303 Principles of Insurance

Compliant
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Terms in this set (152)
Compliant
Carefully define bundled codes and know global periods
Clarify coding and billing questions with physicians
Be clear on professional courtesy and discounts to uninsured/low-income patients
Rejected
Reporting only the top two of a five-level E/M code range for new or established patient office visits.
Using Modifier -91 to report repeat laboratory testing due to laboratory errors, quality control, or confirmation of results
Linkage/Medical Necessity
the CPT procedure codes do not match the ICD-10-CM diagnosis codes
The procedures are elective, experimental, or nonessential
The procedures are not furnished at an appropriate level
Coding
Using diagnosis codes that are not as specific as possible
Mismatch between the gender or age of the patient and the selected code when the code involves selection for either criterion
Reporting items or services that are not actually documented, but that the coder assumes were performed
Coding a unilateral service twice instead of choosing the bilateral code
Billing
Using an inappropriate modifier or no modifier when one is required
Using a procedure code that provides a higher reimbursement rate than the correct code
Billing without proper signatures on file
Place the steps to calculating a Medicare payment in the correct order.

Use the Medicare GPCI list to find the three geographic practice cost indices.
Multiply each RVU by its GPCI to calculate the adjusted value.
Use the Medicare Fee Schedule to find the three RVUs—work, practice expense, and malpractice—for the procedure.
Determine the procedure code for the service.
Add the three adjusted totals, and multiply the sum by the conversion factor to determine the payment.
Determine the procedure code for the service.
Use the Medicare Fee Schedule to find the three RVUs—work, practice expense, and malpractice—for the procedure.
Use the Medicare GPCI list to find the three geographic practice cost indices.
Multiply each RVU by its GPCI to calculate the adjusted value.
Add the three adjusted totals, and multiply the sum by the conversion factor to determine the payment.
The rules from the ______ about billing Medicare are published in the _________.
CMS; Federal Register
Medicare's national policy on correct coding is called the .
Correct Coding Initiative
CCI, updated every , has many thousands of CPT code combinations called CCI that are used by computers in the Medicare system to check
quarter; edits; claims
A claim should report a procedure code instead of codes that describe parts of the complete procedure.
bundled; multiple
Only a biopsy should be reported if both a deep biopsy and a superficial biopsy are performed at the same location in order to pass CCI edits.deepA CCI column 1/column 2 code edit is a Medicare code edit where CPT codes in column 2 will not be paid if reported on the day as the column 1 code.pair; sameA mutually code edit occurs when both services represented by the could not have reasonably been done during a encounter, so they cannot be billed together.exclusive; codes; patientA CCI indicator number shows whether the use of a modifier can bypass a CCI .modifier; editIn the example in Figure 6.4, the lowest cost element in the Medicare RBRVS fees is malpractice expense. practice expense. work expense. customary expense.malpractice expense.In calculations of RBRVS fees, the three relative value units are multiplied by their respective geographic practice cost indices. the neutral budget factor. the national conversion factor. the UCR factor.their respective geographic practice cost indices.Medicare typically pays for what percentage of the allowed charge? 50 percent 60 percent 70 percent 80 percent80 percentIf a participating provider's usual fee is $400 and the allowed amount is $350, what amount is written off? zero $25 $50 $75$50If a nonparticipating provider's usual fee is $400, the allowed amount is $350, and balance billing is permitted, what amount is written off? zero $25 $50 $75zeroIf a nonparticipating provider's usual fee is $400, the allowed amount is $350, and balance billing is not permitted, what amount is written off? zero $25 $50 $75$50Physicians establish a list of their usual fees for the charges they have written off. workers' compensation patients. their Medicare patients. the procedures and services they frequently perform.the procedures and services they frequently perform.An encounter form containing E/M codes should list the most frequently billed codes. just blanks, so the correct E/M code can be entered. the complete ranges of codes for each type or place of service listed. the practice's professional courtesy policies.the complete ranges of codes for each type or place of service listed.The Medicare allowed