Medical Billing & Coding as a Career Correct Answer: *Claims assistant professional or claims manager,
*Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, *
Insura
...
Medical Billing & Coding as a Career Correct Answer: *Claims assistant professional or claims manager,
*Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, *
Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, *
Billing & Coding Specialist
What are Medical Ethics? Correct Answer: Standards of conduct based on moral principle. They are
generally accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? Correct Answer: carrying out one's
responsibilities w/ integrity, dignity, respect, honesty, competence, fairness, & trust.
Legal Aspects of of Medical Billing & Coding: Correct Answer: ...
Compliance regulations: Correct Answer: Most billing-related cases are based on HIPPA and False
Claims Act
Health Insurance Portability & Accountability Act (HIPPA) Correct Answer: Enacted in 1996, created by
the Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? Correct Answer: Title I: Insurance Reform
Title II: Administrative Simplification
What is Title I of HIPPA? Correct Answer: Insurance Reform-primary purpose is to provide continuous
ins coverage for worker & their dependents when they change or lose jobs. Also *Limits the use of
preexisting conditions exclusions *Prohibits discrimination from past or present poor health
*Guarantees certain employees/indv the right to purchase new health ins coverage after losing job
*Allows renewal of health ins cov regardless of an indv's health cond. that is covered under the
particular policy.
What is Title II of HIPPA? Correct Answer: Administrative Simplification-goal is to focus on the health
care practice setting to reduce administrative cost & burdens. Has 2 parts- 1) development and
implementation of standardized health-related financial & administrative activities electronically 2)
Implementation of privacy & security procedures to prevent the misuse of health info by ensuring
confidentiality
What is the False Claims Act (FCA)? Correct Answer: Federal law that prohibits submitting a fraudulent
claim or making a false statement or representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? Correct Answer: Developed by CMS to promote
the national correct coding methodologies & to control improper coding that lead to inappropriate
payment of Part B health ins claims.
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