NHA CBCS EXAM REVIEW

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NHA CBCS EXAM REVIEW

Expected Questions and Verified Answers 100% Guarantee Pass

1. Medical Ethics: Standards of conduct based on moral principles. Generally

accepted as a guide for behavior towards patients, physicians, co-workers, the government, and insurance compaines.

• Compliance Regulations: billing-related cases are based on HIPAA and False Claims

Act.

• Health Insurance Portability and Accountability Act of 1996 (HIPPA): Created the 1 / 4

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Health Care Frad and Abuse Control Prpgram enacted nt check for fraud and abuse in the Medicare and Medicaid programs, and private payers.

• Two provisions of HIPPA: Titile I: Insurance Reform Title

II: Administrative Simplification

• Insurance Reform. -Primary purpose to provide continuous insurance cov- erage for

workers and their dependents when they change or lose their jobs.-

: -Limits the use of preexisting conditions exclusions

-Prohibits discrimination for part or present poor health -Guarantees cetraom employees and individuals the right to purchase health insur- ance coverage after losing a job

• Allows renewal of health insurance coverage regardless of an individual's health condition

that is covered under the particular policy

• Administrative Simplification-The goal is to focus on the health care prac- tice 2 / 4

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setting to reduce administrative cost and burdens.: Two parts:

• Development and implementation of standardized health-related financial and

administrative activities electronically.

• Implementation of privacy and security procedures to prevent the misuse of health

information by ensuring confidentiality.

• False Claim Act (FCA): Federal law that prohibits submittimg a fraudulent claim or

making statement or representation in connection with a claim.

8. National Correct Coding Initiative (NCCI): Developed by the CMS to promote

national correct coding methodologies and to control improper coding that leads to inappropriate payment of part B health insurance claims.

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• Two type of NCCA edits - 1. Column 1 /Column 2 or Comprehensive Com- ponent

Edits: identifies code pairs that should not be billed together because one code.Column 1 includes all the services described by another code in Column 2.: 2. Mutually Exclusive Edits: identifies code pairs that, for clinical reason, are unlikely to be performed on the same patient on the same day.

• Office of Inspector General (OIG): Investigates and prosecute health care fraud

and abuse.

• Fraud: Knowingly and intentionally deceiving or misrepresenting information that

may result in unauthorized benefits.

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