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MIC Exam I
Exam
| 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. |
Created by:
chandymigues
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