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115 terms

medical insurance

MDCA 1343
STUDY
PLAY
The birth law is a change in the order of determination of coordination of benefits regarding primary and secondary insurance carriers for dependent children
true
A requirements specialist should always treat the patient with
all of the above
the blue cross association grew out of what need?
more national coordination between plans
3rd party that require the provider to submit insurance claims for the patient are
federal and state programs
Federal law requires that all provider submit claims to medicare if they provide a medicare covered service to a patient enrolled in medicare part b. This regulation does not apply if
all the above
A 5 digit code in the ICD-9_CM is called
category
the blue sheild plans trace their beginning to a resolution passed by the houses of delegates at a meeting of the
ama
maternal and child health programs (MCHP)
operate with federal grant support under TITLE V of the social security act
important tool for claims submission
computer
astandard information tool used for communication
telephone
credit card type point of service device
electronic swipe device
electric exchange of inofrmation using photo sensors and a phone lin
fascismile machine
an individual cross trained to function in more than one job known as a./an
multiskilled health practitioner
TRICARE formerly known as CHAMPUS, is funded through
congress
a 3 digit code in the ICD-9-CM
category
A combination code in the ICD-9-CM covers the
etiology and manifestation (diagnosis)
before a medical practice releases information about a patients alcohol or drug abuse to an outside party, the patient must sign and date
a specific release of information covering the information
which of the followinf statements about Medicare Part B is not true?
Medicare requires that assigmnet be accepted on all claims for service a performed in an outpatient setting be nurse practitioners.
A disease or procedure that is named for a person is a (n)
eponym
enfororcement of the privacy standards of HIPAA is the responsibility of
OCR
Which of the following statement about a medigap policy is NOT true?
NONPar providers are required to include medigap information on the claim form.
the privacy rule indicates you should scrutinize telephone calls by:
all of the above
periodic payments to keep insurance policy in force
primium
certain illnesses or injuries listed in a policy that the insurance company will not cover
exclusions
insurance company that carriers the insutance
carrier
one who belongs to a group plan
subscriber
a health insurance policy renewal provisions
cancelable
for HMO authorized fee for service specialty care the claims is sent directly to
HMO
What is the term in the diagnostic statment "localized salmonella infection, unspecified?"
infection
A insurance company takes into accounts benefits payable another carrier in determining its own liability
COB
benefits paid by an insurance company to an insured person
indemnity
transfer of one right to collect an amount payable under an insurance contract
assignment
time that must elapse before an indemnity is paid
waiting period
acts for insurance company or insured in settlement of clims
adjuster
the EOB is
a document from the insurance company explaining a patient's benefits
credentialing or certification is important to the reimbursement specialist because
many employers in the medical field are looking for acknowledged expertise in the billing fields.
In the us rising medical costs are due to
all of the above
the following information is gathered from a new patient at a first visit:
the patient personal and insurance inforamtion
the medical documentaion of a patient s care, such as progress notes and reports, belong to
the provider
under CPT- guidelines, all service related to a surgical procedure are not additionally reimbursed
during the gobal period
of the four types of examinations that physicians perdorm, which level is the most complete?
comprehensive
when a patient goes to a physicians office seeking medical services and the physician accepts the patients and agrees to render treatment and both agress to render this conract is kmown as a /an
Implied contract
Professionalism is
how you look, write, act and work
patients who enroll in a HMO many us the service of
only HMO networks providers
to find a code correctly in the ICD-9-Cm the first steps is to locate the code in the
alphabetic index
what is the main term in the diagnostic statement "allergic rhinitis in the fall due to ragweed".?
rhinitis
reimbursement is a term that describes
compensation for service rendered
Protection mandated by state law that covers employees and their dependent against injury and death occurring during the course of employment is called
workers compensation insurance
medical codes are numeric and alphanumeric codes used because
it is easier for the computer program to be developed
Involves linking every procedure or service code reported on the claim to an ICD-9-CM condition code that justifies the necessity for performing that procedure of service
medical necessity
the professional qualifications for a reimbursement specialist include
all of the above
Medical billing reimbursement job are one of the fastest growing careers in the us because
people are living longer and technology is expanding rapidly.
v codes are primary for
medical services having no clear diagnosis or for preventive care.
