WorksheetsWeek 1 - Game
Total questions: 25
Worksheet time: 19mins
These are codes used to identify what was done to or given to a patient
Modifier
Diagnosis Codes
Procedure Codes
These codes are written descriptions of diseases, illnesses and injuries into codes from a particular classification
(a)
TUE or FALSE. If a breach impacts 600 people, companies must notify the Secretary of Health and Human Services (HHS), who would post a list of breaches on the HHS web site, potentially the media and in certain circumstances the information would be posted on the company website.
TRUE
FALSE
It is a written order from your primary care doctor for you to see a specialist or get certain medical services.
(a)
ITS stands for?
(a)
State where the service was rendered
Host Plan
Home Plan
Hold Plan
A collection of programs and policies that enable members to receive healthcare services while traveling or living in another Plan’s service area.
(a)
It is a set of common language data formats, software and procedures that allows Plans to access, send and receive data
Programs
Inter-plan Teleprocessing System
Bluecard
This will allow members to receive healthcare while traveling or living in another Plan’s service area
Programs
Inter-plan Teleprocessing
Host Plan
These codes will describe the type and location of service a patient receives while in a facility.
(a)
What is the place of service code for emergency room?
(a)
They are middleman between a healthcare provider and a health plan that checks claims from healthcare providers to ensure they don´t contain errors before forwarding them to a health plan for payment.
(a)
This is a document sent to the member to let them know a claim has been processed and how much will be their responsibility.
Explanation of Benefits
Evidence of Coverage
Member ID Card
Which of the following is not part of the CMS-1500 form?
Diagnosis Code
Procedure Code
Revenue Code
Modifier Code
PHI stands for?
(a)
It is the acquisition, access, use, or disclosure of Member Confidential Information in a manner not permitted by the Privacy Rule which compromises the security or privacy of the PHI.
(a)
True or False. Noncompliance fines and penalties can range from $100 - $1.5 million. Findings of willful neglect require mandatory penalties.
TRUE
FALSE
The American Recovery and Reinvestment Act of 2009 (ARRA), also referred to as?
HIPAA Law
PHI Act
Stimulus Act
TRUE or FALSE. – When performing HIPAA V&A – you MUST ask for the information from the caller and they should provide to you. Always give information to a caller and ask if it is correct.
TRUE
FALSE
TRUE or FALSE. even after we verify the identity and authority of callers. We remain in compliance with the Privacy Rule by disclosing the maximum information.
TRUE
FALSE
The policy was purchased in Wisconsin and the member got the service in New York. Will you handle the chat if the provider is asking about the claim status?
YES
NO
The policy was purchased in Wisconsin and the member got the service in Nevada. Will you handle the chat if the provider is asking about the claim status?
YES
NO
The policy was purchased in Wisconsin and the member got the service in Georgia. What state will you send the message if provider is calling for benefit?
Georgia
Colorado
Wisconsin
New York
Which of the following provider state we do not handle?
Connecticut
New Hampshire
Indiana
New York
What does P in TPO stand for in HIPAA usage?
(a)
