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Billing/ Insurance
Week 5
| Question | Answer |
|---|---|
| The portion of the medical fees that the patient needs to pay at the time of services is called: | co-pay |
| The largest medical insurance program in the United States is: | Medicare |
| The cost that patients must pay each month (sometimes provided by their employers) is called the: | premium |
| Noncovered services are also known as: | exclusions |
| A statement summarizing how the insurance carrier determined reimbursement for services received by the patient is called a(n): | EOB |
| The medical insurance that covers medical care for certain qualifying low-income individuals is: | Medicaid |
| To ensure that there is a successful flow of adequate income in the clinic or office, the medical assistant should: | bill the insurance carrier or patient as needed, complete forms properly, keep track of again accounts |
| Intentional improper billing practices are considered: | abuse |
| which of the following is a problem with work-related health insurance coverage? | Part-time employees are usually not eligible, medical benefits may not transfer , insurance companies often refuse to provide coverage for some procedures, including experimental treatments |
| the person covered under the terms of an insurance policy is called the: | beneficiary |
| when more than one policy covers the individual, the _______ determines which of the polices will pay first. | coordination of benefits |
| where does one find the address to which insurance claims are to be sent? | on the back of the insurance card |
| Blue Cross and Blue Shield are examples of: | traditional insurance organizations |
| What is the name of the coding system that includes codes for services provided to Medicare or Medicaid patients? | HCPCS |
| A diagnosis code of 670.51 has been entered on the claim form. What system is used to assign that code? | ICD-9 |
| In the CPT manual, the description of the level of E&M codes includes which of the following? | Complexity of the medical decision making, level of history taken, number of systems examined and documented, new versus established patient. |
| An description of Volume II of the ICD-9 | An alphabetic listing of all known diagnoses, including symptoms and accidents and their cause. |
| Deliberately billing a higher rate than what was performed to obtain greater reimbursement is called: | upcoding |
| One way to prevent a breach of confidentiality when processing insurance claim forms is to: | ask the patient, parent, or guardian to sign an Authorization to Release Medical Information form before the claim is completed. |
| When coding, it is imperative to: | to be precise as possible, not to guess, not to code what is not there. |
| Submitting claims electronically: | can improve cash flow, ensures consistency, will reduce the amount of supplies required. |
| Using an electronic device for direct communication between medical offices and a health care plan's computer is called: | point of service |
| The most common claim form for the ambulatory setting is the: | CMS-1500 |
| The codes showing that a patient has been seen for reasons other than sickness or injury are: | V Codes |
| The insurance claims processor will confirm that: | There are no exclusions or restrictions for payment of that diagnosis and the procedure relating to the diagnosis is medically necessary |
| A provider's fee profile is: | a continuous record of usual charges made for specific services |
| Patients who owe money but have moved and left no forwarding address are referred to as: | skips |
| Statues of limitations vary from state to state but should be investigated if an unpaid account is more than: | 3 years old |
| For an insurance claim pending more than 45 days, the medical assistant should: | call the carrier and find out if the claim was received and check on the processing status of the claim with the carrier |
| the most appropriate time to discuss fees for financial concerns of the patient is: | when scheduling an appointment |
| The charge slip is also known as the: | encounter form |
| In determining how aggressive to be in debt collections, you should consider: | the value of the dollar owed. |
Created by:
aparke27
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