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Insurance Handbook

exam 1

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
Created by: FB
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