Like this study set? Create a free account to save it.

Sign up for an account

Already have a Quizlet account? .

Create an account

MDCA 1343

The birth law is a change in the order of determination of coordination of benefits regarding primary and secondary insurance carriers for dependent children


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


the blue sheild plans trace their beginning to a resolution passed by the houses of delegates at a meeting of the


maternal and child health programs (MCHP)

operate with federal grant support under TITLE V of the social security act

important tool for claims submission


astandard information tool used for communication


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


a 3 digit code in the ICD-9-CM


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)


enfororcement of the privacy standards of HIPAA is the responsibility of


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


certain illnesses or injuries listed in a policy that the insurance company will not cover


insurance company that carriers the insutance


one who belongs to a group plan


a health insurance policy renewal provisions


for HMO authorized fee for service specialty care the claims is sent directly to


What is the term in the diagnostic statment "localized salmonella infection, unspecified?"


A insurance company takes into accounts benefits payable another carrier in determining its own liability


benefits paid by an insurance company to an insured person


transfer of one right to collect an amount payable under an insurance contract


time that must elapse before an indemnity is paid

waiting period

acts for insurance company or insured in settlement of clims


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?


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".?


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.


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


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


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)


electronic claims can be submitted

all of the above

Peripheral polyneuropathy due to pellagra what is the secondary trem.?


the term blackfan-diamond anemia is an example of


in cpt-4 a triangle next to a code indicates a


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


the difference between a boss and a leader a boss says go a learder say lets's go


chatacteristic of professionalism includes

skill bassed technical knowledge

In the diagnostic statment "tuberculous rheumatism," which is the main term?



Health Insurance portability and accountability Act

Verbal or written agreement that gives approval to some actions, situation, or statment is called


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


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


American Association of Medical Assistant


American Health Information Management Assoication


American Medical Billing Assoication


Center for Medicare and Medicaid Services


Medical Association of Billers


Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions and try again


Reload the page to try again!


Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

Voice Recording