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Theory TEST

Claims tracking and financial reports can be generated with a software system commonly referred to as practice management software
A specific provider who oversees the total healthcare treatment of an individual enrolled in certain managed care plans is generally referred to as a primary care physician
An independent, not-for-profit organization that sets standards for healthcare in the United States and accredits most major healthcare organizations is The Joint Commission
If a claim is denied as “untimely,” an appeal can be submitted in certain cases
One category that may be exempt from mandatory electronic claim submission is a/an small provider
A group of healthcare providers working under one umbrella to provide medical services at a discount to the individuals who participate in the plan is referred to as a/an PPO
ASCA has identified providers with 25 or fewer full-time employees (FTEs) and physicians, practitioners, and suppliers with 10 or fewer FTEs as small providers
The federal act that sets minimum standards for pension plans for private industry is ERISA
The two basic categories of health insurance are FFS and managed care
A request by a healthcare provider for his or her patient to be evaluated or treated by a specialist is a referral
Documents needed to generate an insurance claim include all of the following except a patient driver’s license
Prior to submitting a claim, the healthcare professional should follow payer guidelines
Which federal act, passed in 1996, is intended to improve the efficiency of healthcare delivery, reduce administrative costs, and protect patient privacy? A very significant piece of legislation passed by Congress in 1996 that affected healthcare and medical billing was the
A relatively small out-of-pocket dollar amount that a member of a managed care plan typically pays up front is a copayment
Submitting claims to third-party carriers within the time limits set forth in the payer’s guidelines is referred to as _____ filing. timely
An advantage of managed care organizations (MCOs) is that their aim is to keep their enrollees healthy, which is commonly referred to as preventive care
Which type of managed care organization is one in which members pay discounted rates if they receive their healthcare from member providers but pay a higher cost when they go outside the organization? PPO
The plan types within managed care plans include all of the following except health savings accounts
According to HIPAA, which of the following code sets is acceptable for the electronic transmission of healthcare data? CPT-4 procedure codes
The time limit for filing claims varies among payers
The two basic methods for submitting claims electronically are the clearinghouse and insurer direct
Medicare claims must be submitted electronically, unless the HHS secretary grants a/an waiver
Most clearinghouses have the ability to meet the requirements of processing claims for each insurance company using their specific computer format
The formal term for a written complaint submitted by an individual covered by a special plan or policy is called a grievance
Created by: Iteach4Docs