charge for a procedure is $80. What amount does the participating provider receive from Medicare, and what amount from the patient, assuming the patient deductible has been met? $64/$16 $60/$20 $40/$20 $80$64/$16To calculate RBRVS fees, multiply each RVU by its __________, add the three adjusted totals, and multiply the sum by the conversion factor. GPCI UCR conversion factor time allowanceGPCIWhat is the fixed prepayment for each plan member in a capitation contract called? capitation rate usual fee allowed amount provider withholdcapitation rateSome possible consequences of inaccurate coding and incorrect billing in a medical practice are denied claims and reduced payments. prison sentences. fines all of these are correct.all of these are correct.If balance billing is permitted under a plan, the insured must pay for the entire provider's charge. pay for only his/her deductible. pay for the difference between the provider's charge and the allowed charge. pay nothing since it is part of the contractual agreement.pay for the difference between the provider's charge and the allowed charge.The CMS/AMA Documentation Guidelines set up the rules for the selection of Evaluation and Management codes. Anesthesia codes. Surgery codes. Pathology and Laboratory codes.Evaluation and Management codes.In an allowed charges payment method, if a provider's charge is higher than the allowed amount, the provider's reimbursement is based on the amount billed. the amount allowed. the deductible. the co-insurance.the amount allowed.A conversion factor is multiplied by a _________ to arrive at a charge. charge relative value unit fee schedule time allowancerelative value unitThe RBRVS fees are based on the __________analysis of what each service costs to provide. local government's state government's federal government's insurance'sfederal government'sUnder a contracted fee schedule, the allowed amount and the provider's charge are different. the same. the same for Medicare patients only. the same for private pay patients only.the same.Which of the following modifiers is important for compliant billing? -25 -59 -91 all of these are importantall of these are importantThe Correct Coding Initiative (CCI) is a program of TRICARE CHAMPVA workers' compensation MedicareMedicareUnless there are indications of a problem, an audit typically involves reviewing every claim and document. a sample of the whole. 10% of the claims. all income and expenses.a sample of the whole.A charge that is written off is balance billed to the patient. balance billed to co-insurance. deducted from patient's account. just written off.deducted from patient's account.The Medicare allowed charge is $240 and the participating (PAR) provider's usual charge is $600. What amount does the patient pay, if the deductible has already been paid? $192 $48 $480 $120$48The Medicare Physician Fee Schedule is based on custom fees. provider fees. RBRVS fees. UCR fees.RBRVS fees.The normal range of fees is different in every town. city. state. geographic state.geographic state.Correct claims report the connection between a billed service and a diagnosis. This is called balance billing. bundled payment. code linkage. downcoding.code linkage.Most practices set their fees slightly above those paid by the highest reimbursing plan. slightly below those paid by the highest reimbursing plan. slightly above those paid by the lowest reimbursing plan. slightly below those paid by the lowest reimbursing plan.slightly above those paid by the highest reimbursing plan.EMRs have which of the following to assist physicians with their documentation process? billing programs documentation templates automatic Code Linkage Tool voice recognition softwaredocumentation templatesMany state and federal laws prohibit which of the following? audits adjustments edits professional courtesyprofessional courtesyThe conversion factor is a(n) __________. number. unit. dollar amount. time allowance.dollar amount.A write-off is required when the patient does not have insurance. the patient has Medicare. a participating physician's usual fee is higher than the payer's allowed charge. a participating physician does not participate with that payer.a participating physician's usual fee is higher than the payer's allowed charge.If a RAC's request is not answered within an appropriate amount of time, which of the following might occur? An error is declared. Penalties may result. An error is declared and penalties may result. None of these are correct.An error is declared and penalties may result.The Medicare allowed charge for a procedure is $150, and a PAR provider's usual charge is $200. What amount must the provider write off? $150 $100 $50 $30$50Put these seven steps of the revenue cycle into the order that will lead to completion of correct private payer claims. Check billing