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Fraud is defined by the federal government as anyone who knowingly or willingly executes, or attempts to execute, a scheme to defraud any healthcare benefit program. True or False

Abuse typically occurs due to ignorance or lack of awareness of proper coding and billing guidelines. True or False.

Security rule is one of the Privacy and Security Standards categories that does not complement the Privacy Rule and established standards for administrative, physical, and technical requirements for protecting PHI. True or False.

Privacy Rule is one of the Privacy and Security Standards categories that does not define requirements for protecting and disclosing protected health information (PHI). This applies to covered entities and their business associates. True or False.

To protect patient privacy, we are expected to disclose any information regarding the patient's medical record through phone calls or any means of communication.  True or False

A sibling of the patient is asking for medical records from the staff of the clinic. The staff immediately gave the medical records to the sibling because it is a family member of the patient. True or False.

There are appropriate physical, administrative, and technical safeguards that must be in place to protect the confidentiality, integrity, and availability of the ePHI on mobile devices and when information is stored in the cloud when working remotely. True or False.

HIPAA set fines of $20,000 per claim and imprisonment of up to 10 years for fraud. True or False.

HITECH an acronym that stands for Health Information Technology for Ecology and Clinical Health Act is another federal law that impacts billing and coding. True or False.

Administrative is one of the categories of reasons claims is rejected. It consists of incomplete info, data mismatch, or typos. True or False

Coding error is one of the categories of reasons the claim is rejected is related to codes. True or False.

Claim Rejection Reasons & Adjustment Codes are one of the reasons or explanations provided in remittance advice or ERA/EOB. True or False.

Here are some of the common denial reasons why a claim is denied by the insurance: Out-of-Network provider, service not medically necessary, and benefit is covered. True or False.

Payers and clearinghouses have the same conventions and explanations in explaining why a claim was rejected. True or False.

The claim appeal process is used when additional explanation or documentation will resolve the insurance payer's reason for denial or reduction in payment. True or False.