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HEALTH CLAIMS FINAL EXAM 12/06/2011

HEALTH CLAIMS FINAL EXAM 12/06/2011
STUDY
PLAY
SPENDING ON HEALTH CARE IS
RISING
THE EMPLOYMENT FORECAST FOR WELL-TRAINED MEDICAL INSURANCE & CODING SPECIALISTS IS
INCREASING OPPORTUNITIES
IN THE U.S., RISING MEDICAL COSTS ARE PRIMARILY DUE TO
ADVANCES IN TECHNOLOGY & AN AGING POPULATION
WHAT KIND OF MEDICAL SERVICES ARE ANNUAL PHYSICAL EXAMINATIONS AND ROUTINE SCREENING PROCEDURES
PREVENTIVE
UNDER A FEE-FOR-SERVICE PLAN, THE THIRD-PARTY PAYER MAKES A PAYMENT
AFTER MEDICAL SERVICES ARE PROVIDED
WHICH OF THE FOLLOWING IS REQUIRED WHEN A HMO PATIENT IS ADMITTED TO THE HOSPITAL FOR NONEMERGENCY TREATMENT
PREAUTHORIZATION
IN A PREFERRED PROVIDER ORGANIZATION (PPO) PLAN, REFERRALS TO SPECIALISTS ARE
NOT REQUIRED
CONSUMER-DRIVEN HEALTH PLANS COMBINE A HEALTH PLAN WITH A SPECIAL "SAVINGS ACCOUNT" THAT IS USED TO PAY WHAT B4 THE DEDUCTIBLE IS MET
MEDICAL BILLS
AN EXAMPLE OF PRIVATE-SECTOR PAYER IS AN
INSURANCE COMPANY
WHICH OF THE FOLLOWING COVERS PATIENTS WHO ARE OVER AGE 65
MEDICARE
WHICH OF THE FOLLOWING PROGRAMS COVERS PEOPLE WHO CANNOT OTHERWISE AFFORD MEDICAL CARE
MEDICAID
A PATIENT LEDGER RECORDS
THE PATIENT'S FINANCIAL TRANSACTIONS
COURTEOUS TREATMENT OF PATIENTS WHO VISIT THE MEDICAL PRACTICE IS AN EXAMPLE OF MEDICAL
ETIQUETTE
THE STATEMENT THAT "CODING PROFESSIONALS SHOULD NOT CHANGE CODES...TO INCREASE BILLINGS" IS AN EXAMPLE OF
PROFESSIONAL ETHICS
THE FEDERAL AGENCY THAT RUNS MEDICARE AND MEDICAID IS
CMS
EDI IS THE ABBREVIATION FOR
ELECTRONIC DATA INTERCHANGE
WHEN PERSONAL IDENTIFIERS HAVE BEEN REMOVED, PROTECTED HEALTH INFORMATION IS CALLED
DE-IDENTIFIED
A COURT ORDER TO APPEAR AND TESTIFY IS A
SUBPOENA
IF A PATIENT HAS COVERAGE UNDER 2 INSURANCE PLANS, 1 UNDER WHICH THE PATIENT IS THE POLICYHOLDER AND 1 UNDER WHICH THE PATIENT IS A DEPENDENT, THE PRIMARY PLAN IS
THE PATIENT'S PLAN
A COURT ORDER TO APPEAR, TESTIFY, AND BRING SPECIFIED DOCUMENTS OR ITEMS IS A
SUBPOENA DUCES TECUM
DISGUISING AN ELECTRONIC MSG SO THAT ONLY RECIPIENTS WITH THE CORRECT KEY CAN READ IT IS CALLED
ENCRYPTION
AN IMPERMISSIBLE USE OR DISCLOSURE UNDER THE PRIVACY RULE THAT COMPROMISES THE SECURITY OR PRIVACY OF PHI AND ALSO THAT COULD POSE A SIGNIFICANT RISK OF FINANCIAL, REPUTATIONAL, OR OTHER HARM TO THE AFFECTED PERSON IS CALLED A
BREACH
AN ESTABLISHED PATIENT IS DEFINED AS ONE WHO HAS SEEN THE PROVIDER WITHIN THE LAST
THREE (3) YEARS
