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Insurance Handbook
exam 1
| Question | Answer |
|---|---|
| What does the abbreviation MSHP designate? | Multiskilled health practitioner |
| Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring | multiskilled health care practitioners |
| Administrative medical office responsibilities include | claims submission |
| A claims assistance professional | works for the consumer, helps patients file insurance claims (Both A and B) |
| What is “cash flow” in a medical practice? | The actual money available to a medical practice |
| Front office medical duties have become increasingly important because | Diagnostic and procedure coding must be reviewed for its correctness and completeness |
| Which level of education is generally required for one who seeks employment as an insurance coder? | Completion of an accredited program for coding certification |
| Which organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing? | American Health Information Management Assoiciation (AHIMA) |
| The amount of money an insurance billing specialist earns is dependent on which of the following factors? | Knowledge, Experience, Size of employing institution (All of the above) |
| A billing specialist is entrusted with | Holding patients' medical information in confidence, collecting monies, being a reliable resource for coworkers. |
| Medical etiquette refers to | Consideration for others |
| Medical ethics include | Standards of conduct |
| The earliest written code of ethical principles for the medical profession is the | Code of Hammurabi |
| What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980? | The principles of medical ethics |
| What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment? | Notify your physician |
| Reporting incorrect information to private insurance carriers is considered | Unethical |
| Which code of ethics is most appropriate for an insurance billing specialist who handles medical records? | AHIMA code of ethics |
| AHIMA publishes | diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements (All of the above) |
| A self-employed medical insurance biller who does independent contracting is responsible for | Advertising, billing, accounting, (All of the above) |
| The Internet Healthcare Coalition has developed | the eHealth Code of Ethics |
| Reporting incorrect information to government funded programs is | Fraud |
| Insurance specialist certificate programs include | (anatomy, diagnostic coding, computer technology, all of the above) |
| The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as | respondeat superior, let the master answer, vicarious liability (All of the above) |
| The AHIMA Code of Ethics is appropriate for | health information specialists, coders, insurance billing specialists (All of the above) |
| Why are multiskilled health practitioners (MSHPs) in demand? | They are cross-trained to provide more than one function, they are often competent in more than one function, and they offer more flexibility to their employer. |
| Confidential information includes | everything that is heard about a patient, everything that is read about a patient, everything that is seen regarding a patient (all of the above) |
| What is the correct response when a relative calls asking about a patient | have the physician return the telephone call |
| Nonprivileged information about a patient consists of the patient’s | city of residence |
| Exceptions to the right of privacy rule include | gunshot wound cases |
| Confidentiality is automatically waived in cases of | gunshot wounds, child abuse, extremely contagious diseases (all of the above) |
| When an insurance billing specialist bills for a physician and completes a Medicare claim form with information that does not reflect the true situation, | he or she may be subject to fines and imprisonment |
| What action could happen if an employee knowingly submits a fraudulent Medicare or Medicaid claim at the direction of the employer and subsequently the medical practice is audited? | The employee and the employer could be brought into litigation by the state or federal government. |
| To bill Medicare beneficiaries at a higher rate than other patients is considered | abuse |
| Electronic media refers to | leased telephone or dial-up telephone lines, the Internet, transmissions that are physically moved from one location to another, (all of the above) |
| The Office of Civil Rights enforces | privacy and security rules |
| What is the best response when telephoning a patient about an insurance matter and the patient’s voice mail is reached? | Use care in the choice of words when leaving the message. |
| A uniform lexicon system used for managing patient electronic health records, information, indexing, and billing laboratory problems is called | SNOMED |
| The focus on the health care practice setting and reducing administrative costs and burdens are the goals of | HIPAA Title II Administrative Simplification |
| Which statement is correct regarding the insurance industry? | The insurance industry is among the world's largest businesses |
| Most legal issues of private 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 exists between | physician and the patient |
| An emancipated minor is | younger than the age of 18 who lives independently |
| The contract in a workers’ compensation case exists between | physician and the insurance company |
| In health insurance, the insured is also known as | subscriber, ,member, policy holder |
| The insured is always | the individual enrollee or organization protected |
| The reason for a coordination of benefits statement in a health insurance policy is | prevent duplication or overlapping of payments for the same medical expense. |
| Mr. Talili has two medical insurance policies. To prevent duplication of payment for the same medical expense, the policies include a | coordination of benefits statement. |
| 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. Basically the payment, just how the payment is made may be know by different terms. |
| 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 |
| According to the birthday law, if both the mother and the father have the same birthday | plan of the person who has coverage longer is the primary payer |
| Conditions that existed and were treated before the health insurance policy was issued are called | preexisting |
| An attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a/an | exclusion/waiver |
| What is the correct term used to determine if a procedure is covered and medically necessary? | preauthorization |
| Mrs. Thompsett leaves her place of employment. She is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as | conversion |
| Why would conversion from a group policy to an individual policy be advantageous? | Benefits would increase |
| Mr. Ott was laid off from his job. He is protected by Consolidated Omnibus Budget Reconciliation Act (COBRA), which requires his employer to | extend group health insurance coverage for 18 months |
| What is the minimum number of employees a company must have to meet the criteria of the COBRA for continued medical benefits if an employee is laid off from a company? | 20 |
| The act created to protect workers and their families so that they can get and maintain health insurance if they change or lose their jobs is called the | Consolidated Omnibus Budget Reconciliation Act (COBRA |
| An organization of physicians, sponsored by a state or local medical association, concerned with the development and delivery of medical services and the cost of health care is known as a/an | foundation for medical care |
| A type 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 |
| A state and federal program for children who are younger than 21 years of age and have special health care needs is | Maternal and Child Health Programs (MCHP). |
| A patient intake sheet is also called a | patient information form |
| The first document obtained in the initial patient visit is a/an | patient information form |
| Assignment of benefits is | transfer of one of ledger right to collect the amount payable under an insurance contract |
| An encounter form may also be known as a | patient service slip |
| The source document for insurance claim data is the | superbill |
| A daily record sheet used to record daily business transactions is called a/an | daysheet |
| It is advisable to process insurance claims | in batches, grouping claims of patients who have the same type of insurance |
| An insurance claims register facilitates | follow up insurance claims |
| When the physician’s services have been submitted to the patient’s insurance company by the physician’s office, the patient should | be sent a monthly statements indicating the insurance company has been billed |
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