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Billing/ Insurance

Week 5

The portion of the medical fees that the patient needs to pay at the time of services is called: co-pay
The largest medical insurance program in the United States is: Medicare
The cost that patients must pay each month (sometimes provided by their employers) is called the: premium
Noncovered services are also known as: exclusions
A statement summarizing how the insurance carrier determined reimbursement for services received by the patient is called a(n): EOB
The medical insurance that covers medical care for certain qualifying low-income individuals is: Medicaid
To ensure that there is a successful flow of adequate income in the clinic or office, the medical assistant should: bill the insurance carrier or patient as needed, complete forms properly, keep track of again accounts
Intentional improper billing practices are considered: abuse
which of the following is a problem with work-related health insurance coverage? Part-time employees are usually not eligible, medical benefits may not transfer , insurance companies often refuse to provide coverage for some procedures, including experimental treatments
the person covered under the terms of an insurance policy is called the: beneficiary
when more than one policy covers the individual, the _______ determines which of the polices will pay first. coordination of benefits
where does one find the address to which insurance claims are to be sent? on the back of the insurance card
Blue Cross and Blue Shield are examples of: traditional insurance organizations
What is the name of the coding system that includes codes for services provided to Medicare or Medicaid patients? HCPCS
A diagnosis code of 670.51 has been entered on the claim form. What system is used to assign that code? ICD-9
In the CPT manual, the description of the level of E&M codes includes which of the following? Complexity of the medical decision making, level of history taken, number of systems examined and documented, new versus established patient.
An description of Volume II of the ICD-9 An alphabetic listing of all known diagnoses, including symptoms and accidents and their cause.
Deliberately billing a higher rate than what was performed to obtain greater reimbursement is called: upcoding
One way to prevent a breach of confidentiality when processing insurance claim forms is to: ask the patient, parent, or guardian to sign an Authorization to Release Medical Information form before the claim is completed.
When coding, it is imperative to: to be precise as possible, not to guess, not to code what is not there.
Submitting claims electronically: can improve cash flow, ensures consistency, will reduce the amount of supplies required.
Using an electronic device for direct communication between medical offices and a health care plan's computer is called: point of service
The most common claim form for the ambulatory setting is the: CMS-1500
The codes showing that a patient has been seen for reasons other than sickness or injury are: V Codes
The insurance claims processor will confirm that: There are no exclusions or restrictions for payment of that diagnosis and the procedure relating to the diagnosis is medically necessary
A provider's fee profile is: a continuous record of usual charges made for specific services
Patients who owe money but have moved and left no forwarding address are referred to as: skips
Statues of limitations vary from state to state but should be investigated if an unpaid account is more than: 3 years old
For an insurance claim pending more than 45 days, the medical assistant should: call the carrier and find out if the claim was received and check on the processing status of the claim with the carrier
the most appropriate time to discuss fees for financial concerns of the patient is: when scheduling an appointment
The charge slip is also known as the: encounter form
In determining how aggressive to be in debt collections, you should consider: the value of the dollar owed.
Created by: aparke27