*NURSING > QUESTIONS & ANSWERS > NHA Billing & Coding Study Guide. Approved Comprehension. Rated A+ (All)

NHA Billing & Coding Study Guide. Approved Comprehension. Rated A+

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Must be included when billing an insurance company: - Ans-DOS, POS, TOS, and dx or DX DOS - Ans-Date of Service POS - Ans-Place of service TOS - Ans-type of service DX or dx - Ans-diagnosi... s HIPAA - Ans-under what rule mays use patients Protected Health Information (PHI) with out specific authorization for treatment, payment, and operation purposes (TPO). T in TPO? - Ans-treatment P in TPO? - Ans-Payment O in TPO? - Ans-Operations What does (T)reatment in TPO mean? - Ans-primarily for the purpose of discussion of the patients case with other providers What does (P)ayment in TPO mean? - Ans-where providers submit claims on behalf of patients What does (O)perations in TPO mean? - Ans-for purposes such as staff training and quality improvement Employer Liability - Ans-physicians are legally responsible for their own conduct and any actions of their employees. Employee Liability - Ans-"errors and omissions insurance" a protection against a loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim Let the master answer - Ans-means an employee can be sued and brought to trial Medical Record - Ans-: documentation on the patients social and medical history, family history, physical examination findings, progress notes, radiology and lab results, consultation reports and correspondence to patient Reason 1 for Documentation of Pt Records - Ans-avoiding denied payments by insurance carriers investigating the medical necessity of services Reason 2 for Documentation of Pt Records - Ans-enforcement of record keeping rules by insurance carriers requiring accurate documentation that supports procedure and diagnostic codes Reason 2 for Documenting of Pt Records - Ans-Subpoena of medical records by state investigators of the court review Reason 4 for Documenting of Pt Records - Ans-Defense of a professional liability claim Indefinitely - Ans-a M.D. must keep living Pt records for 5 years - Ans-a MD must keep deceased Pt records for pain - Ans--algia blood condition - Ans--emia [Show More]

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