Question 1

Common errors on insurance claim forms that may be result in a claim being denied.

Accepted Answer

1.Wrong date 
2. Charges not itemized
3.Missing /incomplete/invalid procedure codes

Question 2

The _ _ is the date the services were performed.

Accepted Answer

Date of service

Question 3

an agency that handles claims and payment?

Accepted Answer

3rd party administrator

Question 4

UCR may be different from the providers - -?

Accepted Answer

Actual charges

Question 5

When preparing ORC scannable claims, be sure to use a - date format.

Accepted Answer

Month day, year

Question 6

With TRICARE, the service member is called the - ?

Accepted Answer

Sponsor

Question 7

Individuals who are eligible for CHAMPVA  - eligible for TRICARE.

Accepted Answer

NOT

Question 8

TRICARE is administered on a - basis

Accepted Answer

Regional

Question 9

With CHAMPVA, the - shares the cost of services and supplies with eligible beneficiaries

Accepted Answer

The VA

Question 10

indemnity plans often have annual - and a - for each visit.

Accepted Answer

annual deductible and co-pay

Question 11

indemnity plans are also called - for - plans

Accepted Answer

Fee-for-Service

Question 12

the max a 3rd party allow for a charge for service

Accepted Answer

allowable charge

Question 13

-of- allows/authorizes the insurance company to pay directly to the provider.

Accepted Answer

Assignment of benefits

Question 14

PPO, HMO,EPO, and POS are all examples of _

Accepted Answer

managed care plans

Question 15

one advantage of a managed care plan is -

Accepted Answer

Lower out-of-pocket costs

Question 16

An example of a cafeteria plan is a - - -

Accepted Answer

Flexible spending account

Question 17

insurance you get through your job, coverage is available to all.

Accepted Answer

Group Health Plan

Question 18

When a patient pays a % of care?

Accepted Answer

coinsurance

Question 19

The out of pocket amount paid before health coverage goes into effect

Accepted Answer

Deductible

Question 20

Money collected at time of service

Accepted Answer

copay

Question 21

Individual who pays the premium

Accepted Answer

policy holder

Question 22

Workers comp is a - system.

Accepted Answer

no fault

Question 23

workers comp benefits include

Accepted Answer

1. Medical expenses 
2. Vocational rehab
3. Disability pay
4. death benefits

Question 24

Type of insurance that may be provided to patients injured on the job.

Accepted Answer

worker's  compensation

Question 25

- allows other health plans to continue health coverage beyond cobra period

Accepted Answer

COBRA

Question 26

Mandatory Benefits states must provide to receive federal matching funds from MEDICAID list them

Accepted Answer

1. Impatient hospital  services 
2.outpatient hospital services 
3. Early and periodic screening 
4. Nursing facilities 
5.labs and x-ray
6.certified pediatric 
7.tobacco cessation
8.family planning services 
9 Diagnostic services

Question 27

Medicaid is run by - and - - within federal quide lines

Accepted Answer

State and local government

Question 28

Medicaid patients usually pay - % of their treatment with covered services

Accepted Answer

0%

Question 29

Medicaid is a - program.

Accepted Answer

Assistance

Question 30

Medicare is run by -

Accepted Answer

CMS

Question 31

Medicare patients pay part of their cost through -

Accepted Answer

deductibles

Question 32

Medicare is an - program

Accepted Answer

insurance company

Question 33

A document from a provider that lists items/services is a -

Accepted Answer

ABN patient must sign

Question 34

The paper claim form is called the -

Accepted Answer

CMS - 1500 Center for medicare services

Question 35

If a person has medicaid and medicare which one is primary?

Accepted Answer

Medicare

Question 36

The - is the policy holder

Accepted Answer

Beneficiary

Question 37

With social security you are automatically enrolled in part - 
medicare

Accepted Answer

Part A

Question 38

Part - is prescription medication coverage
Medicare

Accepted Answer

Part D

Question 39

part - choice of managed care plans 
Medicare

Accepted Answer

Part C

Question 40

Part - pays for physicians fees diagnostic test and some screening 
Medicare

Accepted Answer

Part B

Question 41

part- pays hospital services (usually free) 
Medicare

Accepted Answer

Part A

Question 42

Glyc/o

Accepted Answer

Sugar/glucose

Question 43

Nephr/o

Accepted Answer

Kidney

Question 44

-emia

Accepted Answer

Blood/blood condition

Question 45

cost/o

Accepted Answer

Rib

Question 46

neo

Accepted Answer

New

Question 47

when CPT code and diagnosis code do not match up

Accepted Answer

down coding

Question 48

When providing "pain management" services for workers comp patients, you must submit a - - using appropriate CPT-HCPCS for services

Accepted Answer

Prior Authorization

Question 49

If multiple modifiers are being used when coding the first modifier used is

Accepted Answer

99

Question 50

E/M codes usually begin with/ -

Accepted Answer

99

Question 51

CPT codes are - digits and can be further defined by - digit modifiers

Accepted Answer

5 digits , 2 Digits

Question 52

ICD-10-CM:
VOL. 2 is the - and VOL 1 is the -

Accepted Answer

vol 2 = index
Vol 1 = Tabular list

Question 53

The updated version of the ICD-9 is the -

Accepted Answer

ICD-10-CM

Question 54

Z codes describe

Accepted Answer

Circumstances other that disease, injury or external causes.

