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Stack #215893

QuestionAnswer
An insurance claims representative also may be known as the claims adjudicator. True
A coordination of benefits statement in an insurance policy refers to the waiting period False
Workers' compensation insurance covers off-the-job injuries? False
If a patient has an individual insurance policy, a release of information does not have to be signed before the physician's office submits a claim to the insurance company? False
For Medicaid cases, there is no assignment of benefits unless the patient has other insurance in addition to Medicaid? True
State laws may bar the use of a signature stamp. True
A photocopy of the CMS-1500 claim form that is processed by the insurance carrier using scanning equipment is not acceptable. True
A paper claim is one that is submitted on paper, then optically scanned and converted to electronic form by insurance companies. True
Most major insurance companies accept the CMS-1500 claim for except for TRICARE and the Blue Cross Plans. False
If several services are being billed on the same insurance claim for, you may "ditto" the dates on each line of service below the first line. False
Most legal issues of priviate health insurance claims fall under? Civil law
When does the physician/patient contract begin? When the physician accepts the patient and agrees to treat the patient.
Most physician/patient contracts are? Implied
When a patient carries private medical insurance, the contract for treatment exsists between? The physician and the patient.
An emancipated minor is? A person younger than the age of 18 who lives independently.
Who does the contract exist between in a workers' compensation case? The physician and the Insurance Company.
The insured is always? The individual enrolle or organization protected.
When a medical facility is sent correct reimbursement from an insurance company for professional services, the site receives? The indemnity or also known as the payment or also known as the check. Basicially the payment, just how the payment is made may be know by different terms.
What are the three volumes of the ICD-9-CM:If a child has health insurance coverage from two parents, according to the birthday law? The health plan of the person whose birthday (month and day) falls earlier in the calendar year will pay first.
Mrs Thompson leaves her palce of employment. She is eligible to transfer her medical insurance coverage from a group practise to an individual contract. This is known as? Conversion privilige.
Atype of managed care organization created by the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA), that allows for enrollment of Medicare beneficiaries into managed care plans, is a/an? Competitive Medical Plan
Assignment of Benefits is? The transfer of one's legal rights to collect an amount payable under an insurance contract.
An encounter form may also be known as a? Patient service slip
The health insurance claim form (CMS-1500) is known as the ? Universal claim form.
Words contained within brackets [ ], provide the coder with what: Synonyms, alternative wording, explanatory phrases.
The colon ":" in the Tabular Section tells the coder: The terms below complete the term to make it assignable to a given category.
In the Alphabetic Index, Volume 2 of the ICD-9-CM, the nonessential modifiers are: Terms enclosed in parantheses that have no effect on the selection of the code listed for the main term.
Codes that have mandatory fifth digits are: Codes that always require a 5th digit to fully describe them.
The Table of Drugs and Chemicals is located where: Volume 2 of the ICD-9-CM.
The classification not included (for example) in the Table of Drugs and Chemicals is: Primary Neoplasm. This would be found in the Neoplasm Table.
All ICD-9-CM codes must be supported by: Documentation in the medical record.
The ICD-9-CM manual was developed based on a text by what organization: WHO World Health Organization.
Another name for the Supplementary Classification of Factors Influencing Health Status and Contact with Health Services: V codes, ICD-9-CM manual. Review this by going to the V code section and read the heading.
Created by: douelt
 

 



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