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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
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Created by: lema7609