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mod 150 week 1theory

theory review

Question	Answer
TIME LIMITS ATATED IN INDIVIDUAL HEALTH INSURANCE POLICIES ABOUT AN INSURANCE COMPANY'S OBLIGATION TO PAY BENEFITS ARE THE SAME FOR ALL INSURANCE COMPANIES	FALSE
THERE IS STANDARDIZATION OF FORMAT FOR THE EXPLANATION OF BENEFIT DOCUMENT FOR ALL PRIVATE INSURANCE CARRIERS	FALSE
THE INSURANCE INDUSTRY IS PROTECTED BY A SPECIAL EXEMPTION FROM THE FEDERAL TRADE COMMISSION	TRUE
INSURANCE COMPANIES ARE RATED ACCORDING TO THE NUMBER OF COMPLAINTS RECIEVED ABOUT THEM	TRUE
THE STATUS OF ELECTRONIC INSURANCE CLAIMS MAY BE ACCESSED QUICKLY ELECTRONICALLY OR TELEPHONICALLY BY DIGITAL RESPONSE SYSTEM	TRUE
INQUIRES ABOUT INSURANCE CLAIMS MAY BE IN WRITING OR BY TELEPHONE	TRUE
A REJECTED INSURANCE CLAIM SHOULD BE CORRECTED AND SENT FOR REVIEW OR APPEAL	FALSE
APPROXIMATELY 50% OF INDIVIDUALS PURSUE APPEALS ON A DENIED INSURANCE CLAIM	FALSE
IN THE CASE OF A MEDICARE PART B REDETERMINATION CARRIERS HAVE BEEN INSTRUCTED TO PAY AN APPEALED INS	TRUE
THE HEARING PROCESS IS MORE THEN THE AMOUNT OF THE CLAIM	TRUE
IF YOU HAVE A DENIED INSURANCE CLAIM YOU SHOULD CHANGE THE INFORMATION AND RESUBMIT THE CLAIM	FALSE
ROUTINE USE OF TOO MANY NONSPECIFIC DIAGNOSTIC CODES MAY RESULT IN DOWNCODING	TRUE
IN ANY TYPE OF OVERPAYMENT SITUATION ALWAYS CASH THE THIRD PARTY PAYER'S CHECK AND WRITE A REFUND CHECK PAYABLE TO THE ORIGINATOR OF THE OVERPAYMENT	TRUE
IF THE PROVIDER IS NOTIFIED BY A COMMERICAL INSURANCE CARRIER THAT AN OVERPAYMENT HAS BEEN MADE INVESTIGATE THE REFUND REQUEST	TRUE
A LEVEL 1 MEDICARE REDETERMINATION MAY BE MADE EITHER BY TELEPHONE IN WRITING OR BY SUBMITTING A CMS-20027 FORM	TRUE
A PEER REVIEW IS USUALLY DONE BEFORE THE APPEAL PROCESS	FALSE
APPEAL DECISIONS ON MEDICARE UNASSIGNED INSURANCE CLAIMS ARE SENT TO THE PATIENT	TRUE
THE HIGHEST LEVEL OF A MEDICARE REDETERMINATION IS WITH AN ADMININISTRATIVE LAW JUDGE HEARING	FALSE
THE CODES IN THE EYE AND OCULAR ADNEXA SUBSECTION ARE BILATERAL CODES	FALSE
THE DESTRUCTION CODES IN THE POSTERIOR SEGMENT SUBSECTION INCLUDE ONE OR MORE SESSIONS	TRUE
IF AN INSURED IS IN DISAGREEMENT WITH THE INSURER FOR SETTLEMENT OF A CLAIM A SUIT MUST BEGIN WITHIN	3 YEARS
IF A PAYMENT PROBLEM DEVELOPS WITH AN INSURANCE COMPANY AND THE COMPANY IGNORES CLAIMS AND EXCEEDS TIME LIMITS TO PAY A CLAIM IT IS PRUDENT TO CONTACT THE	STATE INSURANCE COMMISSIONER
