HEALTH CLAIMS FINAL EXAM 12/06/2011

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48 terms · HEALTH CLAIMS FINAL EXAM 12/06/2011

SPENDING ON HEALTH CARE IS

RISING

THE EMPLOYMENT FORECAST FOR WELL-TRAINED MEDICAL INSURANCE & CODING SPECIALISTS IS

INCREASING OPPORTUNITIES

IN THE U.S., RISING MEDICAL COSTS ARE PRIMARILY DUE TO

ADVANCES IN TECHNOLOGY & AN AGING POPULATION

WHAT KIND OF MEDICAL SERVICES ARE ANNUAL PHYSICAL EXAMINATIONS AND ROUTINE SCREENING PROCEDURES

PREVENTIVE

UNDER A FEE-FOR-SERVICE PLAN, THE THIRD-PARTY PAYER MAKES A PAYMENT

AFTER MEDICAL SERVICES ARE PROVIDED

WHICH OF THE FOLLOWING IS REQUIRED WHEN A HMO PATIENT IS ADMITTED TO THE HOSPITAL FOR NONEMERGENCY TREATMENT

PREAUTHORIZATION

IN A PREFERRED PROVIDER ORGANIZATION (PPO) PLAN, REFERRALS TO SPECIALISTS ARE

NOT REQUIRED

CONSUMER-DRIVEN HEALTH PLANS COMBINE A HEALTH PLAN WITH A SPECIAL "SAVINGS ACCOUNT" THAT IS USED TO PAY WHAT B4 THE DEDUCTIBLE IS MET

MEDICAL BILLS

AN EXAMPLE OF PRIVATE-SECTOR PAYER IS AN

INSURANCE COMPANY

WHICH OF THE FOLLOWING COVERS PATIENTS WHO ARE OVER AGE 65

MEDICARE

WHICH OF THE FOLLOWING PROGRAMS COVERS PEOPLE WHO CANNOT OTHERWISE AFFORD MEDICAL CARE

MEDICAID

A PATIENT LEDGER RECORDS

THE PATIENT'S FINANCIAL TRANSACTIONS

COURTEOUS TREATMENT OF PATIENTS WHO VISIT THE MEDICAL PRACTICE IS AN EXAMPLE OF MEDICAL

ETIQUETTE

THE STATEMENT THAT "CODING PROFESSIONALS SHOULD NOT CHANGE CODES...TO INCREASE BILLINGS" IS AN EXAMPLE OF

PROFESSIONAL ETHICS

THE FEDERAL AGENCY THAT RUNS MEDICARE AND MEDICAID IS

CMS

EDI IS THE ABBREVIATION FOR

ELECTRONIC DATA INTERCHANGE

WHEN PERSONAL IDENTIFIERS HAVE BEEN REMOVED, PROTECTED HEALTH INFORMATION IS CALLED

DE-IDENTIFIED

A COURT ORDER TO APPEAR AND TESTIFY IS A

SUBPOENA

IF A PATIENT HAS COVERAGE UNDER 2 INSURANCE PLANS, 1 UNDER WHICH THE PATIENT IS THE POLICYHOLDER AND 1 UNDER WHICH THE PATIENT IS A DEPENDENT, THE PRIMARY PLAN IS

THE PATIENT'S PLAN

A COURT ORDER TO APPEAR, TESTIFY, AND BRING SPECIFIED DOCUMENTS OR ITEMS IS A

SUBPOENA DUCES TECUM

DISGUISING AN ELECTRONIC MSG SO THAT ONLY RECIPIENTS WITH THE CORRECT KEY CAN READ IT IS CALLED

ENCRYPTION

AN IMPERMISSIBLE USE OR DISCLOSURE UNDER THE PRIVACY RULE THAT COMPROMISES THE SECURITY OR PRIVACY OF PHI AND ALSO THAT COULD POSE A SIGNIFICANT RISK OF FINANCIAL, REPUTATIONAL, OR OTHER HARM TO THE AFFECTED PERSON IS CALLED A

