Question 1

What are the skill requirements of an Insurance Specialist

Accepted Answer

1. Medical Terminology
2. Human Biology
3. Critical reading skills
4. excellent communication skills
5. good computer skills
6, math skills
7. application knowledge of medical insurance

Question 2

Needed to help differentiate between technical descriptions of different but similar diagnoses or procedures

Accepted Answer

Critical Reading Skills

Question 3

The Language of the health care industry

Accepted Answer

Medical Terminology

Question 4

What are to 2 most important components of effective oral communication?

Accepted Answer

- Listening
- Speaking

Question 5

What is considered appropriate nonverbal communication with a patient ?

Accepted Answer

- Smiling 
- An open and relaxed posture
-  A light touch on the arm to comfort a patient in distress

Question 6

What are some important humaln relation skills?

Accepted Answer

- Being friendly to coworkers
- Being calm and supportive of patients
- Being attentive to your supervisors

Question 7

What are some basic computer hardware knowledge?

Accepted Answer

-monitor
-hard disk
-mouse
-keyboard
-modem

Question 8

What are some basic computer terms?

Accepted Answer

CPU- Central Processing Unit
RAM- Random Access Memory
ROM- Read Only Memory
Database- A collection of related files that serves as a foundation 
                        for retrieving data

Question 9

brain of the computer

Accepted Answer

CPU

Question 10

porcesses and temporarily holds information

Accepted Answer

RAM

Question 11

Permanently holds programs and other info used

Accepted Answer

ROM

Question 12

A collection of related files that serve as a foundation for retreiving data

Accepted Answer

Database

Question 13

Patient Records Database

Accepted Answer

referred to as biomedical and clinical databases.
meaning the ability to save, retrieve, and backup files as necessary.

Question 14

Insurance specialist must possess a basic understanding of what 2 major codes?

Accepted Answer

-ICD-10-CM
-CPT

Question 15

ICD-10-CM

Accepted Answer

used to code diagnoses

Question 16

CPT

Accepted Answer

used to code procedures

Question 17

The process of converting verbal and written descriptions of medical conditions and procedure into numeric and/ or  alphanumeric codes.

Accepted Answer

Coding

Question 18

Why is managing insurance payments crucial?

Accepted Answer

beacause the livelihood of the physician and staff depend on it

Question 19

Responsibilities of an insurance specialist:

Accepted Answer

-consult with a physician for clarification of data 
-code information from medical records
-verify fee schedules or sheets

Question 20

Professional or Medical Etiquette

Accepted Answer

consideration for others, in conduct, courtesy, and manners

Question 21

The unauthorized release of confidential patient informationto a third party.

Accepted Answer

Breach of Confidentiality

Question 22

Demonstrating the "Need to Know"

Accepted Answer

Never give information over the phone or in persson until you have verified that the party making the request is entitled to the information.

Question 23

from a legal standpoint what raises critical issues in patient confidentiality?

Accepted Answer

faxing patient information

Question 24

An intentional deception or misrepresentation that an individual makes, knowing it to be false which could result in some unauthorized benefit

Accepted Answer

Fraud

Question 25

Submitting Claims for items or services that are not medically necessary to treat the patient's condition

Accepted Answer

Insurance Abuse

Question 26

Private or Commercial Policies (non-government sponsored) such as Blue Cross Blue Shield operate on a fee-for-service basis

Accepted Answer

Traditional Insurance

Question 27

Federal insurance program for senior citizens age 65 or older and retired

Accepted Answer

Medicare (Government Sponsored)

Question 28

Jointly funded by the state and local governments to provide health care benefits to indigent persons on welfare (needy and low income people)

Accepted Answer

Medicaid (Government Sponsored)

Question 29

Provides civilian health benefits for military personnel, military retirees, and their dependents, including some members of the Reserve Component.

Accepted Answer

TRICARE (Government Sponsored)

Question 30

Reimbursement for lost income resulting from temporary or permanent illness or injury.