compliance Prepare and transmit claims Preregister patients Check in patients Check out patients Establish financial responsibility for visits Review coding compliance1. Preregister patients 2. Establish financial responsibility for visits 3. Check in patients 4. Review coding compliance 5. Check billing compliance 6. Check out patients 7. Prepare and transmit claimsThe largest employer-sponsored health program in the United States is Medicare. Medicaid Federal Employees Health Benefits program. workers' compensation.Federal Employees Health Benefits program.In employer-sponsored health plans, employees may choose their plan during the carve out. open enrollment period. contract period. birthday rule period.open enrollment period.Which laws govern the portability of health insurance? ERISA and HIPAA COBRA and HIPAA PPO and HMO FEHB and ERISACOBRA and HIPAASelf-funded health plans are regulated by PHI. PPO. FEHB. ERISA.ERISA.BlueCross BlueShield Association member plans offer all major types of health plans. indemnity plans only. PPOs only. HMOs only.all major types of health plans.Emergency surgery usually requires a deductible paid to the hospital or clinic. precertification (preauthorization) within a specified time after the procedure. a referral before the procedure. a maximum benefit limit.precertification (preauthorization) within a specified time after the procedure.Providers who participate in a PPO are paid a capitated rate. a discounted fee-for-service. an episode-of-care payment. according to their usual physician fee schedule.a discounted fee-for-service.Under a capitated HMO plan, the physician practice receives an encounter report. precertification for services. a monthly enrollment list. a secondary insurance identification number.a monthly enrollment list.What document is researched to uncover rules for private payers' definitions of insurance-related terms? ERISA participation contract HIPAA Security Rule riderparticipation contractConsumer-driven health plans have what effect on a practice's cash flow? A high-deductible payment from the patient takes longer to collect than does a copayment. The health plan's payment arrives faster than under other types of plans. There is no effect on cash flow. The effect is the same as the effect of a capitated plan.A high-deductible payment from the patient takes longer to collect than does a copayment.A member of a consumer-driven health care (CDHP) plan has a health savings account (HSA) fund of $500 and a deductible of $1,000 (which has not yet been met), and the HDHP has an 80-20 coinsurance. Calculate the total amount this patient would owe if the bill for their services is $1,800. $360 $1,500 $660 $1,880$660Which of the following examples demonstrates subcapitation? a capitated provider prepays an ancillary provider an ancillary provider prepays a capitated provider the patient prepays a capitated provider the HMO pays a capitated providera capitated provider prepays an ancillary providerIdentify what may be used to modify the terms of an insurance contract. stop-loss provision section guideline rider provider withholdriderWhich of the following is one of the nation's largest health insurers? Aetna UnitedHealth Group Anthem Kaiser PermanenteAnthemA list of drugs that are covered under an insurance plan is called the tier. creditable. pharmacy benefit. formulary.formulary.What type of plan requires premium, deductible, and coinsurance payments and typically covers 70 to 80 percent of costs for covered benefits after deductibles are met? preferred provider organizations (PPOs) health maintenance organizations (HMOs) point-of-service (POS) plans indemnity plansindemnity plansWhich of the following steps comes first in the standard revenue cycle? Prepare and transmit claims. Preregister patients. Check billing compliance. Establish financial responsibility for a visit.Preregister patients.How often do open enrollment periods usually occur? once per month twice per year once per year every other yearonce per yearWhich of the following types of provider performance would be reimbursed at the highest level in a tiered network? Practice provides quality health care at a low cost. Practice provides quality health care at a high cost. Practice provides average health care at a low cost. Practice provides average health care at a high cost.Practice provides quality health care at a low cost.What might private payers use for a major course of treatment, such as surgery, chemotherapy, and radiation for a patient with cancer? IPA P4P SPD UROUROWhat billing information is summarized by the plan summary grid? patient financial responsibility, billing information, and referral requirements billing information and financial responsibilities referral and preauthorization requirements list of patient names, addresses, and