The Claims Process - Set 3

22 terms by angel_mahal30

Create a new folder

Advertisement Upgrade to remove ads

NCCT Reviewer

peer review

If an appeal for a legitimate claim is unsuccessful, the physician may request a __________?

a) different tracer
b) refund
c) new carrier arrangement
d) peer review

present a military ID

It is important for a TRICARE patients to always ___________?

a) present a military ID
b) submit a claim on-line
c) register with Social Services
d) file a CMS-1500

out of plan

If a nonmember physician treats an HMO patient, the services are termed __________?

a) provisional
b) approved
c) out of plan
d) improper

Excessive overtime

Which of the following practices would NOT be noted by utilization review __________?

a) Churning
b) Turfing
c) Excessive overtime
d) Buffing

type of payment agreement where the physician is paid per person whether seen or not

Capitation refers to a _______________?

a) type of payment agreement where the physician is paid per person whether seen or not
b) type of posting done manually in the physicians office
c) fee for service agreement where a dollor amount is set for each service or precedure
d) tax paid by the physician to the Internal Revenue Service

makes no promise to cover a full fee

An indemnity benefit contract ___________?

a) offers physician participation
b) makes no promise to cover a full fee
c) is a service contract
d) is offered through Medicare

reduce the incidence of surgery

Second opinion programs _________?

a) refer data to clearinghouse
b) are billed electronically
c) benefit referring physicians
d) reduce the incidence of surgery

age of the patient

Itemized bills to Blue Cross and Blue Shield must contain the following EXCEPT _________?

a) professional status of the physician
b) age of the patient
c) date of service
d) type of serice

federal guidelines

Each state designs its own Medicaid program within ________?

a) local guidelines
b) federal guidelines
c) international guidelines
d) AMA guidelines

65 years old business executives

All but which of the following may be covered by Medicaid __________?

a) 65 years old business executives
b) Patients who cannot see
c) Patients with disabilities
d) 65 years old patients

Military dependents

In the medicaid program, which one of the following groups is NOT usually considered categorically needy __________?

a) QMBs
b) AFDC-releated groups
c) SSI cash recipients
d) Military dependents

Cosmeticsurgery

Which of the following is NOT covered by Medicaid _________?

a) Birth control
b) Cosmetic surgery
c) X-rays
d) Immunizations

a true emergency

Prior approval for certain services in the Medicaid program is necessary EXCEPT for ________?

a) transportation
b) a true emergency
c) hearing aids
d) prosthetic devices

Contact lens to change the color of the eyes

All but which of the following might be covered by Medicaid _________?

a) Inpatient care for a digestive disorder
b) Hemodialysis fir a kidney patient
c) Surgery (hysterectomy) for dysfunctional uterine bleeding
d) Conract lens to change the color of the eyes

reciprocity

If a patient requires care while out of state, most states offer Medicaid __________?

a) training
b) education
c) reciprocity
d) refunds

rejected

if a Medicaid bill is submitted after the time limit it will most likely be __________?

a) rejected
b) reviewed
c) paid
d) ignored

month

Medicaid eligibility for participants should be verified every ________?

a) month
b) three months
c) six months
d) year

secondary carrier

If a person elegible for Medicaid has other insurance coverage, Medicaid is always the ____________?

a) first insurance billed
b) responsible third party liability carrier
c) primary carrier
d) secondary carrier

preschool children

Medicare is a federal health insurance program for the following categories of people EXCEPT ________?

a) people 65 years or older
b) preschool children
c) blind individuals
d) disabled widows

day a patient enters the hospital

For Medicare inpatient services, a benefit period begins the ___________?

a) day a patient enters the hosptial
b) first day the physician sees the patient in the office for the illness or injury
c) 3rd day of a hospital stay
d) first day home from the hospital

purchasing medical equipment

A patient might submit his own Medicare claim when __________?

a) the hospital is in a rural location
b) the time liit has passed
c) purchasing medical equipment
d) the physician is too busy

a witnessshould sign the form

When an illiterate patient cannot sign a Medicaid form _______?

a) s/he should be referred to a literacy program
b) a supervisor shoudl be notified
c) a withness should be sign the form
d) care is denied

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set