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, coworkers, the gov, and ins co's
What does acting within e
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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, coworkers, the gov, and ins co's
What does acting within ethical behavior boundaries mean? Correct Answer Carrying out one's responsibilities with integrity, dignity, respect, honesty, competence, fairness, and trust
Compliance regulations Correct Answer Most billing-related cases are based on HIPAA and False Claims Act
Health Insurance Portability & Accountability Act (HIPAA) 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 2 provisions of HIPAA? Correct Answer Title 1: Insurance Reform
Title 2: Administrative Simplification
What is Title 1 of HIPAA? Correct Answer Insurance Reform-primary purpose is to provide continuous coverage for workers & their dependents when they change or lose jobs. Also Limits the use of pre-existing conditions exclusions
Prohibits discrimination from past or present poor health
Guarantees certain employees/ individual the right to purchase new health insurance coverage after losing job
Allows renewal of health insurance coverage regardless of an individual’s health condition that is covered under the particular policy
What is Title 2 of HIPAA? 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 with 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 insurance claims
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