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Week 4
Chapters 15, 16, 17, 18
| Question | Answer |
|---|---|
| A proceeding in which an attorney asks a witness questions regarding a case and the witness answers under oath but not in open court is known as a(n) | deposition |
| An abnormal condition caused by exposure to environmental factors associated with employment is termed a(n) | occupational illness |
| An individualized program of therapy using simulated or real work tasks to build strength and improve the worker's endurance toward a full day's work is known as | work hardening |
| Final determination involving settlement of an industrial accident is known as | adjudication |
| In a PD claim, the physician's final report must include the words | permanent and stationary |
| In a workers' compensation case, the contract and financial responsibility exists between the | physician and the insurance company |
| In an industrial case, if the patient is experiencing pain that can be tolerated but will cause some handicap in the performance of the activity precipitating the pain, it is classified as _____ pain. | slight |
| In many states, workers' compensation laws have exemptions for certain occupations such as | domestic employees, babysitters, and gardeners |
| Nonscheduled injuries may include | injury of the back |
| OSHA stands for | Occupational Safety and Health Administration |
| A form of self-insurance designed to serve a small manufacturing company is known as __________ insurance. | captive |
| A physician hired by the insurance company or appointed by the referee or appeals board to examine an injured worker and render an unbiased opinion regarding the degree of disability is referred to as a(n) __________. | medical evaluator |
| A(n) __________ expresses legal claim on the property of another for the payment of a debt. | lien |
| A(n) __________ report is sent to the insurance carrier after 2 to 4 weeks of treatment to give information on the current status of the patient. | supplemental |
| A(n) __________ evaluation of the worksite may be performed, and modifications may be instituted to lessen the possibility of future injury. | ergonomic |
| A narrative industrial medical report should include only objective findings and not subjective factors. | False |
| A physician who is incorporated is considered an employee under workers' compensation laws. | True |
| All state workers' compensation laws are compulsory. | False |
| Authorization to treat a patient with an industrial injury may be obtained over the telephone. | True |
| Beginning in the 1990s, increases in fraudulent workers' compensation claims have been noted throughout many large metropolitan cities. | True |
| Chiropractic care is a medical benefit offered with state workers' compensation. | True |
| In an industrial case, the physician's office may collect all amounts not covered by the workers' compensation fee schedule. | False |
| Increasing numbers of employers are seeking managed care contracts with preferred provider organizations and health maintenance organizations to insure their workers against industrial accidents and illnesses. | True |
| It is believed that the longer the injured person remains out of work, the better the chance of recovery and return to the workplace. | False |
| Minors are not covered by workers' compensation. | False |
| CHAPTER 16 | |
| A policy that offers an insured person protection when loss of sight or loss of limb(s) occurs is called | dismemberment benefit. |
| Coverage that provides a specific monthly or weekly income when a person is unable to work because of an illness or injury is known as _____ insurance. | disability income |
| Disability income insurance is available from | private insurance companies, employer-sponsored plans, government funded programs |
| Funding for state disability insurance is usually a small percentage of the employee's wage that | is deducted from employees' paychecks each month, the employer may elect to pay a portion of, the employer may elect to pay as a fringe benefit |
| In 1956 the U.S. Congress established a program under Title II of the Social Security Act for long-term disability known as | Social Security Disability Insurance. |
| Provisions written into the insurance contract denying coverage or limiting the scope of coverage are called | exclusions |
| Residual benefits pay a | partial benefit when the insured is not totally disabled. |
| State disability insurance (SDI) is also known as | unemployment compensation disability (UCD), and temporary disability insurance (TDI) |
| State disability insurance benefits begin after the _____ consecutive day of disability. | seventh |
| The Armed Services Disability benefits program is available to | members of the armed services on active duty. |
| A(n) __________ (DDS) team composed of a physician/psychologist and disability examiner makes the determination regarding disability for the SSDI and SSI programs. | disability determination service |
| For a disability income insurance case, the time period from the beginning of disability to receiving the first payment of benefits is called a(n) __________ period. | waiting |
| If a claimant does not agree with the determination of disability, a(n) __________ -level appeal process is available. | four |
| If the validity of a state disability insurance case is in question, a(n) __________ may be asked by the insurance company to examine the disabled individual. | independent medical examiner (IME) |
| In a life insurance policy, a feature that provides for twice the face amount of the policy to be paid if death results from accidental causes is called __________. | DOUBLE INDEMNITY |
| A reason for denial of disability income benefits is insufficient medical information. | True |
| After a state disability claim is approved, basic benefits become payable with the eighth day of disability or the third day of hospital confinement, whichever comes first. | False |
| Benefits for medical expenses are provided through disability income insurance. | False |
| California allows for state disability benefits in a normal routine pregnancy. | True |
