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mod 150 week 1theory

theory review

QuestionAnswer
TIME LIMITS ATATED IN INDIVIDUAL HEALTH INSURANCE POLICIES ABOUT AN INSURANCE COMPANY'S OBLIGATION TO PAY BENEFITS ARE THE SAME FOR ALL INSURANCE COMPANIES FALSE
THERE IS STANDARDIZATION OF FORMAT FOR THE EXPLANATION OF BENEFIT DOCUMENT FOR ALL PRIVATE INSURANCE CARRIERS FALSE
THE INSURANCE INDUSTRY IS PROTECTED BY A SPECIAL EXEMPTION FROM THE FEDERAL TRADE COMMISSION TRUE
INSURANCE COMPANIES ARE RATED ACCORDING TO THE NUMBER OF COMPLAINTS RECIEVED ABOUT THEM TRUE
THE STATUS OF ELECTRONIC INSURANCE CLAIMS MAY BE ACCESSED QUICKLY ELECTRONICALLY OR TELEPHONICALLY BY DIGITAL RESPONSE SYSTEM TRUE
INQUIRES ABOUT INSURANCE CLAIMS MAY BE IN WRITING OR BY TELEPHONE TRUE
A REJECTED INSURANCE CLAIM SHOULD BE CORRECTED AND SENT FOR REVIEW OR APPEAL FALSE
APPROXIMATELY 50% OF INDIVIDUALS PURSUE APPEALS ON A DENIED INSURANCE CLAIM FALSE
IN THE CASE OF A MEDICARE PART B REDETERMINATION CARRIERS HAVE BEEN INSTRUCTED TO PAY AN APPEALED INS TRUE
THE HEARING PROCESS IS MORE THEN THE AMOUNT OF THE CLAIM TRUE
IF YOU HAVE A DENIED INSURANCE CLAIM YOU SHOULD CHANGE THE INFORMATION AND RESUBMIT THE CLAIM FALSE
ROUTINE USE OF TOO MANY NONSPECIFIC DIAGNOSTIC CODES MAY RESULT IN DOWNCODING TRUE
IN ANY TYPE OF OVERPAYMENT SITUATION ALWAYS CASH THE THIRD PARTY PAYER'S CHECK AND WRITE A REFUND CHECK PAYABLE TO THE ORIGINATOR OF THE OVERPAYMENT TRUE
IF THE PROVIDER IS NOTIFIED BY A COMMERICAL INSURANCE CARRIER THAT AN OVERPAYMENT HAS BEEN MADE INVESTIGATE THE REFUND REQUEST TRUE
A LEVEL 1 MEDICARE REDETERMINATION MAY BE MADE EITHER BY TELEPHONE IN WRITING OR BY SUBMITTING A CMS-20027 FORM TRUE
A PEER REVIEW IS USUALLY DONE BEFORE THE APPEAL PROCESS FALSE
APPEAL DECISIONS ON MEDICARE UNASSIGNED INSURANCE CLAIMS ARE SENT TO THE PATIENT TRUE
THE HIGHEST LEVEL OF A MEDICARE REDETERMINATION IS WITH AN ADMININISTRATIVE LAW JUDGE HEARING FALSE
THE CODES IN THE EYE AND OCULAR ADNEXA SUBSECTION ARE BILATERAL CODES FALSE
THE DESTRUCTION CODES IN THE POSTERIOR SEGMENT SUBSECTION INCLUDE ONE OR MORE SESSIONS TRUE
IF AN INSURED IS IN DISAGREEMENT WITH THE INSURER FOR SETTLEMENT OF A CLAIM A SUIT MUST BEGIN WITHIN 3 YEARS
IF A PAYMENT PROBLEM DEVELOPS WITH AN INSURANCE COMPANY AND THE COMPANY IGNORES CLAIMS AND EXCEEDS TIME LIMITS TO PAY A CLAIM IT IS PRUDENT TO CONTACT THE STATE INSURANCE COMMISSIONER