BREACH

AN ESTABLISHED PATIENT IS DEFINED AS ONE WHO HAS SEEN THE PROVIDER WITHIN THE LAST

THREE (3) YEARS

THE TERMS "SUBSCRIBER" AND "GUARANTOR" HAVE THE SAME MEANING AS

INSURED

INSURANCE INFORMATION IS FOUND ON THE

PATIENT INFORMATION FORM

NONPAR STANDS FOR

NONPARTICIPATING

WHICH OF THESE DOCUMENTS MIGHT THE PATIENT COMPLETE

ASSIGNMENT OF BENEFITS
MEDICAL HISTORY
PATIENT INFORMATION FORM

A PROVIDER WHO DIRECLY TREATS A PATIENT IS CALLED A

DIRECT PROVIDER

A PROVIDER SUCH AS A FACILITY WHICH TESTS PATIENTS AS INSTRUCTED BY THE DIRECT PROVIDER IS CALLED A

INDIRECT PROVIDER

A "SELF-PAY" PATIENT IS ONE WHO

IS UNINSURED

THE PRACTICE'S RULES FOR PAYMENTS FOR MEDICAL SERVICES ARE FOUND IN THEIR

FINANCIAL POLICY

AN IMPORTANT INITIAL STEP IN ESTABLISHING FINANCIAL RESPONSIBILITY IS TO

VERIFY INSURED PATIENTS' ELIGIBILITY FOR BENEFITS

THE HIPAA SECURITY RULE SPECIFIES HOW TO SECURE PHI ON

THE INTERNET
COMPUTER NETWORKS
STORAGE DISKS

A NEW PATIENT IS DEFINED AS ONE WHO HAS NOT SEEN THE PROVIDER WITHIN THE LAST

THREE (3) YEARS

WHICH OF THESE HIPAA TRANSACTIONS IS SENT BY A PAYER TO EXPLAIN A CLAIM PAYMENT

835

WHICH OF THESE HIPAA TRANSACTIONS IS SENT BY A PROVIDER TO A PAYER FOR PAYMENT

837

WHICH OF THESE HIPAA TRANSACTIONS IS USED BY MEDICAL OFFICES TO ASK PAYERS ABOUT THE STATUS OF SUBMITTED CLAIMS

276

WHICH OF THESE HIPAA TRANSACTIONS IS SENT BY A PAYER TO ANSWER A QUESTION ABOUT A SUBMITTED CLAIM

277

THE PAYER'S PROCESSING OF CLAIMS IS CALLED

ADJUDICATION

A PAYER'S DECISION REGARDING WHETHER TO PAY, DENY, OR PARTIALLY PAY A CLAIM IS CALLED

DETERMINATION

ON AN AGING REPORT, WHICH CATEGORY DESCRIBES A CURRENT INVOICE

0-30 DAYS

THE PROCESS OF _____________ MEANS VERIFYING THAT THE TOTALS ON THE RA/EOB ARE MATHEMATICALLY CORRECT

RECONCILIATION

THE ADVANTAGE(S) OF EFT FOR PRACTICES IS

FUNDS ARE AVAILABLE IMMEDIATELY
THE TRANSFER IS LESS COSTLY THAN CHECK DEPOSITS

FROM THE PAYER'S POINT OF VIEW, ____________ ARE IMPROPER OR EXCESSIVE PAYMENTS RESULTING FROM BILLING ERRORS FOR WHICH THE PROVIDER OWES REFUNDS

OVERPAYMENTS

IF A MEDICAL PRACTICE BELIEVES THAT IT HAS BEEN TREATED UNFAIRLY BY AN INSURANCE COMPANY, IT HAS THE RIGHT TO FILE A _________ WITH THE STATE INSURANCE COMMISSION

GRIEVANCE

IF A PATIENT HAS ADDITIONAL INSURANCE COVERAGE, AFTER THE PRIMARY PAYER'S RA/EOB HAS BEEN POSTED, THE NEXT STEP IS

BILLING THE SECOND PAYER

IF A PROVIDER HAS ACCEPTED ASSIGNMENT, THE PAYER SENDS THE RA/EOB TO

PROVIDER

IF A PATIENT HAS AN INSURANCE FROM AN EMPLOYER AND IS COVERED BY MEDICARE, THEN MEDICARE IS BILLED:

SECONDARY

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