MAP 64 Final Exam Preparation

Front

A Medicare-Medicaid (Medi-Medi) crossover plan provides both Medicare and Medicaid coverage to _______ beneficiaries with low incomes.

Back

Medicare

Front

Which type of health insurance coverage is subsidized by employers and other organizations? Options: public health insurance, group health insurance, individual health insurance, universal health insurance

Back

group health insurance

Front

HIPAA defines fraud as an _______ deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment.

Back

intentional

Front

A claims attachment is _______ documentation associated with a health care claim or patient encounter.

Back

supporting

Front

The Consolidated Omnibus Reconciliation Act of 1985 (COBRA) allows employees to continue health care coverage beyond the benefit termination date by _________.

Back

paying appropriate premiums

Front

Which specifically requires an individual’s authorization prior to disclosure and for which HIPAA has established specific requirements for an authorization form? Options: treatment, payment, and operations; covered entity data and information; designated record set; protected health information

Back

protected health information

Front

Which involves comparing the claim to payer edits and the patient’s health plan benefits to verify that the required information is available to process the claim, the claim is not a duplicate, payer rules and procedures have been followed, and procedures performed or services provided are covered benefits?

Back

claims adjudication

Front

Which of the following is an example of fraud? Options: submitting claims for services not medically necessary, reporting duplicative charges on an insurance claim, falsifying certificates of medical necessity plans of treatment, billing noncovered services as covered services

Back

falsifying certificates of medical necessity plans of treatment

Front

Which is the term for the reason a claim is denied or rejected as reported on the remittance advice or explanation of benefits? Options: CARC, POS, EOB, ERA

Back

CARC

Front

Which is an autonomous, centrally administered program of coordinated inpatient and outpatient palliative (relief of symptoms) services for terminally ill patients and their families?

Back

hospice