ing - Down-coding - Up-coding Correct Ans:- - Up-coding Rationale: Up-coding is a fraudulent practice in which the provider services are billed at higher
... [Show More] procedure codes than were actually performed, resulting in a higher payment by Medicare or other third-party payers. 1. During a session, your patient asks to be able to contact you via your Facebook page on the internet. You reply: - I cannot do that because I have a concealed Facebook identity; and I cannot reveal that to my patients - I would be happy to communicate with you. It makes it easier for me to reach you this way. - I would be happy to use Facebook but you will have to use a private message so that you can be anonymous - I cannot do that because Facebook does not protect your Private Health Information Correct Ans:- - I cannot do that because Facebook does not protect your Private Health Information Rationale: Using Facebook breaks patient-provider confidentiality, in addition to blurring ethical boundaries of the therapeutic relationship. Facebook does not protect private health information. Information on the site is available for anyone to see or hack into even if private messaged. 1. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) insures which of the following? - Small employers who insure 50 or fewer covered lives are exempt from the provisions of this MHPAEA law. - Annual or lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical and surgical benefits offered by a group health plan. - Mental health and substance use disorder benefits must be available through both in-network providers and out-of-network providers by a group health plan. - Group health plans may obtain an exemption if they can demonstrate expected cost increase resulting from implementation of the parity provisions greater than a 5% increase in the cost under existing plan. Correct Ans:- - Annual or lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical and surgical benefits offered by a group health plan. Rationale: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provides federal legislation that requires any annual or lifetime limits on medical and surgical benefits be the same for mental health and substance use disorder benefits. Small employers who insure 2 to 50 employees can apply for an "opt-out" waiver, but they are not automatically exempt from the MHPAEA requirements. The group health plan will be required to provide in-network and out-of-network mental health and substance use disorder benefits only if it provides both in-network and out-of-network medical and surgical benefits. The group health plan my obtain an exemption or waiver if the first year of implementation results in 2% increase in group health plan costs over [Show Less]