Chapter 01: Pole of Insurance Billing Specialist
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32 terms
Terms | Definitions |
|---|---|
 It is coomonplace to find administrative duties shared by a number of specialists in the physician's office | True |
| The primary goal of an insurance claims assistance professional (CAP) is to assist the consumer in obtaining maximum benefits and to tell the patient what checks to write to providers to make sure there ar no overpayments. | True |
| In a medical practice, front office duties have lost importance. | False |
| Generally, a high school diploma is not required for an insurance billing specialist. | False |
| Workimg in a physician's office as an insurance billing specialist carries greater responsibilites thean operating a self-owned insurance billing business. | False |
| Electronic claims submissions are a format of the past. | False |
| It is acceptable practive for medical office personnel to use a patient's first name when speaking to the patient about his or her insurance. | False |
| The medical professioin has long subscribed to a body of ethical statements developed primarily for the benefit of the physician | False |
| The Centers for Medicare and Medicaid Services, formerly known as the Helath Care Financing Administration, adopted the Principles of Medical Ethics in 1980. | False |
| Illegal coding practices are subject to penalties, fines, and/orimprisonment. | True |
| At certain times medical office staff members are allowed to make critical remarks about a physician to a patient. | False |
| It is illegal to report incorrect information to government-funded programs such as Medicare, Medicaid, an TRICARE. | True |
| The title used for medical billing personnel may depend on the region of the United States where they wrok. | True |
| Medical billing employees should be able to perform a variety of administrative duties pertaining to the business office. | True |
| Insurance companies never require the patient to submit the claim form. | False |
| Physicians are legally responsible for any actions of their employees performed within the context of their employment" therefore an employee cannot be sued or brought to trial. | False |
| Rules of etquette for e-mail and cell telephone calls fall under the Health Insurance Portability and Accountability Act | True |
| A claims assistance professional (CAP) acts as an informal representative of patients and helps patients interpret insurace contracts. | True |
| In some states, giving an insured client advice on purchase or discountinuance of insurance policies is construed as being an insurance agent. | True |
| An insurance billing specialist uses general skills in following an employer's established when dealing with the health care contract. | True |
| The best way for an insurace specialist to keep up to date in the profession is to read health care industry association publications, attend seminars on billing and coding, and participate in e-mail listserv discussions. | True |
| What does the abbreviation MSHP designate? a. Multiple service health care professional b. Multiskilled health practitioner c. Multiskilled health professional d. Managed care solo health practice | b. Multiskilled health practitioner |
| Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring a. specialized health care practitioners b. health care workers with college degrees. c. multiskilled health care practitioners d. untrained health care practitioners | c. multiskilled health care practitioners |
| Administrative medical office responsibilities include a. laboratory analyses b. claims submission c. taking x-rays d. venipunctures | b. claims submission |
| A claims assistance professional a. works foth the consumer b. belps patients file insurance claims c. Neither A nor B d. Both A and B | d. Both A and B |
| What is "cash flow" in a medical practice? a. The actual money available to a medical practice b. The amount of money received by a medical practice in 1 month | a. The actual money available to a medical practice |
| Front office medical duties have become increasingly important because a. diagnostic and procedure coding must be reviewed for its correctness and completeness b. the number of office visits for patients has increased c. the number of patients belonging to managed care plans has decreased. d. the number of doctors has decreased | a. diagnostic and procedure coding must be reviewed for its correctness and completeness |
| What level of education is generally required for one who seeks employment as an insurance coder? a. College diploma b. High school diploma c. Completion of an accredited program for coding certification d. No specific level of education is required. | c. Completion of an accredited program for coding certification |
| What organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing? a. American Management Association (AMA) b. American Academy of Professional Coders (AAPC) c. American Association of Medical Assistants (AAMA) d. American Health Information Management Assoiciation (AHIMA) | d. American Health Information Management Assoiciation (AHIMA) |
| The amount of money an insurance billing specialist earns is dependent on which of the following factors? a. Knowledge b. Experisnce c. Size of employing institution d. All of the above | d. All of the above |
| Medical etiquette refers to a. consideration for others b. moral principles or practices. c. laws d. the Oath of Hippocrates | a. consideration for others |
| Medical ethis include a. state laws b. federal laws c. standards of conduct d. civil torts | c. standards of conduct |
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