent and malicious misconduct.

Match the positions below with the description of that person or entity. -Individual who renders medical services, furnishes bills, or is paid for health care in the normal course of business.

Under more recent legislation known as the Affordable Care Act, _________ compliance program requirements were implemented.

List three things that can be done to avoid having a patient hear confidential information regarding other patients.

The Office of Civil Rights enforces

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed. -Changing the date of service.

Determine whether the following statements are cases of insurance (a) abuse or (b) fraud. You may use the two choices as many times as needed. -Billing Medicare beneficiaries at a higher rate than other patients.

List five of the disciplinary standards resulting from misconduct.

Disclosing PHI as authorized by the laws relating to workers' compensation does not require a signed authorization.

Employees should be required to attend a compliance training session at least __________.

To bill Medicare beneficiaries at a higher rate than other patients is considered