Question

When it comes to billing and collection issues, some of the main rules that physician billers and biller services must follow are (Ch 9) determination of patient third-party status, amount of copayment that needs to be collected from the patient, correct coding, coordination of benefits, preauthoritzation of services, referral, second opinion, fraud and abuse regulations O collection of deductible, timely coding, fraud and abuse regulations, provider credential verification, second option, income verification, coordination of benefits o preauthorization of services, access to care standards, patient satisfaction, coordination of benefits, second opinion, correct coding, fraud and abuse regulations, deductible collection, amount of copayment that needs to be collected from patient provider credential verification, timely coding, correct coding, second opinion, referral, preauthorization of services, fraud and abuse regulations, coordination of benefits, risk management reporting, determination of patient third party status QUESTION 5 Under HIPAA Title II, Section F, which are identified as the six major elements of administrative simplification? (Ch 10) O Privacy O Identity O Electronic transaction standards O Security O Staff training O Unique health identifiers O Data warehouses O Standard code sets O Confidentiality O Electronic signature standards

Answer 1

provider credential verification, timely coding, correct coding, second opinion, referral, preauthorization of service, fraud and abuse regulations, coordination of benefits, risk management reporting, determination of patient thrid party status
Patient billing and collection issues are a complicated process, to avoid that billing process should include
Patient copayment during patient check-in or checkout, third party payers like Medicare and Medicaid substitution for a claim, accurate coding and format process, explanation of benefits, biller should include with the statement preauthorization of services that cover specific services, referral authorization to send patient to another practitioner including second opinion, HIPAA guidelines to ensure standards of billing compliance, Provider credentialing verification as a part of the payer's network important for authorization to provide service, it is under payers' plan. Risk management reporting is the way for performance indicators to meet the benchmark, it is a proactive way of identifying and managing the risk.
A deductible not always applies to all health care services.

Question 5:
Privacy, security, electronic transaction standard, standard code sets, unique health identifier, electronic signature standards.
to improve the efficiency of the health care system, HIPAA included administrative simplification of these six elements that make HHS adopt national standards.
HIPAA administrative safeguard includes identity, staff training, data warehouse, confidentiality.