THE DOCUMENT TOGETHER WITH THE PAYMENT VOUCHER THAT IS SENT TO A PHYSICIAN WHO HAS ACCEPTED ASSIGNMENT OF BENEFITS IS REFERRED TO AS AN	EOB
WHEN RECIEVING PAYMENT FROM A PRIVATE INSURANCE CARRIER CHECK THE AMOUNT OF PAYMENT ON THE EOB WITH THE	PATIENT'S FINANCIAL ACCOUNTING RECORD
AN INSURANCE CLAIMS REGISTER PROVIDES A	FOLLOW UP PROCEDURE FOR INSURANCE CLAIMS
PENDING OR RESUBMITTED INSURANCE CLAIMS MAY BE TRACKED THROUGH A	TICKLER FILE
THERE ARE SEVERAL WAYS TO FILE PENDING INSURANCE CLAIMS WHAT IS THE BEST WAY TO FILE SO THAT TIMELY FOLLOW UP CAN BE MADE?	FILE BY PATIENT'S LAST NAME
A FOLLOW UP EFFORT MADE TO AN INSURANCE COMPANY TO LOCATE THE STATUS OF AN INSURANCE CLAIM IS CALLED A /AN	INQUIRY
IF AN INSURANCE CLAIM HAS BEEN LOST BY THE INSURANCE CARRIER THE PROCEDURE TO FOLLOW IS TO	ASK IF THERE IS A BACKLOG OF CLAIMS AT THE INSURANCE OFFICE
AN EXAMPLE OF A TECHNICAL ERROR ON AN INSURANCE CLAIM IS	DUPLICATE DATES OF SERVICE
AN INSURANCE CLAIM WITH AN INVALID PROCEDURE CODE WOULD BE	REJECTED
WHAT SHOULD YOU DO IF AN INSURANCE CARRIER REQUESTS INFORMATION ABOUT ANOTHER INSURANCE CARRIER	PROVIDE THE INFORMATION
AN INSURANCE CLAIM WITH A BUNDLED SERVICE WOULD BE	PAID
AN INSURANCE CLAIM FOR WHICH PRIOR APPROVAL WAS NOT OBTAINED WOULD BE	PAID
WHAT SHOULD BE DONE IF AN INSURANCE CLAIM DENIAL IS RECIEVED BECAUSE A BILLED SERVICE WAS NOT A PROGRAM BENEFIT?	SEND THE PATIENT A STATEMENT WITH A NOTATION OF THE RESPONSE FROM THE INSURANCE COMPANY
WHAT SHOULD BE DONE IF AN INSURANCE COMPANY DENIES A SERVICE STATING IT WAS NOT MEDICALLY NECESSARY AND THE PHYSICIAN BELIEVES IT WAS?	REBILL WITH A LETTER OF EXPLANATION FROM THE PHYSICIAN
WHEN DOWNCODING OCCURS PAYMENT WILL	BE LESS
IF AN INSURANCE COMPANY ADMITS THAT A PATIENT SIGNED AN ASSIGNMENT OF BENEFITS DOCUMENT AND THAT IT INADVERTENLY PAID THE PATIENT INSTEAD OF THE PHYSICIAN THE INSURANCE COMPANY SHOULD	PAY THE PHYSICIAN WITHIN 2-3 WEEKS AND HONOR THE ASSIGNMENT EVEN BEFORE THE COMPANY RECOVERS ITS MONEY FROM THE PATIENT
THE TOTAL NUMBER OF LEVELS OF REDETERMINATION THAT EXIST IN THE MEDICARE PROGRAM IS	FIVE
THE FIRST LEVEL OF APPEAL IN THE MEDICARE PROGRAM IS	REDETERMINATION
THE CORRECT METHOD TO SEND DOCUMENTS FOR A MEDICARE RECONSIDERATION (LEVEL2) IS BY	CERTIFIED MAIL WITH RETURN RECIEOT REQUESTED
