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63 terms

Coding, Billing and insurance

Final Exam
STUDY
PLAY
The medical office assistant might compile and record medical charts, reports, and correspondence.
True
HOPPA is an abbreviation for hospotal information per american medical association
False
Math skills are important when working with refunds and posting of payments.
True
Coding accuracy is very inportent to healthcare organizations because funding cannot be recieved without accurate coding
True
What job description requires escellent data entry dkills , math skills and a good working knowledge of insurance contracts?
payment poster
a medical collector will contact most patients by
Telephone
a refund specialist position requires ______and _____
researching and analytical skills
the knowledge of _____and ______ in imperitave to perform well in all medical administrative positions
coding and billing
coinsurance is paid by the provider
...
the deductivle is the amount the insured must pay for each healthcare encounter sugh as an office visit
...
A policyholder is a person who buys an insurance plan.
...
The role of a PCP is to coordinate a patients overall care.
...
One incentive for an insured to use a network provider is reduced out of pocket costs.
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Under an indemnity plan, a patient may use the services of ____________
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A policyholder's _____ includes the spouse and children.
...
______ plans are regulated by the Employee Retirement Income Security act. (ERISA)
...
The ____ is the percentage of each claim that the insured must pay.
...
In managed care, patients often pay a specified amount called a _______ for an office visit to a provider.
...
A member of an HMO must get a _____from the PCP before seeing a specialist.
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A capitated payment is prepaid to a provider to cover a plan member's health services for a specified period.
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The amount that an insured person must pay for each office visit is call the co-payment.
...
Ethics are standards of behavior for licensed medical staff an other employees of medical practices.
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A patients bill of rights consists of this principle____.
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COB is defined as _______.
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The list of medical services covered the insureds' policy is called ______.
...
The term medically necessary refers to the use of services or supplies or both as determined by the corporation medical director or his designee that ________.
...
A sudden flare up of a patient's chronic condition may be characterized as acute.
True
The alphabetic index of the ICD 9 is used first which locating a diagnostic code.
True
A coexisting condition is reported when it effects the patients primary condition or is also treated during an encounter.
True
The etiology is the origin or cause of a disease.
Tru
A late effect occurs some period of time after the acute disease is resolved.
True
In the ICD9 NOS or not otherwise specified indicates a code to be used when too little info is available to assign another more specific code.
True
Sub-terms appear below the main term in the ICD9 alphabetic index
True
The ICD9 diagnotic codes are made of either 3, 4, or 5 digits and a description.
True
Codes in the tabular list of the ICD9 are organized according to anatomic system or cause.
True
In the ICD9 () are used around descriptions that are not essential parts of a term.
True
The alphbetic index of the ICD 9 can be used alone to correctly locate a diagnostic code.
False
Signs and Symptoms are reported when a patients condition has not been diagnosed.
True
An annual preventive vaccination is reported using a "V" code from the ICD9
True
A disease or procedure that is named for a person is an_______
EPONYM
A person history of cancer is reported with a _____.
"V"code
An annual checkup is classified with a
"V" code
The statement "patient has a famiily history of breast cancer" requires a _______
V code
A physicians description of the main reason for a patients encounter is call the diagnostic______
statement
When diagnostic codes are reported, the code for the ______diagnosis is listed first followed by the current co-existing condition.
primary
The patient is the insured person, the "self" entry is marked under the patient relationship to the insured on the CMD 1500 claim form.
True
If the patient has addition insurance through a spounse, this information must be provided onthe CMS 1500 claim form.
True
The birthday rule states that the patient whose day of birth is earlier in the calender year will be considered the primary insurer.
True
HIPAA develops standards and regulations to be used by all providers carriers, billing services and clearing houses in order to _______.
...
The intermediary is a company that is paid to process claims for Medicare Part A.
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Medicare covers an anual physical examination.
...
Under the Medicare program non participating non accepting assignment physician may not bill morethan 115% of _______
...
When a patient is over age 65 and employed the employees group health plain, not medicare is the _________plan.
primary
What does CMS mean?
...
Accounts Receivable include money owed the practice by the payers and patients.
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An adjustment is a negative or positive change to an acount balance.
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The medicare allowed charge for a procedure is $80.00. what amount does a participating provider receive from Medicare and what amount from the patient?
$64/$16
The medicare allowed charge for a procedure is $150. A par providers usual charge is $200. What amount must the provider write off?
$50.00
The deductibles co insurance and co payments patients pay are called ____________
Out of Pocket expenses
Down coding is also called ________
...
Under the formula for calculating a medicare fee for a procedure, the sum of adjusted totals for work, practice expense, and malpractice are multiplied by a _______
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Medical insurance plans require patients to pay for all ________services.
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If a carrier has continued to deny all the practices appeal requests, the provider can file a request to the ______for assistance.
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