Accepted Answer

Disability Insurance

Question 31

Examples of Liability Insurance :

Accepted Answer

-automobile
-business
-homeowner's
-worker's compensation
-malpractice

Question 32

Which Parent's policy is primary in the case of  divorced parents with a minor child (both parents have insurance on the child)?

Accepted Answer

The policy is usually covered by the custodial parent primarilly (unless ordered otherwise by the court)

Question 33

A specified amount of annual out-of-pocket expenses for covered health care services the insured must pay to a health care provider before the the insurer pays benefits

Accepted Answer

Deductible

Question 34

The percentage paid by the insurance carrier or that paid by the insured. After the spplication of the deductible to the submitted bills, the insurance policy pays a percentage of the remaining amount.

Accepted Answer

Coinsurance

Question 35

Participating Provider

Accepted Answer

the in-network provider or preferred provider
they are the physicians or medical facility that the insurance company is contracted with - the  allowed amount as payment in full for service provided in exchange for direct payment

Question 36

CMS-1500

Accepted Answer

Insurance claim form used by Medicare and accepted by nearly all insurance carriers. Formerly known as the HCFA-1500 form

Question 37

Fair Debt Collection Practice Act

Accepted Answer

1977 federal law that outlines collection practices. Collection calls are only to be done between the hours of 8am and 9pm.

Question 38

What information should be obtained when a New Patient arrives?

Accepted Answer

1. Patient's name, address, phone numbers, social security 
     number, and date of birth. (If the patient is a minor- obtain the 
     name of the parent or guardian.

2. the reason for the appointment 

3. if the patient has insurance

Question 39

Who should sign an Authorization for Release of Medical Information Form?

Accepted Answer

All Patients (with insurance)

Question 40

Encounter form or charge slip

Accepted Answer

the financial record source document used by health care providers

Question 41

An alphanumerical desination for a specific illness, injury, or disease

Accepted Answer

Diagnosis Code

Question 42

The insurance form used to report provider services is known as the?

Accepted Answer

CMS-1500 form (formerly HCFA-1500) Developed by CMS-Centers for Meidcare and Medical services

Question 43

The bottom of the CMS-1500 form is

Accepted Answer

divided into 33 sections or blocks

Question 44

some reasons for Claim rejections:

Accepted Answer

-incorrect coding of diagnosis or procedures
-missing policy numbers
-diagnosis codes and procedure codes do not match
-charges not itemized

Question 45

The Explanation of Benefits Form (EOB)

Accepted Answer

is a statement telling the patient and/or provider how the insurance company determined it's share of the reimbursement.

Question 46

"Stark Law"

Accepted Answer

3 seperate provisions that govern phsician self-referral patients.

Question 47

"Stark II"

Accepted Answer

clarification and modification of both services and items.

