NEW 2026/2027 CBCS STUDY GUIDE WITH COMPLETE SOLUTION (18pages)

When was the Health Information and Accountability Act (HIPAA) created? - answer1996 What are Medical Ethics? - answerStandards of conduct based on moral principals. What are the two provisions of HIPPA? - answer1. Insurance Reform 2. Administrative Simplification What is the False Claims Act (FCA) - answerA Federal law that prohibits submitting a false claim or making a false statement or representation in connection with a claim. What is the National Correct Coding Initiative (NCCI)? - answerInitiative developed by CMS to promote national correct coding methods and control improper coding that leads to wrong payments of Part B health claims. What are the two types of edits that the NCCI implements? - answer1. Column 1/ Column 2; identified unbundled codes. 2. Mutually Exclusive Edits: Codes that are unlikely to be performed on the same patient in the same day. Who investigates and prosecutes Health Care fraud? - answerOffice of Inspector General (OIG) When can a provider share PHI without specific permission from the patient? - answer1. For treatment (discussing the case with another professional) 2.Payment (When providers submit claims on the patient's behalf). 3. Operations: Staff training and Quality Improvement. What is Employer Liability? - answerPhysicians are legally responsible for their actions and their employee's actions. a.k.a Respondant Superior. (Let the master answer.) What is Employee Liability Insurance? - answerProtection against loss of money caused by failure through error or unintentional omission of the individual or service submitting the claim. What is in a Medical Record? - answer-Social and Medical History -Family History -Physical Exam Findings -Progress Notes -Lab/Rad Results -Consultation Reports -Correspondence to the patient When billing an insurance company, what information must be included? - answer-Date of Service (DOS) -Place of Service (POS) -Type of Service (TOS) -Diagnosis -Procedure(s) How long should Medical Records be retained? - answerGoverned by State and Local laws; should be retained indefinitely. For deceased patients, they should be kept at least 5 years. -algia - answerPain -emia - answerBlood Condition -itis - answerInflammation -megaly - answer-Enlargement -meter - answerMeasure -oma - answerMass -osis - answerAbnormal condition -pathy - answerDisease Condition -rrhagia - answerBursting forth blood -rrhea - answerDischarge, Flow -sclerosis - answerHardening -scopy - answerTo view -centisis - answerSurgical Puncture -ectomy - answerRemoval, Excision, Resection -gram - answerRecord -lysis - answerSeparation, Breakdown