A REQUEST FOR A MEDICARE ADMINISTRATIVE LAW JUDGE HEARING CAN BE MADE IF THE AMOUNT IN CONTROVERSY IS AT LEAST	$120.00
HOW MANY LEVELS OF REVIEW EXIST FOR TRICARE APPEAL PROCEDURES?	THREE
TRICARE APPEALS ARE NORMALLY RESOLVED WITHIN	60 DAYS
IN A TRICARE CASE A REQUEST FOR AN INDEPENDENT HEARING MAY BE PURSUED IF THE AMOUNT IN QUESTION IS	$300 OR MORE
CATARACT AND LENS REPLACEMENT USES___DIFFERENT APPROACHES	3
STRABISMUS SURGERY	CORRECTS THE MUSCLE MISALIGNMENT
THE INNERMOST LAYER OF THE EYE IS THE	RETINA
AN INSTRUMENT USED TO MEASURE INTRAOCULAR PRESSURE IS	TONOMETER
THE COLORED MEMBRANE ATTACHED TO THE CILIARY BODY IS	IRIS
IN THE TERM MIOTIC THE COMBINING FORM MI/O MEANS	LESS, SMALL
IN THE TERM RETROLENTAL THE PREFIX RETRO- MEANS	BEHIND
THE MEIBOMIAN GLANDS SECRETE	SEBUM
THE MEDICAL TERM FOR NORMAL OR PERFECT VISION IS	EMMETROPIA
THE ROOT IN THE TERM KEATOCONJUNCTIVITIS MEANS	JOIN TOGETHER
AN AGENT THAT CAUSES THE PUPIL TO DILATE IS CALLED	MYDRIATIC
THE MEASUREMENT OF THE CORNEA IS CALLED	KERATOMETRY
HOW MANY EYE MUSCLES CONTROL MOVEMENT OF THE EYE?	SIX
A CONDITION IN WHICH THE PUPILS ARE UNEQUAL IS TERMED	ANISOCORIA
___IS THE PROCESS OF THE EYES MAKING ADJUSTMENTS FOR SEEING AT VARIOUS DISTANCE	ACCOMMODATION
DRYNESS OF THE CONJUNCTIVA IS CALLED	XEROPHTHALMIA
THE___IS THE OPENING IN THE CENTER OF THE IRIS	PUPIL
CONJUNCTIVITIS IS OFTEN CALLED	PINKEYE
THE TERM USED TO DESCRIBE THE CONDITION OF AN EYE BEING TURNED INWARD IS	ESOTROPIA
OPACITY OF THE CRYSTALLINE LENS IS CALLED	CATARACT
AN UNUSUAL INTOLERANCE OF LIGHT IS KNOWN AS	PHOTOPHOBIA
AN INVOLUNTARY CONSTANT RYTHMIC MOVEMENT OF THE EYEBALL IS CALLED	NYSTAGMUS
IN THE TERM MYDRIATIC, THE ROOT MYDRIAT MEANS	DILATION, WIDEN
A MALIGNANT TUMOR ARISING FROM THE GERM CELL OF THE RETINA IS	RETINOBLASTOMA
ALL OF THE FOLLOWING MAKE UP THE EXTERNAL STRUCTURE OF THE EYE EXCEPT	UVEA
THE ANTERIOR CHAMBER IS FILLED WITH	AQUEOUS HUMOR
A SURGICAL PROCEDURE THAT MAY BE PERFORMED TO CORRECT MYOPIA IS KNOWN AS	RADIAL KERATOTOMY
THE SUFFIX IN BLEPHAROPTOSIS MEANS	DROOPING
IN OLDER ADULTS THE LEADING CAUSE OF NEW CASES OF BLINDNESS IS	MACULAR DEGENERATION
THE MIDDLE OR VASCULAR LAYER OF THE EYEBALL IS CALLED	UVEA
THE MEDICAL TERM FOR NIGHT BLINDNESS IS	NYCTALOPIA
LAZY EYE IS ALSO KNOWN AS	AMBLYOPIA
___IS USED TO IDENTIFY CHANGES IN THE BLOOD VESSELS IN THE EYE AND TO DIAGNOSE SYSTEMIC DISEASES	OPHTHSLMOSCOPY
THE __IS THE ANTERIOR TRANSPARENT PORTION OF THE EYEBALL	CORNEA