copaymentspatient financial responsibility, billing information, and referral requirementsA plan pays 50 percent of the provider's usual charge and requires the copayment of $5 to be applied toward the provider's payment. Calculate what the plan pays the provider when the usual charge is $200? $45 $95 $145 $200$95Which of these is the primary factor that providers examine to decide whether to participate in managed care plans? the type of patients served the financial arrangements the duties of the PCP the medical necessity guidelinesthe financial arrangementsWhich of the following describes a consultation? a patient independently seeks the opinion of another physician a physician examines the patient at the request of another physician and provides report to requesting physician care for a patient is transferred to another physician a patient must be admitted to a hospital for medical reviewa physician examines the patient at the request of another physician and provides report to requesting physicianA female member of a CDHP has an HSA fund of $820 and a deductible of $500 (which has not yet been met), and the HDHP has a 75-25 coinsurance. Calculate the amount this patient would owe after drawing down her HSA if the bill for her services is $2,100. $500 $80 $400 $2,100$80Define parity as it relates to medical insurance. concept of a network system that reimburses more for quality, cost-effective health care concept of diversity in the quality of medical service concept of equality with medical/surgical benefits concept of impartiality in selecting a PCPconcept of equality with medical/surgical benefitsWhat is the electronic format used to verify benefits? HIPAA 837 HIPAA 278 HIPAA 270/271 HIPAA 276/277HIPAA 270/271A plan pays 75 percent of the provider's usual charge and requires the copayment of $15 to be applied toward the provider's payment. Calculate what the plan pays the provider when the usual charge is $380? $15 $255 $270 $380$270Which of the following is a method a practice can use to avoid major problems with payers? Use good communication skills in working with payers. Routinely meet with payers to question the fee schedule. Use the patients as an intermediary in helping to communicate. Contact the employers to file complaint.Use good communication skills in working with payers.Self-funded health plans pay premiums to insurance carriers. managed care organizations. third-party administrators. no one because they assume the risk.no one because they assume the risk.Which of the following steps comes second in the standard revenue cycle Prepare and transmit claims. Preregister patients. Check billing compliance. Establish financial responsibility for a visit.Establish financial responsibility for a visit.A repricer is a company that works for the federal government to monitor fraud and abuse. works for hospitals and sets up their networks. works for a health plan and sets the discounts for out-of-network visits. works for the GHP and sets medical necessity guidelines.works for a health plan and sets the discounts for out-of-network visits.What should be prepared or updated for each participation contract? plan summary grid formulary repricer stop-loss provisionplan summary gridWhich term refers to an individual who enrolls in a health plan after the original enrollment date? waiting period late enrollee group enrollee COBRA enrolleelate enrolleeWhich of the following is normally not included on the monthly enrollment list? the type of plan or program patients' dates of birth patients' identification numbers the name of the employerthe name of the employerA PCP is usually a gastroenterologist. dentist medical biller. medical provider or practice.medical provider or practice.The TRICARE plan that is an HMO and requires a PCM is TRICARE Prime. TRICARE For Life. TRICARE Extra. TRICARE Standard.TRICARE Prime.__________ receive priority at military treatment facilities. Active-duty service members TRICARE Prime enrollees TRICARE Extra enrollees TRICARE Select enrolleesActive-duty service membersA TRICARE For Life beneficiary must be at least __________ years old. seventy twenty-one sixty-five thirtysixty-fiveTRICARE Prime is available to those eligible within __________ miles of a Primary Care Manager. 80 100 200 50100The TRICARE health care program is a covered entity and subject to privacy rules under NAS HIPAA TCS CHAMPVAHIPAAA person enrolled in CHAMPVA is responsible for __________ percent of covered charges. 20 25 50 6025Nonparticipating TRICARE providers cannot bill for more than __________ percent of allowable charges. 