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Final Exam
| TRICARE is a healthcare program for | Active duty members of the military and their family members |
| Which act or amendment established an employee's right to continue healthcare coverage beyond a scheduled benefit termination date? | COBRA of 1985 |
| 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? | Individual states |
| According to the national standards mandated by HIPAA for the electronic exchange for 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 | first seeks treatment for a work-related illness or injury |
| The filing deadline for the First Report of Injury form is determined by | state requirements |
| Workers' compensation premiums are paid by the | Employer |
| Workers' compensation laws protect the employer by ____? | Limiting the award an injured can recover from an employer |
| Veteran Healthcare Expansion 1973 authorized (VA) establish to provide healthcare benefits dependents of veterans rated 100% permanently & totally disabled as result of service-connected conditions, & veterans who dies duty less than 30 days of service | CHAMPVA |
| What is COBRA? | Provides medical insurance to employees that have lost their jobs |
| The insurance and coding specialist is billing the insurance company of a 66-year-old woman who has Medicare and is covered under her husband's private insurance. Which of the following should be billed first? | Medicare |
| If a married couple is covered under both spouses' health insurance and the husband wishes to schedule an appointment for an annual exam, he should call his primary care provider and ____? | Schedule an appointment using both his insurance befits and his wife's insurance benefits |
| A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim? | Part B |
| Based on the CMS manual system, when updating or maintain the billing code database, which of the following does the "R" denote? | Revised |
| Collection agencies are regulated by the ______. | Fair Debt Collections Practices Act |
| Which of the following patient information is needed to determine a Medicaid sliding fee scale? (select three correct answers) | number of dependents, poverty level, salary |
| Encounter forms should be audited to ensure the ______ | Diagnosis is proper ICD-10_CM format |
| Which of the following regulations prohibits the submission of a fraudulent claim or making a false statement or representation in connection with a claim? | Federal False Claims Act |
| Which of the following is the correct procedure for keeping a Workers' compensation patient's financial and health records when the same physician is also the patient as a private patient? | Separate financial and health records must be used |
| Which of he following federals regulations requires disclosure of finance charges, late fees, amount, and due dates for all payment plans? | Truth and Lending Act |
| 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 remittance advice is received by the medical practice |
| Practices that submit paper insurance 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 information |
| What is another name for an encounter form? | Superbill |
| What is the most common medical documentation format? | SOAP |
| What does the abbreviation CHEDDAR stand for? | C-Chief Complaint, H-history of present illness, E-examination, D-details of problems and complaints, D-drugs and dosage, A-assessment, R-return visit or referral to a specialist |
| What is an NPI? | A standardized identifier for all healthcare providers |
| When posting transactions for electronic claims submission, it is necessary to enter which of the following items onto the claim? | Physician's office fee |
| Which of the following forms should be transmitted to obtain reimbursement following a physician's office visit for a patient with active Medicaid coverage? | CMS-1500 |
| A claim submitted with all the necessary and accurate information so that it can be processed and paid is called a ______ | Clean Claim |
| Claims are often rejected because a provider needs to obtain _________? | Pre-authorization |
| When filing an electronic insurance claim, the insurance and coding specialist processes which of he following forms? | CMS-1500 |
| Developing an insurance claim begins ______? | When the patient calls to schedule an appointment |
| A patient has two health insurance policies - a group through her full-time employer and another group insurance plan through her husband's employer. Which of the following policies should be billed as primary? | Her policy |
| \4 |
Created by:
lema7609
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