THE DOCUMENT TOGETHER WITH THE PAYMENT VOUCHER THAT IS SENT TO A PHYSICIAN WHO HAS ACCEPTED ASSIGNMENT OF BENEFITS IS REFERRED TO AS AN EOB
WHEN RECIEVING PAYMENT FROM A PRIVATE INSURANCE CARRIER CHECK THE AMOUNT OF PAYMENT ON THE EOB WITH THE PATIENT'S FINANCIAL ACCOUNTING RECORD
AN INSURANCE CLAIMS REGISTER PROVIDES A FOLLOW UP PROCEDURE FOR INSURANCE CLAIMS
PENDING OR RESUBMITTED INSURANCE CLAIMS MAY BE TRACKED THROUGH A TICKLER FILE
THERE ARE SEVERAL WAYS TO FILE PENDING INSURANCE CLAIMS WHAT IS THE BEST WAY TO FILE SO THAT TIMELY FOLLOW UP CAN BE MADE? FILE BY PATIENT'S LAST NAME
A FOLLOW UP EFFORT MADE TO AN INSURANCE COMPANY TO LOCATE THE STATUS OF AN INSURANCE CLAIM IS CALLED A /AN INQUIRY
IF AN INSURANCE CLAIM HAS BEEN LOST BY THE INSURANCE CARRIER THE PROCEDURE TO FOLLOW IS TO ASK IF THERE IS A BACKLOG OF CLAIMS AT THE INSURANCE OFFICE
AN EXAMPLE OF A TECHNICAL ERROR ON AN INSURANCE CLAIM IS DUPLICATE DATES OF SERVICE
AN INSURANCE CLAIM WITH AN INVALID PROCEDURE CODE WOULD BE REJECTED
WHAT SHOULD YOU DO IF AN INSURANCE CARRIER REQUESTS INFORMATION ABOUT ANOTHER INSURANCE CARRIER PROVIDE THE INFORMATION
AN INSURANCE CLAIM WITH A BUNDLED SERVICE WOULD BE PAID
AN INSURANCE CLAIM FOR WHICH PRIOR APPROVAL WAS NOT OBTAINED WOULD BE PAID
WHAT SHOULD BE DONE IF AN INSURANCE CLAIM DENIAL IS RECIEVED BECAUSE A BILLED SERVICE WAS NOT A PROGRAM BENEFIT? SEND THE PATIENT A STATEMENT WITH A NOTATION OF THE RESPONSE FROM THE INSURANCE COMPANY
WHAT SHOULD BE DONE IF AN INSURANCE COMPANY DENIES A SERVICE STATING IT WAS NOT MEDICALLY NECESSARY AND THE PHYSICIAN BELIEVES IT WAS? REBILL WITH A LETTER OF EXPLANATION FROM THE PHYSICIAN
WHEN DOWNCODING OCCURS PAYMENT WILL BE LESS
IF AN INSURANCE COMPANY ADMITS THAT A PATIENT SIGNED AN ASSIGNMENT OF BENEFITS DOCUMENT AND THAT IT INADVERTENLY PAID THE PATIENT INSTEAD OF THE PHYSICIAN THE INSURANCE COMPANY SHOULD PAY THE PHYSICIAN WITHIN 2-3 WEEKS AND HONOR THE ASSIGNMENT EVEN BEFORE THE COMPANY RECOVERS ITS MONEY FROM THE PATIENT
THE TOTAL NUMBER OF LEVELS OF REDETERMINATION THAT EXIST IN THE MEDICARE PROGRAM IS FIVE
THE FIRST LEVEL OF APPEAL IN THE MEDICARE PROGRAM IS REDETERMINATION
THE CORRECT METHOD TO SEND DOCUMENTS FOR A MEDICARE RECONSIDERATION (LEVEL2) IS BY CERTIFIED MAIL WITH RETURN RECIEOT REQUESTED
