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

Name three measures that should be taken by a coder who has knowledge of fraud or abuse.

Health care organizations are encouraged to have a(n) ________________ policy to allow effective lines of communication whereby staff feel secure to report questionable or suspicious activities relating to fraud and abuse.

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. -Unbundling or exploding charges.

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. -Filing insurance claims for services not medically necessary.

List the six federal rights that patients are granted under the HIPAA Privacy Rules which allow them to be informed about PHI and to control how their PHI is used and disclosed.

Under HIPAA guidelines, an outside billing company that manages claims and accounts for a medical clinic is known as a covered entity.

Explain the difference between use and disclosure under HIPAA Privacy Rules.

The Office of Civil Rights' (OCR) mission is to protect the integrity of the Medicare and Medicaid programs.

Match the positions below with the description of that person or entity. -A health care coverage carrier, clearinghouse, or physician who transmits health information in electronic form in connection with a transaction covered by HIPAA.

The Stark Law is commonly referred to as the Anti-Kickback statute.