80 50 100 115115Active-duty service members are automatically enrolled in TRICARE Prime. TRICARE Select. CHAMPUS. TRICARE For Life.TRICARE Prime.For individuals enrolled in TRICARE For Life, the primary payer is TRICARE. CHAMPVA. a supplementary plan. MedicareMedicareDecisions about an individual's eligibility for TRICARE are made by the military treatment facility. provider Defense Enrollment Eligibility Reporting System. branch of military service.branch of military service.Which of the following services are covered under TRICARE Prime? maternity care outpatient care surgery all of theseall of theseWho is responsible for the costs of healthcare services not covered by CHAMPVA? the beneficiary the provider, as a write-off Medicar No one CHAMPVA pays 100%the beneficiaryWhat is the basis for the submission of TRICARE claims to the regional contractor? the physician's office address the location of the facility the patient's home address the patient's work addressthe patient's home addressWhich of the following examples demonstrates an abuse activity versus a fraudulent one? billing more than once for the same service changing dates of service, frequency of service, or names of recipients providing care that is of inferior quality altering CPT codes to increase the amount of payment to the providerproviding care that is of inferior qualityExplain the terms with which providers who choose to participate in CHAMPVA must agree. not to charge more than 125% of the CHAMPVA allowable amounts to accept CHAMPVA payment and the patient's cost-share payment as payment in full for services to accept the catastrophic cap per patient, meaning they will receive no more than $1,000 per patient per calendar year, regardless of what services they provide accept what they pay as payment in full and write off any remaining cost shareto accept CHAMPVA payment and the patient's cost-share payment as payment in full for servicesWho is not eligible for CHAMPVA? survivors of a veteran who died in the line of duty survivors of a veteran who died as a result of a service-related disability dependents of a veteran who is totally and permanently disabled due to a service-connected condition families of active duty membersfamilies of active duty membersWhat program did TRICARE replace? CHAMPUS PHS CHAMPVA DEERSCHAMPUSThe husband of an active duty service member and an actual active duty service member have both arrived at a MTF. Who should be given priority? the husband of an active duty service member the active duty service member neither is given priority none of these; these individuals cannot seek treatment at an MTFthe active duty service memberThe TRICARE program that offers benefits to Medicare-eligible military retirees and family members is TRICARE Select TRICARE Extra CHAMPUS TRICARE For LifeTRICARE For LifeIdentify the best practice for filing paper TRICARE claims. Check with each payer for specific information required on the form. Check the NUCC instructions. Check with the QIC. None of these are correct.Check with each payer for specific information required on the form.Which party is responsible for obtaining preauthorization under CHAMPVA? the patient the provider the PCP the VAthe patientWhat regulations cover the CHAMPVA, MHS, and TRICARE programs? TRICARE HIPA DEERS CHAMPUSHIPAAWhich program extends CHAMPVA benefits to spouses or dependents who are age sixty-five and over? TRICARE For Life CHAMPVA For Life Medicare MedicaidCHAMPVA For LifeWhat is the purpose of TRICARE Prime annual catastrophic cap? to limit the maximum amount a sponsor will pay each year to limit the maximum benefit a sponsor will receive each year to limit the maximum reimbursement a provider will receive each year to eliminate government spending by making the patient responsible for 50% co-shareto limit the maximum amount a sponsor will pay each yearGeographic areas in the US that are designated to ensure medical readiness for active-duty members are known as PSA (Prime Service Areas) POS (point of service) MTF (Military Treatment Facility) PCM (Primary Care Manger)PSA (Prime Service Areas)How much does a not active-duty family member have to pay to join TRICARE Prime for an individual? $0 $289.08 $578.16 $1,000$289.08Why can't providers contact DEERS directly regarding sponsors? the information is protected by the HIPAA Security Act the information is protected by the HIPAA Privacy Act there is no contact person at DEERS; it is only a database the information is protected by the HIPAA Code Setthe information is protected by the HIPAA Privacy ActThe TRICARE program that offers an HMO-like plan requiring no annual deductible is TRICARE Standard TRICARE Prime TRICARE Extra TRICARE Reserve SelectTRICARE PrimeName the Department of Defense's health insurance plan for military personnel and their families. CHAMPUS TRICARE CHAMPVA DEERSTRICAREWhat is the TRICARE term for coinsurance? capitation copayment cost-share allowable chargecost-shareWhich of the following is the uniformed services member in a family qualified for TRICARE? enrolle subscriber sponsor