| Disability income insurance provides benefits for work-related disability. | False |
| Disability income policies do not provide medical expense benefits. | True |
| Disabled workers younger than 65 years of age are eligible for SSDI. | True |
| For patients receiving VA medical care, travel expenses to and from the facility are a benefit. | True |
| For people trying to qualify for SSDI or SSI, determination is made by the physician. | False |
| If a state has state disability insurance, all types of workers are covered. | False |
| CHAPTER 17 | |
| A patient is considered an inpatient to the hospital on admission | for an overnight stay. |
| A review for additional Medicare reimbursement is called | day outlier review. |
| All of the following are considered computer security safeguards except | downloading of unauthorized data from a website. |
| Confidential information about patients should never be discussed with | news media, family, & friends. |
| Daily progress notes are entered on the patient's medical record by a(n) | nurse. |
| ICD-10-PCS codes are used to identify | inpatient surgery. |
| ICD-10-PCS codes contain | seven characters. |
| If a patient is being admitted to a hospital and refuses all preadmission testing, but a bill is sent to the insurance carrier for these services anyway, this is called | phantom charges |
| Medicare's Inpatient Prospective Payment System has approximately _______ MS-DRGs. | 745 |
| On the CMS 1450 (UB-04) claim form, code 6 (transfer from another health care facility) in Field 15 is used to indicate | source of admission. |
| An unethical practice of upcoding a patient's DRG category for a more severe diagnosis to increase reimbursement is called ___________ . | DRG creep |
| Medicare provides stop loss called __________ in its regulations. | outliers |
| On the CMS 1450 (UB-04) claim form, 1553 listed as the hour of admission indicates that the patient was admitted at _________ . | 3:53 PM |
| On the CMS 1450 (UB-04) claim form, the second digit of the four-digit bill code in Field 4 indicates the type of | facility |
| PAT is an abbreviation for | preadmission testing |
| A patient has a right to request an itemized bill from a hospital stay with no cost to the patient. | True |
| A patient who is covered under an HMO plan must have authorization prior to admission unless the patient is admitted for an emergency. | True |
| Ambulatory payment classifications (APCs) are based on the principal diagnosis. | False |
| Elective surgeries are deferrable. | True |
| Emergency department charges are billed along with the inpatient stay on the CMS-1500 claim form. | False |
| Information such as "condition is employment-related" (code 02), listed in Fields 18 through 28 of the CMS 1450 (UB-04) claim form, is called a condition code. | True |
| Insurances from different states have the same standards for reimbursement. | False |
| MS-DRGs are weighted to reflect the average costs for inpatient care. | True |
| On the CMS 1450 (UB-04) claim form in Field 17, code 20 (patient expired) is used to indicate the patient's discharge status. | True |
| On the CMS 1450 (UB-04) claim form, the patient's date of birth should be entered using six digits in block 14. | False |
| CHAPTER 18 | |
| A claims assistance professional should promote and market to | Medicare recipients. |
| A functional résumé | states the applicant's qualifications or skills the individual is able to perform. |
| A medical insurance billing specialist prices his or her services by | percentage of reimbursement, annual or hourly fee, & set fee per claim. |
| According to the IRS, payroll records and summaries should be retained | for 7 years |
| Accounts receivable bookkeeping experience would be listed on a résumé under the heading | skills |
| After an interview, a follow-up letter should be written to | thank the employer for granting the interview & keep the applicant's name at the attention of the potential employer. |
| All of the following should be included in a résumé except | salary requirements. |
| Cover letters should be | customized, typed for neatness, & addressed to a specific person. |
| In an interview, inquiries about the following are illegal except | place of last employment. |
| Internet access for a job search is available through | all of the above. |
| A résumé that provides recent experiences first, with dates and descriptive data for each job, is __________ . | chronologic resume |
| A résumé that states the skills an individual is able to perform is __________. | functional resume |
| A résumé that summarizes the applicant's job skills, as well as educational and employment history, is the __________. | combination resume |
| An employer may evaluate the application itself to determine whether the applicant can follow __________. | instructions |
| It has been found that when applicants have similar skills and education, the decision to hire has been based on __________ at the interview. | physical appearance |
| A blind mailing means sending information to potential employers who have not advertised a job opening. | True |
| A résumé may be posted in an online job information site or bulletin board on the Internet. | True |
| According to the IRS, tax returns should be maintained permanently. | True |
| An alien employee must have on file with his or her employer an Employment Eligibility Verification Form. | True |
| An insurance billing specialist may be employed by a physician, hospital, or other medical facility or may choose to be self-employed. | True |
| An insurance billing specialist should join a professional organization of billers because this helps in keeping up-to-date with coding information. | True |
| Education and professional experience should be listed on a résumé in chronologic order. | False |
| If an employer asks an illegal question, it is acceptable for an applicant to answer the question and ignore the fact that he or she knows it is illegal. | True |
| In completing an application for employment, abbreviations are not used unless space is extremely limited. | True |
| It is discriminatory for an employer to ask if an applicant smokes. | False |
Created by:
csalamon722