Question | Answer |
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. |