1. Name the non privacy HIPAA. CMS is authorized by the HHS to investigate complaints of non compliance and enforce what non privacy HIPAA standards?

HIPAA Electronic Health Care Transaction and Code Sets Standards (TCS). The National Employer Identifier Number (EIN) Rule. The Security Rule. The national Provider Identifier Rule and the national Plan identifier rule.

2. How many types of plans are there? and which one is the most popular one?

two types; Indemnity and Managed Care plans. Managed care plan is the most popular one.

3. Acute care facility

Provide Continuous Professional Medical Care to Patients who are in the ACUTE STAGES of CONDITIONS and ILLNESSES.

4. Hospice

is an Organization that Provides Health Care for People with Terminal Illnesses

5. Medicare covers

100 Percent Federally Funded Health Plan

6. Title ll of HIPAA

Administrative Simplification; FILING CLAIMS for PAYMENT. CHECKING PATIENT ELIGIBILITY for BENEFITS. REQUSTING AUTHORIZATION for SERVICES. NOTIFYING PROVIDERS of PAYMENTS

7. What are the 3 main HIPAA laws

HIPPA Privacy Rule. HIPAA Security Rule. HIPPA Electronic Health Care Transaction and Code Set Standards.

8. Medicaid covers

LOW-INCOME PEOPLE

9. Ambulatory surgery center

SAME-DAY SURGERY CENTERS or UNITS. provide SURGICAL SERVICES ONLY for ambulatory patients. Ambulatory patients' planned procedures do not usually require hospitalization.

10. Under indemnity plan.name the four conditions that should be met before the insurance makes a payment.

1. The MEDICAL CHARGE MUST be for MEDICALLY NECESSARY SERVICES and must be covered by the insured's health plan. 2. The PREMIUM PAYMENT MUST be UP TO DATE. 3. If the policy has a DEDUCTIBLE -the AMOUNT that the INSURED MUST PAY on covered services before benefits begin -the deductible must have been met. Deductible range widely, usually from $200 to thousands of dollars annually, higher deductible generally mean lower premiums. 4. Any COINSURNACE- the PERCENTAGE of EACH COVERED CHARGE that the INSURED MUST PAY-has to have been taken into account. The coinsurance rate shows the insurance company's percentage of payment for the charge followed by the insured's percentage, such as 80-20. This means that the PAYER PAYS 80 percent of the covered amount and the PATIENT PAYS 20 percent aft he premiums and deductibles are paid.

11. What happens during pre-registration/registration process

HOSPITAL POLICY is EXPLAINED, VERIFY ELIGIBILITY COVERAGE, SIGNED CONSENT FORM, PERSONAL DATA, BASIC BILLING DATA, MEDICAL INFORMATION, ACCOUNT NUMBER, MEDICAL RECORED NUMBER.

12. Inpatient routine charger include

ADMISSION KITS and PREP KITS, LUBRICANTS, OXYGEN, IRRIGATION SOLUTIONS, DRAPES, GLOVES, REUSABLE ITEMS such as MICROSCOPES and HUMIDIFIERS

13. Ancillary charges include

Operating Room, Anesthesia, Blood Products and Administration, Pharmacy, Radiology Services, Laboratory, Medical, Surgical, and Central Supplies (each item taken from inventory must be billed out), Physical, Occupational, Speech, and Inhalation Therapy.

14. Billing errors:

BILLING for SERVICES and SUPPLIES that are NOT DOCUMENTED in the PATIENT'S MEDICAL RECORD. BILLING for SERVICES that are INSUFFICIENTLY DOCUMENTED in the PATIENT'S MEDICAL RECORD. BILLING TWICE for the SAME SERVICE, BILLING for MEDICALLY UNNECESSARY SERVICES. BILLING for SERVICES that are INCLUDED in OTHER CHARGES, BILLING INACCURATE INFORMATION about PROVIDERS or the WRONG PROVIDERS.

15. A condition must meet what conditions to be considered medical necessary

The PROCEDURE MUST be APPROPRIATE for the PATIENT'S DIAGNOSIS. The PROCEDURE is NOT ELECTIVE. The PROCEDURE is NOT EXPERIMENTAL. The PROCEDURE MUST be APPROVED by the APPROPRIATE FEDERAL REGULATORY AGENCY. The PROCEDURE is NOT PERFORMED for the CONVENIENCE of the PATIENT or the PATIENT'S FAMILY. The PROCEDURE is FURNISHED at an APPROPRIATE LEVEL.

16. Name the 3 major tasks the Health Information Management (HIM) is responsible for

MEDICAL TRANSCRIPTIONS, MEDICAL RECORDS and MEDICAL CODING.

17. Are the Medical, surgical, and central supplies included in the routine charges

NO, THEY ARE INCLUDED IN THE ANCILLARY CHARGES.

18. Oxygen, Irrigation solutions drapes are example of what type of charges

ROUTINE CHARGES

19. Is it true to say that patient statements are generated after they are discharged

NO FALSE, after RAs are received and posted, patient statement (bills) are generated. The health provider is sent the statement first, once payment is received the patient is sent a statement for the unpaid balance

20. The next step after claims are submitted is

the FOLLOW-UP after THIRTY DAYS, after which the PAYER has ANOTHER THIRTY DAYS to DECIDE WHETHER to PAY THE CLAIM.