The concept that every procedure or service reported to a third-party payer must be linked to a condition code that justifies the procedure or service is called medical
Correcting claims processing errors
Which is a typical responsibility of a health insurance specialist?
The mutual exchange of information between providers and payers is called electronic
The document submitted by a provider to a third-party payer for the purpose of requesting reimbursement for services provided is an
Health insurance specialists play an important role in the ----------- of denied or unpaid claims.
The notice received by a provider from a payer that contains payment information for a claim is the
A coding consultant who is paid by a practice to assist the coding and billing staff would most likely be classified as an
A customer was severely injured in a grocery store when a pallet of soda cans toppled onto him. What insurance would be billed for the customers medical care?
What type of insurance provides financial and medical benefits for an injured employee?
Health information management professionals can achieve certification by successfully passing an exam offered by which professional association?
Data entry of insurance information is important because ------------ are rejected by insurance companies if data are missing erroneous
A patient was diagnosed with asthma. which coding system is used to report this condition on a claim?
Federal Employees' Compensation Act
In1916, the ---------- replaced the 1908 workers' compensation legislation, and civilian employees of federal government were provided medical care, survivors' benefits and compensation for lost wages.
During World War II, the government restricted the wages employers could offer employees; thus, employers began offering which of the following to their employees?
When three or more doctors deliver health care and make joint use of equipment, supplies, and personnel,this is called a
Which coding system is used to report procedures and services on physician office insurance claims?
Which is a government-sponsored health program that provides benefits to low income patients?
The specified amount of annual out-of-pocket expenses for covered healthcare services that the insured must pay annually for health care is called the
The standard claim developed by CMS and used to report procedures and services delivered by physicians is called the
The act passed in 1997 that resulted in the development of coding compliance programs by the federal government is the
The act passed in 1996 that had had a great impact on confidentiality, electronic information transmission, and standardization is the
The veterans Healthcare Expansion Act of 1973 authorized Veterans Affairs to establish --------------- to provide healthcare benefits for dependents of veterans rated as 100 percent permanently and totally disabled as a result of service connected condition, veterans who died as a result of service- connected conditions, and veterans who died on duty with less than 30 days of active service.
the ambulatory payment classification prospective payment system is used to reimburse claims for what services?
The health Maintenance Organization Assistance Act of ------- authorized federal grants and loans to private organizations that wished to develop health maintenance organizations which are responsible for providing healthcare services to subscribers in a given geographic area for a fixed fee.
The Inpatient Psychiatric Facility Prospective Payment System includes a patient classification system that reflects differences inpatient resources use and costs, replacing the -------- payment systems with a per Diem IPF PPS
The Standard Unique Health Identifier for Health Care Providers, or National Provider (NPI) identifier was implemented in
Physician work, practice expense, and malpractice insurance expense
Which three components constitute the RBRVS payment system?
In which year was the first recognized commercial insurance company policy developed in the united states?
An official from Baylor University in Dallas developed what is recognized now as the first ---------------- plan.
Group health insurance
Insurance that is available through employers, labor unions, consumed health cooperatives, and other organizations are
The type of insurance that provides coverage for catastrophic or prolonged illnesses and injuries is
A provider's list of predetermined payments for healthcare services to patients is known as the
Which term describe the process of developing patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner?
Measures and evaluates the quality of managed care plan's performance.
The national Committee on Quality Assurance is a nonprofit organization that
The review for appropriateness and necessity of care provided to patients, prior to the administration of care or retrospectively, is called
Which act or amendment to the HMO offers subscribes healthcare services by physicians who remain in their individual office setting?
COBRA of 1985
Which act or amendment established an employee's right to continue healthcare coverage beyond a schedule benefit termination date?
Federally qualified HMOs could permit members to occasionally use non-HMO providers and be partially reimbursed.
The 1988 amendment to the HMO Act 1973 added which provision?
to make available capitated healthcare services to medicare beneficiaries.
A risk contract is defined as an arrangement among healthcare providers
If an HMO has met the federal standards established in the HMO Act of 1973, the HMO can be
pay higher out-of-pocket costs
If a plan allows enrollees to seek care from non-network providers . what effects will have on the enrollee who sees a non-network provider? the enrollee will
Illegal wording in a managed care contract that prohibits a provider from discussing all possible treatment options with a patient is an--------clause.
exclusive provider organization
Which type of managed care plan provides benefits to subscribers if they receive services only from network providers?
A medical group that has been specially formed to serve a particular HMO is part of what type of HMO?
The newly emerging health plan that focuses on asking employees to be more responsible for healthcare decisions and cost- sharing is the ----------- health plan.
when a provider receives a fixed amount to provide only the care that an individual needs from that provider, this is known as a --------- payment.
Medicare Modernization Act
Which 2003 legislation allows tax deductions for amounts contributed to a health savings account?
utilization review organization
Managed care plans can contract with an outside vendor to establish and maintain a utilization management program. The plan can contract with a TPA or with a