A REQUEST FOR A MEDICARE ADMINISTRATIVE LAW JUDGE HEARING CAN BE MADE IF THE AMOUNT IN CONTROVERSY IS AT LEAST $120.00
HOW MANY LEVELS OF REVIEW EXIST FOR TRICARE APPEAL PROCEDURES? THREE
TRICARE APPEALS ARE NORMALLY RESOLVED WITHIN 60 DAYS
IN A TRICARE CASE A REQUEST FOR AN INDEPENDENT HEARING MAY BE PURSUED IF THE AMOUNT IN QUESTION IS $300 OR MORE
CATARACT AND LENS REPLACEMENT USES___DIFFERENT APPROACHES 3
STRABISMUS SURGERY CORRECTS THE MUSCLE MISALIGNMENT
THE INNERMOST LAYER OF THE EYE IS THE RETINA
AN INSTRUMENT USED TO MEASURE INTRAOCULAR PRESSURE IS TONOMETER
THE COLORED MEMBRANE ATTACHED TO THE CILIARY BODY IS IRIS
IN THE TERM MIOTIC THE COMBINING FORM MI/O MEANS LESS, SMALL
IN THE TERM RETROLENTAL THE PREFIX RETRO- MEANS BEHIND
THE MEIBOMIAN GLANDS SECRETE SEBUM
THE MEDICAL TERM FOR NORMAL OR PERFECT VISION IS EMMETROPIA
THE ROOT IN THE TERM KEATOCONJUNCTIVITIS MEANS JOIN TOGETHER
AN AGENT THAT CAUSES THE PUPIL TO DILATE IS CALLED MYDRIATIC
THE MEASUREMENT OF THE CORNEA IS CALLED KERATOMETRY
HOW MANY EYE MUSCLES CONTROL MOVEMENT OF THE EYE? SIX
A CONDITION IN WHICH THE PUPILS ARE UNEQUAL IS TERMED ANISOCORIA
___IS THE PROCESS OF THE EYES MAKING ADJUSTMENTS FOR SEEING AT VARIOUS DISTANCE ACCOMMODATION
DRYNESS OF THE CONJUNCTIVA IS CALLED XEROPHTHALMIA
THE___IS THE OPENING IN THE CENTER OF THE IRIS PUPIL
CONJUNCTIVITIS IS OFTEN CALLED PINKEYE
THE TERM USED TO DESCRIBE THE CONDITION OF AN EYE BEING TURNED INWARD IS ESOTROPIA
OPACITY OF THE CRYSTALLINE LENS IS CALLED CATARACT
AN UNUSUAL INTOLERANCE OF LIGHT IS KNOWN AS PHOTOPHOBIA
AN INVOLUNTARY CONSTANT RYTHMIC MOVEMENT OF THE EYEBALL IS CALLED NYSTAGMUS
IN THE TERM MYDRIATIC, THE ROOT MYDRIAT MEANS DILATION, WIDEN
A MALIGNANT TUMOR ARISING FROM THE GERM CELL OF THE RETINA IS RETINOBLASTOMA
ALL OF THE FOLLOWING MAKE UP THE EXTERNAL STRUCTURE OF THE EYE EXCEPT UVEA
THE ANTERIOR CHAMBER IS FILLED WITH AQUEOUS HUMOR
A SURGICAL PROCEDURE THAT MAY BE PERFORMED TO CORRECT MYOPIA IS KNOWN AS RADIAL KERATOTOMY
THE SUFFIX IN BLEPHAROPTOSIS MEANS DROOPING
IN OLDER ADULTS THE LEADING CAUSE OF NEW CASES OF BLINDNESS IS MACULAR DEGENERATION
THE MIDDLE OR VASCULAR LAYER OF THE EYEBALL IS CALLED UVEA
THE MEDICAL TERM FOR NIGHT BLINDNESS IS NYCTALOPIA
LAZY EYE IS ALSO KNOWN AS AMBLYOPIA
___IS USED TO IDENTIFY CHANGES IN THE BLOOD VESSELS IN THE EYE AND TO DIAGNOSE SYSTEMIC DISEASES OPHTHSLMOSCOPY
THE __IS THE ANTERIOR TRANSPARENT PORTION OF THE EYEBALL CORNEA