insuredsponsorWhat does a qualified independent contractor (QIC) ensure regarding TRICARE claims? that procedures have only one diagnosis code that care was up to ethical medical standards that services were medically necessary and appropriate that all claims be processed and paidthat services were medically necessary and appropriateDetermine the correct order of coverage between Medicare, Medicaid, and TRICARE for Life. Medicare first, Medicaid second, TRICARE third Medicaid first, Medicare second, TRICARE third Medicare first, TRICARE second, Medicaid third TRICARE first, Medicare second, Medicaid thirdMedicare first, TRICARE second, Medicaid thirdAll eligible beneficiaries in CHAMPVA possess a CHAMPVA Authorization Card, known as a(n) Member Card A-Card C-Card User CardA-CardOnce an application for Social Security Disability Insurance (SSDI) is filed, there is a __________ waiting period before benefits begin. thirty day five month fourteen day one monthfive monthA __________ is a denial of employer liability issued by the workers' compensation insurance carrier. First Report of Liability Notice of Contest No-Fault Notice Denial of FindingNotice of ContestAn individual with a disability described as precluding heavy work has lost __________ of the capacity to push, pull, bend, stoop, and climb. 20 percent 25 percent 90 percent 50 percent50 percentBefore an injured employee can return to work, a physician must write a progress report. a final report. an admission of liability report. a final report of injury.a final report.__________ provides workers' compensation insurance coverage to employees of the federal government. Office of Workers' Compensation Programs (OWCP) Federal Insurance Contribution Act (FICA) Supplemental Security Income (SSI) Federal Employees' Compensation Act (FECA)Federal Employees' Compensation Act (FECA)The classifications of pain used in workers' compensation claims are minimal, moderate, severe. slight, moderate, major, severe. minimal, slight, moderate, severe. minimal, slight, major, severe.minimal, slight, moderate, severe.Vocational rehabilitation programs provide __________ for individuals with job-related disabilities. physical therapy compensation for lost wages training in a different job payment for medical expensestraining in a different jobFor a widow or widower age fifty years or older who is disabled to qualify for Social Security Disability Insurance (SSDI), his or her spouse must have paid into Social Security for at least six months one year five years ten yearsten yearsAn employee who believes the work environment to be dangerous may file a complaint with the Office of Workers' Compensation Programs. local Social Security office. Occupational Safety and Health Administration. Workers' Compensation Board in the state in which the company is headquartered.Occupational Safety and Health Administration.What type of pain will force an employee to avoid any activities that will lead to the pain? minimal pain slight pain moderate pain severe painsevere painWhat does the physician of record file with the insurance carrier every time there is a substantial change in the patient's condition that affects disability status or when required by state rules and regulations? progress report official notice patient report progress noticeprogress reportFederal workers hired after 1984 are covered by SSDI SSI FICA FERSFERSWhich of these categories applies to a worker who is injured on the job, requires treatment, is unable to return to work, and is not expected to be able to return to his or her regular job in the future? injury without disability injury with temporary disability injury with permanent disability injury requiring vocational rehabilitationinjury with permanent disabilityWhat conditions would exclude benefits from the Veteran's Pension Program? The disability must be total. The disability must be permanent. The disability must be service-related. The veteran is injured while working for a private employer.The veteran is injured while working for a private employer.Which of the following is an example of an injury that is generally covered? an injury resulting from an employee's intoxication by alcohol an injury that was intentionally self-inflicted an injury due to heavy lifting an injury resulting from an employee's failure to use safety equipmentan injury due to heavy liftingWhere is payment made when a federal worker injured on the job is treated by a physician authorized by the OWCP? directly to the patient directly to the provider directly to Medicare through a clearinghouse which forwards the paymentdirectly to the providerWhat is the purpose of an IME? to provide an additional, impartial medical opinion before a final determination is made to provide an additional, impartial medical opinion after the final determination is