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

Define compliance.

Exceptions to the right of Privacy Rule include

A well-designed compliance program should show a ______________ effort to submit claims appropriately.

"What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about," is attributed to _________.

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 fees on an insurance claim form to obtain higher payment.

A HIPAA compliance exception to the right of privacy and privileged communication is a patient's records pertaining to his or her industrial accident case.

Since April 14, 2003, when privacy regulations became enforceable, providers are required to document which four things?

What is the best response when telephoning a patient about an insurance matter and the patient's voice mail is reached?

The Security Rule that addresses electronic protected health information is divided into which three main sections?

Explain when a physician's office would be considered a "covered entity."

What does "safe harbor" refer to?

Match the positions below with the description of that person or entity. -Individual who is hired by a medical practice to process claims to a third-party payer.

A billing practice such as excessive referrals to other providers for unnecessary services is considered ________________________.

List five specific risk areas identified by OIG that an office needs to monitor and follow.

The process of meeting regulations, recommendations, and expectations of federal and state agencies that pay for health care services and regulate the industry is known as eHealth information management.

Qui tam suits are those cases in which a private citizen known as a whistleblower reports a fraudulent activity within his or her organization.

The key individual who oversees an organization's compliance program is referred to as the _________________.

Under HIPAA guidelines, a chiropractor or dentist's office would never be considered a covered entity.

Confidential information includes

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. -Charging excessively for services and supplies.