Because of today's techonology physicians are treating patients
both b and c
Medicaid is always the
paywe of last resort
The priniciples of right or good conduct, and rules that governs the conduct of member of a porfession.
ethics
how many codes does the entry Cataract, myotoin 359.2 {366.43} in the ICD-9-CM's alphabetic Index require?
two codes
Durable medical equipment (DME) such as wheelchairs covered by the medicare programs are reported using
HCPCS codes
Preauthorizations are
promises from the insuranc company for reimbursement on procedures
Fax machines in the medical office
all of the above
Certification as a Certified medical Assistant (CMA) is awarded by
AAMA
the primary CPT-$ code that is listed first for encourter is the procedure thatt
is the most resource-intensive
Electronic office equipment helps the medical office
all of the above
Encounters in which a problem needs to be noted that does not presently affect the patient health status are reported with a (n)
v code
A condition that arisies because of an injury or illness in the patients medical history is called
late effect
Under CPT-$ definition, after a consulation, who takes responsibility for the patient's care?
the referring physician
In CPT-4 what type of code is described by the following entry? +33961 each additional 24 hours
add-on code
The EMR is
the electronic medical record
Health insurance is defined as
a contract between an insurance company and as individual to pay for halth care treatment
A patient's insurance card usually shows
none of the above
Patient who enroll in a point of service type of HMO may use the service of
HMO network or out of network providers.
Healthcare facility that employs health insurance specialist is legally responsible for employees' action performed within the contect of their employment is called
respondeat superior
in a preferred provide organization (PPO) plan referrals to specialists are
not required
The AMA, AHA, and HBMA are examples of
professional organizations
under a writtne insurance contract, the policyholder pays a premium, and the insurance company provides
payment rfor medical service
Patient demographics do not include
their treatment plan
which kind of code is required to report a motor vehicle traffic accident?
e code
the designation of registered medical assistant (RMA) is awarded by
AMT
the process of checking and confirming that a patient is covered under an insurance plan is known as
eligibility verification
CMS-1500 is
the universal billing form for physicinas office
the administrative agency within the federal department of health and human service (DHHS)
CMS
electronic claims can be submitted
all of the above
Peripheral polyneuropathy due to pellagra what is the secondary trem.?
polyneuropathy
the term blackfan-diamond anemia is an example of
eponym
in cpt-4 a triangle next to a code indicates a
revised
the source document refers to the
all of the above
review health related claims to determine the medical necessity for procedures or service performed before payment is made to the provider is called a-n
both a and b
a provision in a health insurance policy in which two insurance carriers work together for payments so that there is no duplication of benefits paid between the primary insurance carrier and the secondary insurance carrier is called
coordination of benefits
In cpt4 a bullet (a black circle) next to a code indicates a
add on code
In the icd-9-cm tabular list a code followed the instruction "use additional code, If desired to identify the type of infection How many codes are required
one code
Medicaid is billed only
all of the above
following correct for documention
CC, history and exam (PE,ROS), diagnosis, and treatment
is correwct process for selecting cpt-4 codes?
determine the procedures and service to report, identify the correct codes and determine the need for modifiers
a cleaninghouse
a company that links the physicians office with insurance company
In the ICD-9-Cm burns are classified according to the rule of
nines
the difference between a boss and a leader a boss says go a learder say lets's go
leardership
chatacteristic of professionalism includes
skill bassed technical knowledge
In the diagnostic statment "tuberculous rheumatism," which is the main term?
rheumatism
HIPAA
Health Insurance portability and accountability Act
Verbal or written agreement that gives approval to some actions, situation, or statment is called
authorization
A fax cover sheet should inculde
both A and C
to code surgery, the coder must know
all of the above
If we don't change we don't grow. If we don't grow we aren't really living
managing change
even if you are on the right track, you'll get run over if you just sit here
productivity
always do right this will grafity some and astonish the rest
professional ethics
micheal if you can pass you cant play
team building
if you don't care take care of our customers, someone else will
customer service
the real death of america will come when everyone is alike
diversity service
the primary purpose of medical record involves documenting patient care service so that others who treat the patient have asource of information to assist with additional care and treatment.
coninuity of care
American academy of professional coders
AAPC
American Association of Medical Assistant
AAMA
American Health Information Management Assoication
AHIMA
American Medical Billing Assoication
AMBA
Center for Medicare and Medicaid Services
CMS
Medical Association of Billers
MAB