made to determine if an injury resulting in death was a result of work conditions none of these are correctto provide an additional, impartial medical opinion before a final determination is madeWhich of the following authorizes payroll deductions for the Social Security Disability Program? SSDI SSI FICA FERSFICAHow is workers' compensation insurance funded under a state fund? Companies pay premiums to a central state insurance fund. Companies pay premiums to a federal insurance fund. Employees pay premiums to a central state insurance fund. Employees pay premiums to a federal insurance fund.Companies pay premiums to a central state insurance fund.What was created to protect workers from health and safety risks on the job? OSHA FICA OWCP FECAOSHAWhat program helps to pay living expenses for people who are blind or have disabilities and those of low-income older people? SSDI SSI FICA FERSSSIInjuries are generally covered under workers' compensation except for? if an injury occurs by accident if an injury results in personal injury or death if an injury arises out of employment and it occurs during the course of employment if an injury was an intentional injuryif an injury was an intentional injuryFor how many days of disability are cash benefits generally not paid? the first day the first three days the first seven days the first ten daysthe first seven daysWhen do temporary partial and temporary total disability benefits not cease? the employee has returned to work the employee has died the employee cannot work due to circumstances other than the work-related injury the employee cooperates with request for medical examinationthe employee cooperates with request for medical examinationWhat type of pain will markedly limit an employee's performance but is not intolerable? minimal pain slight pain moderate pain severe painmoderate painFor a company to self-insure for workers' compensation, most states require you to file proof of workers' compensation insurance. obtain authorization. contract with private insurance carriers. deduct premiums from employee payroll.obtain authorization.Which of these categories applies to a worker who is injured on the job, requires treatment, and is unable to return to work within several days? injury without disability injury with temporary disability injury with permanent disability injury requiring vocational rehabilitationinjury with temporary disabilityWhat type of workers are covered by the programs of the OWCP? those who have sustained workplace injuries those who have congenital diseases those who have been injured serving in the armed forces those who have been killed in the line of duty while serving in the militarythose who have sustained workplace injuriesWhat is the first step in the process of appealing workers' compensation decisions? file for a redetermination request a hearing request mediation request a meeting at a workers' compensation appeals boardrequest mediationWhich form should always be used in completing a workers' compensation claim form? CMS-1500 HIPAA 837 the plan's own claim form none of these are correct; there is no universal rulenone of these are correct; there is no universal ruleA patient presents with an injury suffered while working on an offshore fishing ship. By which OWCP program are they likely to be covered? The Federal Employees' Compensation Program The Energy Employees Occupational Illness Compensation Program The Federal Black Lung Program The Longshore and Harbor Workers' Compensation ProgramThe Longshore and Harbor Workers' Compensation ProgramWhat is the most common method states use to determine wage-loss benefits? They compensate employees based on a percentage of their salary before the injury. They compensate employees based on a percentage of their average salary over the last five years. They compensate employees at the full rate of their normal salary before the injury. They compensate employees at 115 percent of their normal salary before the injury.They compensate employees based on a percentage of their salary before the injury.Which of the following individuals would generally not be covered by state workers' compensation insurance? a part-time employee of a private insurance company a sixteen-year-old working for a private investment company a self-employed individual a full-time employee of a public trucking companya self-employed individualWhich of these accidents is an example of an unexpected result over time? an employee develops a hearing disability after years in a noisy work environment an employee is injured off-site due to a fall while walking to the post office on the company's behalfan employee injures his/her back when lifting a heavy box an employee breaks their ankle working in an officean employee develops a hearing disability after years in a noisy work environment