The goals of managed care include all of the following EXCEPT:
A. medical care that is medically necessary and appropriate based on the patient's condition and diagnosis.
B. medical care rendered by the most appropriate provider.
C. medical care rendered in the most appropriate setting.
D. medical care rendered in the most profitable setting.
Answer: medical care rendered in the most profitable setting.
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Which of the following best defines the National Correct Coding Initiative?
a. A unique number that is required by Medicare to identify each individual qualified healthcare provider and each individual healthcare organization and that must be used when reporting any healthcare service performed by the individual qualified healthcare provider and/or individual healthcare organization b. A tool intended to reduce incorrect coding and improper overpayments and underpayments through the identification of codes that may or may not be utilized together, that are medically unlikely, or that are mutually exclusive of one another c. A billing mechanism defined by CMS to help identify, report, and appropriately bill incidental clinical, medical, or professional services performed by an NPP when those provided services are integral to the physician's overall care of the patient d. A federal program intended for Americans 65 years of age or older
Which HIPAA section dictates the provider must have privacy policies and disclose these to patients?
A. The administration simplification rule B. Title I: Portability C. The security rule D. Red flags rule