Question	Answer
What are the skill requirements of an Insurance Specialist	1. Medical Terminology 2. Human Biology 3. Critical reading skills 4. excellent communication skills 5. good computer skills 6, math skills 7. application knowledge of medical insurance
Needed to help differentiate between technical descriptions of different but similar diagnoses or procedures	Critical Reading Skills
The Language of the health care industry	Medical Terminology
What are to 2 most important components of effective oral communication?	- Listening - Speaking
What is considered appropriate nonverbal communication with a patient ?	- Smiling - An open and relaxed posture - A light touch on the arm to comfort a patient in distress
What are some important humaln relation skills?	- Being friendly to coworkers - Being calm and supportive of patients - Being attentive to your supervisors
What are some basic computer hardware knowledge?	-monitor -hard disk -mouse -keyboard -modem
What are some basic computer terms?	CPU- Central Processing Unit RAM- Random Access Memory ROM- Read Only Memory Database- A collection of related files that serves as a foundation for retrieving data
brain of the computer	CPU
porcesses and temporarily holds information	RAM
Permanently holds programs and other info used	ROM
A collection of related files that serve as a foundation for retreiving data	Database
Patient Records Database	referred to as biomedical and clinical databases. meaning the ability to save, retrieve, and backup files as necessary.
Insurance specialist must possess a basic understanding of what 2 major codes?	-ICD-10-CM -CPT
ICD-10-CM	used to code diagnoses
CPT	used to code procedures
The process of converting verbal and written descriptions of medical conditions and procedure into numeric and/ or alphanumeric codes.	Coding
Why is managing insurance payments crucial?	beacause the livelihood of the physician and staff depend on it
Responsibilities of an insurance specialist:	-consult with a physician for clarification of data -code information from medical records -verify fee schedules or sheets
Professional or Medical Etiquette	consideration for others, in conduct, courtesy, and manners
The unauthorized release of confidential patient informationto a third party.	Breach of Confidentiality
Demonstrating the "Need to Know"	Never give information over the phone or in persson until you have verified that the party making the request is entitled to the information.
from a legal standpoint what raises critical issues in patient confidentiality?	faxing patient information
An intentional deception or misrepresentation that an individual makes, knowing it to be false which could result in some unauthorized benefit	Fraud
Submitting Claims for items or services that are not medically necessary to treat the patient's condition	Insurance Abuse
Private or Commercial Policies (non-government sponsored) such as Blue Cross Blue Shield operate on a fee-for-service basis	Traditional Insurance
Federal insurance program for senior citizens age 65 or older and retired	Medicare (Government Sponsored)
Jointly funded by the state and local governments to provide health care benefits to indigent persons on welfare (needy and low income people)	Medicaid (Government Sponsored)
Provides civilian health benefits for military personnel, military retirees, and their dependents, including some members of the Reserve Component.	TRICARE (Government Sponsored)
Reimbursement for lost income resulting from temporary or permanent illness or injury.	Disability Insurance
Examples of Liability Insurance :	-automobile -business -homeowner's -worker's compensation -malpractice
Which Parent's policy is primary in the case of divorced parents with a minor child (both parents have insurance on the child)?	The policy is usually covered by the custodial parent primarilly (unless ordered otherwise by the court)
A specified amount of annual out-of-pocket expenses for covered health care services the insured must pay to a health care provider before the the insurer pays benefits	Deductible
The percentage paid by the insurance carrier or that paid by the insured. After the spplication of the deductible to the submitted bills, the insurance policy pays a percentage of the remaining amount.	Coinsurance
Participating Provider	the in-network provider or preferred provider they are the physicians or medical facility that the insurance company is contracted with - the allowed amount as payment in full for service provided in exchange for direct payment
CMS-1500	Insurance claim form used by Medicare and accepted by nearly all insurance carriers. Formerly known as the HCFA-1500 form
Fair Debt Collection Practice Act	1977 federal law that outlines collection practices. Collection calls are only to be done between the hours of 8am and 9pm.
What information should be obtained when a New Patient arrives?	1. Patient's name, address, phone numbers, social security number, and date of birth. (If the patient is a minor- obtain the name of the parent or guardian. 2. the reason for the appointment 3. if the patient has insurance
Who should sign an Authorization for Release of Medical Information Form?	All Patients (with insurance)
Encounter form or charge slip	the financial record source document used by health care providers
An alphanumerical desination for a specific illness, injury, or disease	Diagnosis Code
The insurance form used to report provider services is known as the?	CMS-1500 form (formerly HCFA-1500) Developed by CMS-Centers for Meidcare and Medical services
The bottom of the CMS-1500 form is	divided into 33 sections or blocks
some reasons for Claim rejections:	-incorrect coding of diagnosis or procedures -missing policy numbers -diagnosis codes and procedure codes do not match -charges not itemized
The Explanation of Benefits Form (EOB)	is a statement telling the patient and/or provider how the insurance company determined it's share of the reimbursement.
"Stark Law"	3 seperate provisions that govern phsician self-referral patients.
"Stark II"	clarification and modification of both services and items.

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MIC Exam I

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