THE MIDDLE LAYER OF THE EYEBALL IS KNOWN AS THE UVEA
MACULAR DEGENERATION INVOLES THE MACULAR AREA OF THE RETINA
THE ROOTS IN ORTHOPTICS MEANS STRAIGHT
IN THE TERM KERATOCONJUNCTIVITIS THE COMBING FORM KERAT/O MEANS PUPIL
THE MEASUREMENT OF THE INTRAOCULAR PRESSURE OF THE EYE IS TONOMETRY
THE PIGMENT NECCESSARY FOR NIGHT VISION IS RHODOPSIN
THE SMALL DEPRESSION LOCATED IN THE MACULA LUTEA IS KNOWN AS THE FOVEA CENTRALIS
SURGICAL DESTRUCTION AND REMOVAL OF THE LENS TERMED PHACOLYSIS
IN THE TERM CRYOSURGERY THE COMBINING FORM CRY/O MEANS COLD
IN THE TERM PHACOEMULSIFICATION THE COMBINING FORM PHAC/O MEANS LENS
A PROCESS OF REMOVING AN ENTIRE PART OR MASS WITHOUT RUPTURE IS CALLED ENUCLEATION
THE PROCESS OF USING ULTRASOUND TO DISINTEGRATE A CATARACT IS KNOWN AS PHACOEMULSIFICATION
IN THE TERM CONJUNCTIVITIS THE ROOT CONJUNCTIV MEANS TO JOIN TOGETHER
DRYNESS OF THE CONJUNCTIVA IS TERMED XEROPHTHALMIA
AN AGENT THAT CAUSES THE PUPIL TO COTRACT IS CALLED MIOTIC
THE MOST COMMON SURGERY TO REMOVE A CATARACT IS PHACOEMULSIFICATION
A DROOPING OF THE UPPER EYELID IS KNOWN AS BLEPHAROPTOSIS
A CONDITION OF HARDENING OF THE CRYSTALLINE LENS IS CALLED PHACOSCLEROSIS
A PHYSICIAN WHO SPECIALIZES IN THE STUDY OF THE EYE IS OPHTHALMOLOGIST
IN THE TERM NYCTALOPIA THE ROOT NYCTAL MEANS NIGHT
THE MEDICAL TERM FOR FARSIGHTEDNESS IS HYPEROPIA
THE AGENT USED TO CAUSE PUPILS TO CONTRACT IS A/AN MIOTIC
THE COLORED TISSUE ATTACHED TO THE CILIARY BODY IS THE IRIS
THE MEDICAL TERM FOR DULLNESS OF VISION IS AMBLYOPIA
BETA BLOCKERS INCREASE THE PRODUCTION OF INTRAOCULAR FLUID FALSE
THE IRIS IS ATTACHED TO THE CHOROID FALSE
THE NASOLACRIMAL DUCT DRAINS LACRIMAL FLUID INTO THE NOSE TRUE
THE PROTECTIVE COVERING FOR THE EXPOSED SURFACE OF THE EYEBALL IS THE SCLERA FALSE
THE LEADING CAUSE OF BLINDNESS OVER AGE 55 IS MACULAR DEGRNERATION TRUE
THE CIRCULAR OPENING IN THE CENTER OF THE IRIS IS CALLED THE PUPIL TRUE
THE ANTERIOR TRANSPARENT PORTION OF THE EYE'S FIBROUS OUTER SURFACE IS THE SCLERA FALSE
AN INCREASED AMOUNT OF TEARS CAN BE A SYMPTOM OF CONJUNCTIVITIS TRUE
AQUEOUS HUMOR IS LOCATED IN THE ANTERIOR CHAMBER TRUE
CATARACT REMOVAL IS ONE OF THE MOST COMMON OPERATIONS PERFORMED IN THE UNITED STATES TODAY TRUE
Created by: moviegrl on 2011-05-19



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