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Final Review

QuestionAnswer
What are typical responsibilities of a health insurance specialist? Review health-related claims to determine the medical necessity for procedures or services performed before payment is made to the provider.
Conduct and qualities that characterize a professional person are called? Professionalism
Health insurance specialists play an important role in the ________ of denied or underpaid claims. Protection
It is the Health Insurance Specialist role to conduct all of the following except:
Rules that govern the conduct of members of a profession are called? Ethics
Which is another name for professional liability insurance? Errors and omissions insurance
Physician offices should bond employees who have which responsibility? Financial
Breach of confidentiality can result from? Unauthorized release of patient information to a third party
Which term describes an individual's right to keep healthcare information from being disclosed to others? Privacy
The safekeeping of patient information by controlling access to hard-copy and computerized records is a form of ? Security Management
Excessive charges for services, equipment, or supplies is an example of? Abuse
The recognized difference between fraud and abuse is? Individual's intent
When a Medicare provider commits fraud, which entity conducts the investigation? Department of Health and Human Services Office of Inspector General
As part of the administrative simplification provisions of HIPAA, which of the following unique identifiers is assigned to third party payers? Health Plan Identifier (HPID)
A dispute resolution process in which a final determination is made by an impartial person who may not have judicial powers is known as? Arbitration
Which type of HMO offers subscribers healthcare services by physicians who remain in their individual settings? Closed-panel HMO
Provider services for inpatient medical cases are billed on what basis? Fee for service
Disability insurance typically provides what type of insurance to the injured person?
A participating provider is one who enters into a contract with a Blue Cross Blue Shield (BCBS) corporation and agrees to? Bill patients for only deductible and copay/Coinsurance amounts
TRICARE is a healthcare program for? Active duty members of the military and their qualified family members
Which act or amendment established an employees' right to continue healthcare coverage beyond a scheduled benefit termination date? COBRA
Which is a government-sponsored health program that provides benefits to low-income patients? Medicaid
The triple option plan can also be known as the cafeteria plan or a? Flexible Benefit Plan
The Insurance Industry is regulated by whom? Federal Insurance Office
According to the national standards mandated by HIPAA for the electronic exchange of administrative and financial care transactions, which would be a covered entity? Managed care organization
The workers' compensation First Report of Injury form is completed when the patient initially seeks treatment for a work-related illness or injury
The filing deadline for the First Report of Injury form is determined by? Varies from 24 hours to 14 calendar days depending on state requirements
Workers' compensation premiums are paid by the? Employer
Workers' compensation laws protect the employer by? Limiting the award an injured employee can recover from an employer
The Veteran Healthcare Expansion Act of 1973 authorized the Veterans Affairs(VA) to establish to provide healthcare benefits for dependents of veterans rated as 100 percent permanently and totally disables as a result of service-connected conditions.. 1973: CHAMPVA
Data entry of insurance information is important because ______ are rejected by insurance companies if data is missing or erroneous. Claims
When is it appropriate to file a patient's secondary insurance claim? After the primary insurance plan has paid its contracted amount
Practices that submit paper insurance claims obtain the patient's signature in block 12. Block 12 on the CMS-1500 claim form represents which of the following pieces of information? Release of medical information
Created by: mirandaag.
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