Terms in this set (70)
Medical covers all health-care expenses.
billing for an Evaluation and Management service when the only service provided was a simple injection is an example of
B. reporting services at a higher level than was carried out.
when a physician agrees to accept assignment, this means the physician
C. will accept the amount of money that Medicaid will pay as payment in full for the Medicaid covered services.
a patient who has been hospitalized up to 90 days for each benefit period is covered under
A. medicare paart A
coding for injections and infusions requires only one code.
which of the following is diplomatic way to ask a patient for payment?
B. "For today's visit, the total charge is $50. How would you like to pay?"
the authorization for an insurance carrier to pay the physician or the medical practice directly is the
C. assignment of benefits.
which of the following ICD-9-CM conversations enclose a series of terms, each of which is modified by the statement that appears to the right of it?
Modifiers to CPT codes indicate
B. that some special circumstance applies to the service.
which of the following is a characteristic of Medicaid?
it is a health cost assistance program
which of the following types of insurance covers injuries that are caused by the insured or that insured or that occurred on the insured's property?
which of the following is appropriate when calling a patient about collections?
assume the patient forgot to pay or was unable to pay
In most cases, the insurer pays an annual cost or___ for health -care insurance.
the most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be
denied as a billing error because the treatment was not medically necessary based on the diagnosis.
which if the following may occur when providers submit claims that do not meet Medicare's coding or medical necessary policies?
denial of claim
the most appropriate response for a medical assistant when a patient calls the medical practice questioning why an insurance claims was rejected is
" check your explanation of benefits form"
the global period is the period of time that is covered for follow-up care after a surgical procedure.
criteria for hardship cases include patients who
may be poor, underinsured, elderly or have suffered severe financial loss.
what is the birthday rule?
The insurance policy of the policyholder whose birthday comes first in the calendar year is the primary payer for all dependents.
which of the following patients would a physician most likely treat as a matter of professional courtesy?
other health-care professionals
an account that is open to change made occasionally as needed is called a(n)
Which of the following is included under workers' compensation insurance?
rehabilitation costs are covered to return an employee to work
billing for and Evaluation and Management service when the only service provided was a simple injection is an example of
reporting services at a higher level than was carried out.
an accounts receivable policy
ensures that the practice with have sufficient income to cover expected expenses.
V codes are used to identity external causes of injuries and poisoning
skills of a coding, billing, and insurance specialist include
assigning a code for every recognizable disease
what does the ICD-9-CM convention NEC indicate
not elsewhere classifiable
procedure codes and ICD codes are the same
the amount Medicare pays the physician or health-care prvider after the $100 annual deductible is met is
the most appropriate way to determine which parent has consent ability and payment responsibility of a minor child is to
assume that the parent who brings the child for treatment has consent ability and payment responsibility.
all medical practices have to cover worker's compensation cases.
outpatient care means that a patient is not confined to the hospital for treatment.
a person in town on vacation goes to physician with symptoms of food poisoning. type of account set up for this patient is a(n)
ICD-9 codes are updated
free treatment for hardship cases is at the physician's discretion
which ICD-9-CD convention indicates that an entry is not classified as part of the preceding code?
when analyzing diagnoses and locating the current ICD code, in which step of the five-step process do you record the diagnosis code on the insurance claim?
the person whose name the insurance is carried under is called the
includes the charges rendered each day, an invoice for payment, and all information for submitting an insurance claim.
the tabluar list is organized by
the part of the body involved
when a physician agrees to accept assignment, this means the physician
will accept the amount of money that Medicaid will pay as payment in full for the medicaid covered service.
the most frequently used CPT codes are the _____.
evaluation and management codes
the alphabetic index is organized by
older or disabled patients who have Medicare and cannot pay the difference between the bill and the Medicare payment qualify for medi/medi.
a condition that is of sudden onset or that suddenly becomes much worse in considered a(n) _______.
acute condition (on and off)
step 4 of the five-step process of analyzing and locating the correct ICD involves
finding the code that corresponds to the patients specific disease or condition.
the relative value unit system was created to
cover credit agreements that involve more than four payments.
for reprting purposes, CPT considers a patient "new" if the patient has not received professional services within the past _____ year(s).
a health-care provider who practices under false qualifications/ credentials is guilty of
who is responsible for payment and for giving consent for the treatment of a 5-year-old child of divorced parents?
the parent who has legal custody
the use of ICD-9 codes is mandated by
of the federal programs providing health care, the largest is _____, which provides
the ____ state that creditors may not discriminate on the basis of sex, race, marital status, national origin, religion, or age.
Equal Credit Opportunity Act
a physician would never extend credit to a patient who is unable to pay because of high medical bills.
payments by credit card for a medical practice
provides prompt payment from the credit card company.
medicaid is not an insurance program
when entering data in medical billing programs, always
enter information using capital letters.
an appropriate approach to maintaining patient confidentiality on the computer is to
change your password every 90 days
a written-contract account is
one in which the physician and patient sign an agreement starting that the patients will pay the bill in more than four installments.
a fixed dollar amount the subscriber must pay or "meet" each year before the insurer begins to cover expenses is the
which of the following applies to a physician who agrees to accept Medicaid patients?
the physician can bill the patient for services that Medicaid does not cover.
the appropriate way to handle a patient relocation and address change is to
ask a third party for the patient's new address
a(n) ________ occours if insurance payments and patient payments exceed allowed charges.
Some medical practices may require the subscriber to pay a small fee at the time of service. this is called
only one diagnosis at a time should be coded to prevent coding errors
an easy way to remember when an E code is required is
if the diagnosis makes you ask "how did that happen?"
which of the following protects telephone subscribers from unwanted telephone solicitations?
Telephone Consumer Protection Act
a written - contract account is
one in which the practitioner and patient sign an agreement starting that the patient will pay the bill in more than four installments.
which of the following is included when determining an appropriate fee schedule?
fees are compared with fees that other doctors in the area charge for the same service.
a statement is generally sent to the patient when an account is _____ days past due.