THE TERMS "SUBSCRIBER" AND "GUARANTOR" HAVE THE SAME MEANING AS
INSURED
INSURANCE INFORMATION IS FOUND ON THE
PATIENT INFORMATION FORM
NONPAR STANDS FOR
NONPARTICIPATING
WHICH OF THESE DOCUMENTS MIGHT THE PATIENT COMPLETE
ASSIGNMENT OF BENEFITS
MEDICAL HISTORY
PATIENT INFORMATION FORM
A PROVIDER WHO DIRECLY TREATS A PATIENT IS CALLED A
DIRECT PROVIDER
A PROVIDER SUCH AS A FACILITY WHICH TESTS PATIENTS AS INSTRUCTED BY THE DIRECT PROVIDER IS CALLED A
INDIRECT PROVIDER
A "SELF-PAY" PATIENT IS ONE WHO
IS UNINSURED
THE PRACTICE'S RULES FOR PAYMENTS FOR MEDICAL SERVICES ARE FOUND IN THEIR
FINANCIAL POLICY
AN IMPORTANT INITIAL STEP IN ESTABLISHING FINANCIAL RESPONSIBILITY IS TO
VERIFY INSURED PATIENTS' ELIGIBILITY FOR BENEFITS
THE HIPAA SECURITY RULE SPECIFIES HOW TO SECURE PHI ON
THE INTERNET
COMPUTER NETWORKS
STORAGE DISKS
A NEW PATIENT IS DEFINED AS ONE WHO HAS NOT SEEN THE PROVIDER WITHIN THE LAST
THREE (3) YEARS
WHICH OF THESE HIPAA TRANSACTIONS IS SENT BY A PAYER TO EXPLAIN A CLAIM PAYMENT
835
WHICH OF THESE HIPAA TRANSACTIONS IS SENT BY A PROVIDER TO A PAYER FOR PAYMENT
837
WHICH OF THESE HIPAA TRANSACTIONS IS USED BY MEDICAL OFFICES TO ASK PAYERS ABOUT THE STATUS OF SUBMITTED CLAIMS
276
WHICH OF THESE HIPAA TRANSACTIONS IS SENT BY A PAYER TO ANSWER A QUESTION ABOUT A SUBMITTED CLAIM
277
THE PAYER'S PROCESSING OF CLAIMS IS CALLED
ADJUDICATION
A PAYER'S DECISION REGARDING WHETHER TO PAY, DENY, OR PARTIALLY PAY A CLAIM IS CALLED
DETERMINATION
ON AN AGING REPORT, WHICH CATEGORY DESCRIBES A CURRENT INVOICE
0-30 DAYS
THE PROCESS OF _____________ MEANS VERIFYING THAT THE TOTALS ON THE RA/EOB ARE MATHEMATICALLY CORRECT
RECONCILIATION
THE ADVANTAGE(S) OF EFT FOR PRACTICES IS
FUNDS ARE AVAILABLE IMMEDIATELY
THE TRANSFER IS LESS COSTLY THAN CHECK DEPOSITS
FROM THE PAYER'S POINT OF VIEW, ____________ ARE IMPROPER OR EXCESSIVE PAYMENTS RESULTING FROM BILLING ERRORS FOR WHICH THE PROVIDER OWES REFUNDS
OVERPAYMENTS
IF A MEDICAL PRACTICE BELIEVES THAT IT HAS BEEN TREATED UNFAIRLY BY AN INSURANCE COMPANY, IT HAS THE RIGHT TO FILE A _________ WITH THE STATE INSURANCE COMMISSION
GRIEVANCE
IF A PATIENT HAS ADDITIONAL INSURANCE COVERAGE, AFTER THE PRIMARY PAYER'S RA/EOB HAS BEEN POSTED, THE NEXT STEP IS
BILLING THE SECOND PAYER
IF A PROVIDER HAS ACCEPTED ASSIGNMENT, THE PAYER SENDS THE RA/EOB TO
PROVIDER
IF A PATIENT HAS AN INSURANCE FROM AN EMPLOYER AND IS COVERED BY MEDICARE, THEN MEDICARE IS BILLED:
SECONDARY