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FLAVIN MOS150U2
Theory TEST
| Question | Answer |
|---|---|
| Claims tracking and financial reports can be generated with a software system commonly referred to as | practice management software |
| A specific provider who oversees the total healthcare treatment of an individual enrolled in certain managed care plans is generally referred to as a | primary care physician |
| An independent, not-for-profit organization that sets standards for healthcare in the United States and accredits most major healthcare organizations is | The Joint Commission |
| If a claim is denied as “untimely,” | an appeal can be submitted in certain cases |
| One category that may be exempt from mandatory electronic claim submission is a/an | small provider |
| A group of healthcare providers working under one umbrella to provide medical services at a discount to the individuals who participate in the plan is referred to as a/an | PPO |
| ASCA has identified providers with 25 or fewer full-time employees (FTEs) and physicians, practitioners, and suppliers with 10 or fewer FTEs as | small providers |
| The federal act that sets minimum standards for pension plans for private industry is | ERISA |
| The two basic categories of health insurance are FFS and | managed care |
| A request by a healthcare provider for his or her patient to be evaluated or treated by a specialist is a | referral |
| Documents needed to generate an insurance claim include all of the following except a | patient driver’s license |
| Prior to submitting a claim, the healthcare professional should | follow payer guidelines |
| HIPAA | HIPAA |
| Which federal act, passed in 1996, is intended to improve the efficiency of healthcare delivery, reduce administrative costs, and protect patient privacy? | A very significant piece of legislation passed by Congress in 1996 that affected healthcare and medical billing was the |
| A relatively small out-of-pocket dollar amount that a member of a managed care plan typically pays up front is | a copayment |
| Submitting claims to third-party carriers within the time limits set forth in the payer’s guidelines is referred to as _____ filing. | timely |
| An advantage of managed care organizations (MCOs) is that their aim is to keep their enrollees healthy, which is commonly referred to as | preventive care |
| Which type of managed care organization is one in which members pay discounted rates if they receive their healthcare from member providers but pay a higher cost when they go outside the organization? | PPO |
| The plan types within managed care plans include all of the following except | health savings accounts |
| According to HIPAA, which of the following code sets is acceptable for the electronic transmission of healthcare data? | CPT-4 procedure codes |
| The time limit for filing claims | varies among payers |
| The two basic methods for submitting claims electronically are the | clearinghouse and insurer direct |
| Medicare claims must be submitted electronically, unless the HHS secretary grants a/an | waiver |
| Most clearinghouses have the ability to meet the requirements of processing claims for each insurance company using their | specific computer format |
| The formal term for a written complaint submitted by an individual covered by a special plan or policy is called a | grievance |
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Iteach4Docs
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