question

Physicians are paid according to relative value units that are based on cost of delivering care, malpractice insurance, and the physician's work.

answer

True

question

It is not necessary to refer to coding books because medical practices use a fee schedule.

answer

False

question

It is the coder's responsibility to inform administration or his or her immediate supervisor if unethical or illegal coding practices are occurring.

answer

True

question

When one code is available that includes all of the services, it is permissible to bill using separate codes for the services.

answer

False

question

Depending on the circumstances of the case, an insurance billing specialist can be held personally responsible under the law for billing errors.

answer

True

question

Individually identifiable health information (IIHI) is any part of a person's health data (e.g., demographic information, address, date of birth) obtained from the patient that is created or received by a covered entity.

answer

True

question

HIPAA requirements protect disclosure of protected health information outside of the organization but not for internal use of health information.

answer

False

question

Under HIPAA, patients may request confidential communications and may restrict certain disclosures of protected health information.

answer

True

question

It is not necessary to turn documents over or lock them in a secure drawer if you are only leaving your desk for a few minutes.

answer

False

question

Under HIPAA Privacy regulations, patients do not have the right to access psychotherapy notes.

answer

True

question

If a physician belongs to a preferred provider organization (PPO) and does not follow his or her contract with the PPO, the patient is liable for the bill.

answer

False

question

The birthday law is a change in the order of determination of coordination of benefits (COB) regarding primary and secondary insurance carriers for dependent children.

answer

True

question

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) mandates that when an employee is laid off from a company, the group health insurance coverage must continue at group rates for up to 18 months.

answer

True

question

A group policy usually provides better benefits; however, the premiums are generally higher than an individual contract would be.

answer

False

question

A signature stamp is acceptable by all insurances as proof of the provider's signature on a CMS-1500 claim form.

answer

False

question

The insurance billing specialist does not need to know how to complete a paper claim as most claims are submitted electronically.

answer

False

question

Physicians who experience downtimes of Internet services which are out of their control for more than 2 days may submit claims to Medicare on paper.

answer

True

question

The goal of the NUCC is to provide a warehouse for providers to purchase CMS-1500 claim forms.

answer

False

question

Effective June 1, 2013, providers were required to only use the CMS-1500 claims form (02-12).

answer

False

question

Use of the standardized CMS-1500 claim form has simplified processing of paper claims.

answer

True

question

Quantities of the CMS-1500 (02-12) claim form can be purchased through CMS or downloaded from their website and used for submission.

answer

False

question

Interest rates which apply to the Prompt Payment Interest Rate can be located on the Treasury's Financial Management Service page.

answer

True

question

Medicare claims which require further investigation prior to being processed are referred to as \"other\" claims.

answer

True

question

A diagnosis should never be submitted without supporting documentation in the medical record.

answer

True

question

Claims for dates of services in two different years may be submitted on the same claim form.

answer

False

question

Services which are inclusive in the global surgical package that have no charge associated with them should not be submitted on the CMS-1500 claim form.

answer

True

question

Proofreading claims prior to submission can prevent denials and delay of claim processing.

answer

True

question

When submitting supplemental documentation for processing of a claim, the patient's name and date of service only need to be on the front of a two-sided document.

answer

False

question

Handwriting is permitted on optically scanned paper claims.

answer

False

question

Use DNA when information is not applicable.

answer

False

question

Like paper claims, electronic claims require the performing physician's signature.

answer

False

question

Claims can be submitted to various insurance payers in a single-batch electronic transmission.

answer

True

question

Under HIPAA, insurance payers can require health care providers to use the payer's own version of local code sets.

answer

False

question

As ICD-9 and CPT codes are deleted and become obsolete, they should immediately be removed from the practice's computer system.

answer

False

question

HIPAA has brought forth electronic formats for determination of eligibility for a health insurance plan.

answer

True

question

If the provider has no contract with the insurance carrier, the provider is not obligated to the carrier's deadline.

answer

True

question

A patient should be asked to sign an Advanced Beneficiary Notice if he or she has decided to undergo plastic surgery that is not related to a medical condition.

answer

True

question

An overpayment is receipt of less than the contract rate from a managed care plan for a patient who has received medical services.

answer

False

question

In the Medicare reconsideration Level 2 process, the request must be within 9 months from the date of the original determination shown on the remittance advice.

answer

False

question

A decision to appeal a claim should be based on whether there is sufficient data to back up the claim and if there is a large amount of money in question.

answer

True

question

Insurance companies and the federal government do not recommend waiving copayments to patients.

answer

True

question

Regulation Z of the Truth in Lending Consumer Credit Cost Disclosure law applies if the patient is making three payments.

answer

False

question

Most sate collection laws allow telephone calls to the debtor between 8 AM and 9 PM.

answer

True

question

When a patient has declared bankruptcy, it is permissible to continue to send monthly statements for a balance due.

answer

False

question

A collection agency must follow all the laws stated in the Fair Debt Collection Practices Act.

answer

True

HIS Chapter Review Questions (True/False)

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