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Med billing and code

billing chapter 1 & 2

QuestionAnswer
What is another title for reimbursement specialist? health insurance specialist
Coding is the process of reporting diagnoses, procedures, and services as numeric and alphanumeric characters on the insurance claim
Which professional is considered a health care provider physician assistant
The mutual exchange of data between a provider and the payer is called: electronic data interchange
Payment of claims may be denied if requirements are not met for which insurance rule preauthorization
The HCPCS coding system consists of how many levels two
Which of the following is a report that details to the patient the results of a processed claim explanation of benefits
A health insurance specialist who exclusively files claims on behalf of patients would most likely pursue professional credentials with which organization NEBA
An independent contractor should carry which type of insurance? professional liability
Respondeat superior is Latin for which phrase? Let the master answer
Medical malpractice insurance is considered what type of insurance? liability
Which term or phrase defines the profession, delineates qualifications and responsibilities, and clarifies supervision requirements? scope of practice
CHAMPUS stands for: Civilian Health and Medical Plan of the Uniformed Services
CPT stands for: current procedural terminology
The WHO, located in Geneva, Switzerland, is the originator of the ICD coding system. The acronym WHO is: World Health Organization
Between 1965 and 1966, three government-sponsored programs for health care were instituted. These programs were: Medicare, CHAMPUS, Veteran’s Administration
The government-regulated Medicaid program is also known as: Title XIX or Title 19
If a liability insurer denies payment, a claim is filed with the patient’s insurance plan. What other documentation must accompany the claim? copy of written denial of responsibility from liability insurer
Group health insurance is coverage available through whom employers
A program responsible for providing health services to subscribers in a given geographical area for a fixed fee is known as a: health maintenance organization
Which health care plan is designed for patients age 65 and older? Medicare
When a person’s property is secured as payment for a debt, this is known as (a): lien
The act that prohibits sharing of medical information among health insurers and financial institutions for use in making credit decisions is the Financial Services Modernization Act
The Standard Unique Health Identifier for Health Care Providers is also known as the: NPI
Which event would be covered by automobile liability insurance? pain and suffering due to an accident
Diagnoses are coded using the HCPCS coding system. true
For each procedure or service reported on a claim form, there must be a link to the condition that justifies the medical necessity of performing the procedure or service. true
The insurance specialist is expected to accurately code diagnoses and procedures or services rendered by the provider(s) in a practice. true
Because health insurance specialists are not providers of treatment, ethics are not important in their job. true
Consulting is a viable career option for a professional health insurance specialist. true
With respondeat superior, employees are free from any repercussions as a result of their negative actions or omissions while performing within the scope of their job. fals
Disability insurance is designed to replace lost income as a result of a temporary or permanent illness or injury. true
Liability insurance is a policy that covers losses caused by the insured, an object of the insured, or on the premises covered by the insured. true
To file a liability claim, an insurance claim is always required. false
In 1988, Medicare began requiring physician offices to enter ICD-9-CM codes on the claims submitted for reimbursement. true
Created by: 506255616
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