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exam review 14 & 15
review
| Question | Answer |
|---|---|
| What is a condition that has existed before the insurance policy had been put into effect? | Preexisting condition |
| This type of insurance is established for the spouses and dependents of vets who have total permanent service connected disabilities | CHAMPVA |
| What is the name of the person who is insured or called the policyholder? | subscriber |
| This type of insurance purchased by an individual or family that does not have access to a group health insurance? | Individual insurance |
| This is a specified amount that the insured must pay toward the charge for professional services rendered at the time of service | Copayment |
| This is insurance offered to all employees by the employer | Group insurance |
| This type of insurance was established to aid dependents of active service personnel, retired service personnel and those who died on active duty | TRICARE |
| This is a government insurance program that provides insurance coverage for those who are injured on the job or who have developed work-related disorders, injuries or illness | workers comp |
| What are ICD codes descriptive of? | present a disease or condition |
| If a record is reviewed by a third party payer and a procedure was never documented it means that- | it never happened |
| When must any new, revised or deleted codes must be implemented? | Every January 1st |
| Who publishes the Current Procedural Terminology Manual? | American Medical Association |
| Why is the ICD-9CM manual running out of capacity? | it doesn't allow for the medical advances |
| When are modifiers used? | circumstances for a particular code has been altered |
| Who records the services performed on an encounter form? | physician (provider) |
| Most physicians utilize what volume of the ICD-9 manual? | ONE AND TWO |
| What is the name for the date when the insurance policy goes into effect | Effective date |
| This type of insurance entitles to services provided by participating hospitals, clinics, and physicians | HMO |
| What are the procedures used to ensure no duplication of payment on claims when a pt. has more than one insurance? | Coordination of benefits |
| This is a predetermined amount that the insured must pay each year before the insurance company will pay for an accident or illness | Deductible |
| what is a service area? | Geographic area served by an insurance carrier |
| what is the approval obtained before the pt. is admitted to the hospital or receives specified outpatient or in office procedures called? | Precertification |
| What is the name for a plan that the health care delivery system combines the delivery of health care and payment of services | Managed care |
| What is assignment of benefits? | Authorized by pt. to allow the Dr. to get paid directly from the insurance company |
| This is an insurance plan for the medical care of low income population | Medicaid |
| What is the name of the insurance plan in which the provider gets paid monthly whether the pt. is seen or not? | Capitation |
Created by:
bpstears
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