THE MIDDLE LAYER OF THE EYEBALL IS KNOWN AS THE	UVEA
MACULAR DEGENERATION INVOLES THE MACULAR AREA OF THE	RETINA
THE ROOTS IN ORTHOPTICS MEANS	STRAIGHT
IN THE TERM KERATOCONJUNCTIVITIS THE COMBING FORM KERAT/O MEANS	PUPIL
THE MEASUREMENT OF THE INTRAOCULAR PRESSURE OF THE EYE IS	TONOMETRY
THE PIGMENT NECCESSARY FOR NIGHT VISION IS	RHODOPSIN
THE SMALL DEPRESSION LOCATED IN THE MACULA LUTEA IS KNOWN AS THE	FOVEA CENTRALIS
SURGICAL DESTRUCTION AND REMOVAL OF THE LENS TERMED	PHACOLYSIS
IN THE TERM CRYOSURGERY THE COMBINING FORM CRY/O MEANS	COLD
IN THE TERM PHACOEMULSIFICATION THE COMBINING FORM PHAC/O MEANS	LENS
A PROCESS OF REMOVING AN ENTIRE PART OR MASS WITHOUT RUPTURE IS CALLED	ENUCLEATION
THE PROCESS OF USING ULTRASOUND TO DISINTEGRATE A CATARACT IS KNOWN AS	PHACOEMULSIFICATION
IN THE TERM CONJUNCTIVITIS THE ROOT CONJUNCTIV MEANS	TO JOIN TOGETHER
DRYNESS OF THE CONJUNCTIVA IS TERMED	XEROPHTHALMIA
AN AGENT THAT CAUSES THE PUPIL TO COTRACT IS CALLED	MIOTIC
THE MOST COMMON SURGERY TO REMOVE A CATARACT IS	PHACOEMULSIFICATION
A DROOPING OF THE UPPER EYELID IS KNOWN AS	BLEPHAROPTOSIS
A CONDITION OF HARDENING OF THE CRYSTALLINE LENS IS CALLED	PHACOSCLEROSIS
A PHYSICIAN WHO SPECIALIZES IN THE STUDY OF THE EYE IS	OPHTHALMOLOGIST
IN THE TERM NYCTALOPIA THE ROOT NYCTAL MEANS	NIGHT
THE MEDICAL TERM FOR FARSIGHTEDNESS IS	HYPEROPIA
THE AGENT USED TO CAUSE PUPILS TO CONTRACT IS A/AN	MIOTIC
THE COLORED TISSUE ATTACHED TO THE CILIARY BODY IS THE	IRIS
THE MEDICAL TERM FOR DULLNESS OF VISION IS	AMBLYOPIA
BETA BLOCKERS INCREASE THE PRODUCTION OF INTRAOCULAR FLUID	FALSE
THE IRIS IS ATTACHED TO THE CHOROID	FALSE
THE NASOLACRIMAL DUCT DRAINS LACRIMAL FLUID INTO THE NOSE	TRUE
THE PROTECTIVE COVERING FOR THE EXPOSED SURFACE OF THE EYEBALL IS THE SCLERA	FALSE
THE LEADING CAUSE OF BLINDNESS OVER AGE 55 IS MACULAR DEGRNERATION	TRUE
THE CIRCULAR OPENING IN THE CENTER OF THE IRIS IS CALLED THE PUPIL	TRUE
THE ANTERIOR TRANSPARENT PORTION OF THE EYE'S FIBROUS OUTER SURFACE IS THE SCLERA	FALSE
AN INCREASED AMOUNT OF TEARS CAN BE A SYMPTOM OF CONJUNCTIVITIS	TRUE
AQUEOUS HUMOR IS LOCATED IN THE ANTERIOR CHAMBER	TRUE
CATARACT REMOVAL IS ONE OF THE MOST COMMON OPERATIONS PERFORMED IN THE UNITED STATES TODAY	TRUE

Created by: moviegrl

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