Question 55

A "X" in ICD-10-CM codes is a -

Accepted Answer

place holder

Question 56

ICD-10-Cm 
1st Character is a -

Accepted Answer

letter

Question 57

The first step when using ICD_10_CM is to-

Accepted Answer

locate the term within the alphabetic index

Question 58

NPI Numbers are issued by -

Accepted Answer

CMS

Question	Answer
Common errors on insurance claim forms that may be result in a claim being denied.	1.Wrong date 2. Charges not itemized 3.Missing /incomplete/invalid procedure codes
The _ _ is the date the services were performed.	Date of service
an agency that handles claims and payment?	3rd party administrator
UCR may be different from the providers - -?	Actual charges
When preparing ORC scannable claims, be sure to use a - date format.	Month day, year
With TRICARE, the service member is called the - ?	Sponsor
Individuals who are eligible for CHAMPVA - eligible for TRICARE.	NOT
TRICARE is administered on a - basis	Regional
With CHAMPVA, the - shares the cost of services and supplies with eligible beneficiaries	The VA
indemnity plans often have annual - and a - for each visit.	annual deductible and co-pay
indemnity plans are also called - for - plans	Fee-for-Service
the max a 3rd party allow for a charge for service	allowable charge
-of- allows/authorizes the insurance company to pay directly to the provider.	Assignment of benefits
PPO, HMO,EPO, and POS are all examples of _	managed care plans
one advantage of a managed care plan is -	Lower out-of-pocket costs
An example of a cafeteria plan is a - - -	Flexible spending account
insurance you get through your job, coverage is available to all.	Group Health Plan
When a patient pays a % of care?	coinsurance
The out of pocket amount paid before health coverage goes into effect	Deductible
Money collected at time of service	copay
Individual who pays the premium	policy holder
Workers comp is a - system.	no fault
workers comp benefits include	1. Medical expenses 2. Vocational rehab 3. Disability pay 4. death benefits
Type of insurance that may be provided to patients injured on the job.	worker's compensation
- allows other health plans to continue health coverage beyond cobra period	COBRA
Mandatory Benefits states must provide to receive federal matching funds from MEDICAID list them	1. Impatient hospital services 2.outpatient hospital services 3. Early and periodic screening 4. Nursing facilities 5.labs and x-ray 6.certified pediatric 7.tobacco cessation 8.family planning services 9 Diagnostic services
Medicaid is run by - and - - within federal quide lines	State and local government
Medicaid patients usually pay - % of their treatment with covered services	0%
Medicaid is a - program.	Assistance
Medicare is run by -	CMS
Medicare patients pay part of their cost through -	deductibles
Medicare is an - program	insurance company
A document from a provider that lists items/services is a -	ABN patient must sign
The paper claim form is called the -	CMS - 1500 Center for medicare services
If a person has medicaid and medicare which one is primary?	Medicare
The - is the policy holder	Beneficiary
With social security you are automatically enrolled in part - medicare	Part A
Part - is prescription medication coverage Medicare	Part D
part - choice of managed care plans Medicare	Part C
Part - pays for physicians fees diagnostic test and some screening Medicare	Part B
part- pays hospital services (usually free) Medicare	Part A
Glyc/o	Sugar/glucose
Nephr/o	Kidney
-emia	Blood/blood condition
cost/o	Rib
neo	New
when CPT code and diagnosis code do not match up	down coding
When providing "pain management" services for workers comp patients, you must submit a - - using appropriate CPT-HCPCS for services	Prior Authorization
If multiple modifiers are being used when coding the first modifier used is	99
E/M codes usually begin with/ -	99
CPT codes are - digits and can be further defined by - digit modifiers	5 digits , 2 Digits
ICD-10-CM: VOL. 2 is the - and VOL 1 is the -	vol 2 = index Vol 1 = Tabular list
The updated version of the ICD-9 is the -	ICD-10-CM
Z codes describe	Circumstances other that disease, injury or external causes.
A "X" in ICD-10-CM codes is a -	place holder
ICD-10-Cm 1st Character is a -	letter
The first step when using ICD_10_CM is to-	locate the term within the alphabetic index
NPI Numbers are issued by -	CMS

"Know" box contains:
Time elapsed:
Retries:

MAA 102 Final Review