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kelly hansen
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Decks in this class (47)
Chapter 1
What does hipaa stand for 1,
What is the main purpose of hipaa 2,
What are the 3 hipaa core rules 3
110
cards
Ch1 Topic: HIPAA
What does hipaa stand for 1,
What is the main purpose of hipaa 2,
What are the 3 hipaa core rules 3
13
cards
Ch1 Topic: (CoPs) & Records Retention
What are conditions of participat...,
Examples of entities subject to c...,
Why must medical records be retai...
12
cards
Ch1 Topic: Fraud, Abuse & False Claims Act (FCA)
What is the difference between fr...,
Examples of cms fraud 2,
Examples of cms abuse 3
14
cards
Ch1 Topic:Stark Law & Anti-Kickback Statute
What does the stark law prohibit 1,
What is the purpose of the stark ...,
What is an exception to stark law 3
8
cards
Ch1 Topic: Criminal Healthcare Fraud Statute & TILA
What is the criminal healthcare f...,
What are penalties under the crim...,
What is the truth in lending act ...
6
cards
Ch1 Topic: Quality Payment Program (QPP)
What law created the quality paym...,
When was qpp launched 2,
What are the two qpp tracks 3
4
cards
Ch1 Topic: MIPS (core)
What is the goal of mips 1,
What programs were combined to fo...,
How does medicare evaluate provid...
11
cards
Ch1 Topic: MIPS (Scoring, MVPs, APMs)
What determines a provider s mips...,
What happens if a provider scores...,
What are mips value pathways mvps 3
11
cards
Ch1 Glossary
What does abuse mean 1,
What does anti kickback mean 2,
What is a beneficiary 3
14
cards
Chapter 2
What is the definition of a healt...,
What are the objectives of chapte...,
What is the difference between gr...
246
cards
Ch2 Topic: Managed Care Models
What is managed care 1,
What is the focus of managed care 2,
What are the three main types of ...
10
cards
Ch2 Topic: Medicare
What is medicare 1,
When was medicare established 2,
What are the four parts of medica...
12
cards
Ch2 Topic: Medicaid
What is medicaid 1,
When was medicaid established 2,
Who funds medicaid 3
10
cards
Ch2 Topic: Other Government Programs
What is tricare 1,
Who administers tricare 2,
What does tricare cover 3
10
cards
Ch2 Topic: Commercial Insurance
What is commercial insurance 1,
Who regulates commercial insurance 2,
What are the two main categories ...
14
cards
Ch2 Topic: deep dive into HMOs, PPOs, POS, and EPOs
What is managed care 1,
What are the goals of managed care 2,
What is a provider network 3
20
cards
Ch2 Topic: Indemnity / Traditional Insurance subdeck
What is indemnity insurance 1,
What is another name for indemnit...,
How does indemnity ffs coverage w...
14
cards
Ch2 Topic: Consumer-Driven Health Plans (CDHPs: HSAs, HRAs, FSAs)
What is a consumer driven health ...,
What are the main types of cdhp a...,
What is a health savings account ...
14
cards
Ch2 Topic: Government-Sponsored Insurance (Medicare, Medicaid, TRICARE, etc.)
What is medicare 1,
What are the four parts of medica...,
What does medicare part a cover 3
15
cards
Ch2 Topic: Coordination of Benefits & COBRA
What is coordination of benefits ...,
What is the primary goal of coord...,
Which insurance is usually consid...
11
cards
Ch2 Topic: Affordable Care Act (ACA)
What does aca stand for 1,
When was the affordable care act ...,
What is the primary goal of the a...
12
cards
Ch2 Topic: Fraud & Abuse Laws
What is the false claims act fca 1,
What are penalties under the fals...,
What is the anti kickback statute 3
10
cards
Ch2 Topic: Revenue Cycle / Billing Process
What is the revenue cycle in heal...,
What is the first step of the rev...,
Why is accurate patient registrat...
14
cards
Ch2 Topic: Claims & Clearinghouses
What is a clean claim 1,
What is the purpose of a clearing...,
What is the benefit of using a cl...
6
cards
Ch2 Topic: Denials & Appeals
What is claim adjudication 1,
What are common reasons claims ar...,
What is the purpose of claim foll...
6
cards
Ch2 Topic: EOB & RA
What is an explanation of benefit...,
What is a remittance advice ra 2,
What is the difference between an...
4
cards
Ch2 Topic: Revenue Cycle:: Patient Registration & Demographics
What is the first step of the rev...,
What information is collected dur...,
What are patient demographics 3
9
cards
Ch2 Topic: Revenue Cycle:: Collections
What is the purpose of collection...,
When is patient financial respons...,
What is point of service collecti...
10
cards
Ch2 Topic: Medical Necessity & ABNs (Advance Beneficiary Notices)
What does medical necessity mean ...,
Why is medical necessity importan...,
What document is used to notify m...
10
cards
Ch2 Topic: Medical Record Documentation & Compliance
Why is accurate medical record do...,
What does if it isn t documented ...,
What are the key elements of prop...
11
cards
Ch2 Topic: Compliance Programs & OIG Guidance
What is the purpose of a complian...,
Which government office provides ...,
What are the 7 elements of an eff...
11
cards
Ch2 Topic: Coding Compliance & Documentation Integrity
What is coding compliance 1,
Why is coding compliance important 2,
What is upcoding 3
11
cards
Ch2 Topic: Auditing & Monitoring in Compliance
What is the purpose of auditing i...,
What is monitoring in compliance ...,
How do auditing and monitoring di...
10
cards
Ch2 Topic: HIPAA & Patient Privacy in Compliance
What does hipaa stand for 1,
What is the primary purpose of hi...,
What is phi under hipaa 3
15
cards
Ch2 Topic: HITECH & Data Security
What does hitech stand for 1,
What was the main purpose of hite...,
How does hitech strengthen hipaa 3
14
cards
Ch2 Topic: Revenue Cycle ((DEEPER STEPS))
What is the revenue cycle in heal...,
What is the first step in the rev...,
What occurs after registration in...
10
cards
Ch2 Topic: Claims Follow-Up
What is claims follow up 1,
Why is claims follow up important 2,
When should claims follow up begin 3
8
cards
Ch2 Topic: Payment Posting & Reconciliation.
What is the purpose of payment po...,
What does reconciliation mean in ...,
Why is accurate payment posting i...
8
cards
Ch2 Topic: Patient Financial Responsibility
What is patient financial respons...,
What is a copayment 2,
What is a deductible 3
8
cards
Ch2 Topic / Billing Compliance & Ethics
What is the main purpose of billi...,
Why is billing ethics important 2,
What is considered unethical bill...
9
cards
Ch2 Topic / Healthcare Fraud Prevention Programs (CMS, OIG, DOJ roles)
What is the role of cms in health...,
What is the fraud prevention syst...,
What is the role of the oig in fr...
8
cards
Ch2 Topic: Healthcare Reform & Quality Initiatives
What was the primary goal of heal...,
What does quality of care mean in...,
What is pay for performance p4p 3
10
cards
Ch2 Topic: Healthcare Technology & Innovation (EHRs, Interoperability, Telehealth, etc.)
What is an electronic health reco...,
What are key benefits of ehrs 2,
What is meant by interoperability...
10
cards
Ch2 Glossary
What is an accountable care organ...,
What is capitation 2,
What is a carve out 3
26
cards
Ch2 more glossary terms
What is an open panel hmo 1,
What is an out of pocket maximum 2,
What are patient centered medical...
20
cards
Ch1: Acronyms
0
cards
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AAPC CPB Training Manual 2025
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