NHA CBCS Study Guide (2024/ 2025 Update) | Questions and Verified Answers| 100% Correct| A Grade
QUESTION
Explain the difference between fraud and
... [Show More] abuse?
Answer:
Fraud - intentionally misrepresenting services rendered for the purpose of receiving a higher payment
Abuse - refers to practices that are often done unknowingly as a result of poor business practices, directly, or indirectly resulting in unnecessary costs to the program through improper payments
QUESTION
What is the difference between Medicare and Medicaid?
Answer:
Medicare is federally funded and administered health insurance provided to people age 65 and older, people with certain disabilities, and ESRD
Medicaid is a government based health insurance for individuals who have low-income and limited financial resources. Funded at the state and federal level but administered at the state level.
QUESTION
Define abstracting
Answer:
The extraction of specific data from a medical record, often for use in an external database, such as a cancer registry
QUESTION
What is the difference between distal and proximal?
Answer:
Distal - Far away from origin
Proximal - Near the origin
QUESTION
Define root word gastro-
Answer:
Stomach
QUESTION
_________________________________ have completed their residency and fellowship requirements.
Answer:
Attending or staff physicians
QUESTION
What is a preauthorization?
Answer:
is approval from the health plan for an inpatient hospital stay or surgery.
QUESTION
What is an aging report?
Answer:
identifies the outstanding balances in each account. 30 day increments.
QUESTION
Define mortality
Answer:
the incidence of death in a population
QUESTION
What are Category II CPT Codes?
Answer:
Supplemental tracking codes - used for performance measurement
QUESTION
What is coinsurance?
Answer:
Percentage of costs the insurance company and insured each pay (usually 80/20)
QUESTION
What does block 33 on the CMS-1500 claim form indicate?
Answer:
The billing information (either the servicing provider's info or a 3rd party billing company)
QUESTION
What is an authorization?
Answer:
Permission granted by the patient or patient's representative to release information for reason other than treatment, payment, or health care operations
QUESTION
What is a consent?
Answer:
A patient's permission evidenced by a signature.
QUESTION
What are Medicare Advantage Plans?
Answer:
Provides combined package of benefits under Parts A and B in addition to vision, hearing and dental and can sometimes include drug coverage
TAKES THE PLACE OF TRADITIONAL MEDICARE
QUESTION
What is the purpose of the OIG?
Answer:
Protects Medicare and HHS programs from fraud and abuse by conducting audits, investigations, and inspections
QUESTION
charge amount
Answer:
The amount the facility charges for the procedure or service.
QUESTION
charge description master [Show Less]