#14 Diagnosis reference numbers are entered on the CMS-1500 claim to:

a. report mortality data

b. justify medical necessity

c. analyze quality of services provided

d. report morbidity data

Which program was created by the Tax Relief and Health Care Act of 2006(TRHCA) as a "pay for quality data reporting program," which was implemented by CMS for outpatient hospital services?

a. Quality Improvement Organizations (QIO) program

b. Recovery Audit Contractor (RAC) program

c. Reporting Hospital Quality Data for Annual Payment Update program

d. Hospital Outpatient Quality Reporting (Hospital QR) program

How can you help a patient when the insurance company will not reimburse for procedures reported with certain diagnosis codes?

(A) Change the diagnosis codes for them.

(B) Explain that their insurance company will not cover it, and there is nothing you can do.

(C) Explain the reasons for any inconvenience.

(D) Double check the medical documentation, and ask the physician if you are unsure.

Select fraud, abuse, or neither, for each scenario.

(1) Dr. Bateman has decided to send his patient, Mrs. Lattamee, to Dr. Snyder, a gastroenterologist who was a medical student with him. In exchange for this referral, Dr. Snyder has agreed to provide Dr. Bateman with a percentage of the reimbursement he receives for each patient sent to him.

(2) Fred Barron has arteriosclerosis and needs a stent placed in his right carotid artery. Dr. Allen also decided to put a stent in Fred's left carotid artery as a precaution to prevent arteriosclerosis.

(3) Dr. Brown has several Medicare patients who are on a limited and fixed income and have a hard time paying their bills and buying food. The doctor has instructed his billing staff to write-off the coinsurance that is indicated on the Medicare Summary Notice as an adjustment against his charges.

(4) Physical Therapy Associates has been billing insurance companies for services provided by an unsupervised physical therapy student in the practice manager's name because he is responsible for that student.