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Study for final exam

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
Administrative medical office responsibilities include...   show
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show The actual amount of money available to a medical practice.  
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show American Health Information Management Association (AHIMA).  
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show holding patients' medical information in confidence, collecting monies, and being a reliable resource for coworkers.  
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show consideration for others.  
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Medical ethics include...   show
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show respondeat superior.  
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The earliest written code of ethical principles for medical profession is the...   show
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What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?   show
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show city of residence.  
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Exceptions to the right to privacy rule include...   show
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show The employee and the employer could be brought into litigation by the state or federal government.  
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To bill Medicare beneficiaries at a higher rate than other patients is considered...   show
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The office of Civil Rights enforces...   show
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Most legal issues of private health insurance claims fall under...   show
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show federal laws.  
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show Privacy officer/privacy official.  
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show Covered entity.  
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Who is an individual who renders medical services, furnishes bills, or is paid for health care in the normal course of business?   show
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Who is the third-party administrator wh receives insurance claims from the physician's office, performs edits, and redistributes the claims electronically to various insurance carriers?   show
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Who is an individual who is hired by a medical practice to process claims to a third-party payer?   show
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show Chief complaint.  
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show When the physician accepts the patient and agrees to treat the patient.  
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show implied.  
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show The subscriber, the member, and the policyholder.  
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show the individual enrollee or organization protected  
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If a child has health insurance coverage from two parents, according to the birthday law...   show
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show pre-existing.  
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An attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a/an...   show
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show extended group health insurance coverage for 18 months.  
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A patient intake sheet is also called a ...   show
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show superbill.  
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show day sheet.  
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This means stealing money that has been entrusted in one's care...   show
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show state preemption.  
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Most policies, including Medicare part B have a cost sharing requirement which is known as?   show
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show eligibility.  
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show pre-authorization.  
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In CPT coding, the three key components are?   show
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According to CPT guidelines, what type of patient is one who has received professional services from the physician or from another physician of the same specialty who belongs to the same group practice within the past three years?   show
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show new.  
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show Non-physician practioner.  
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show primary care physician.  
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Who is an individual in the hospital directing the selection, preparation, or administration of tests, medication, or treatment?   show
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What is the condition of being secluded from the presence or view of others?   show
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What term means using discretion in keeping secret information?   show
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show high risk.  
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What means a condition that runs a short (typically 3-5 days) but relatively severe course?   show
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The health insurance claim form (CMS 1500) is known as the   show
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show a physically clean claim.  
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An insurance claim submitted with errors is referred to as...   show
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show Request a fee from the insurance company before sending the attending physician's statement.  
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show is consecutive, uses the same procedure code, and results in the same fee.  
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show optical character recognition.  
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show do not fold insurance claim forms when mailing, do not use symbols with data on insurance claim forms, and do not strike over errors when making a correction on an insurance claim form.  
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show batch.  
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show entity that receives transmission of insurance claims, separates the claims, and sends each one electronically to the correct insurance payer.  
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show accounts receivable.  
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show the Internal Revenue Service.  
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show away from the office.  
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When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as...   show
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Back-and-forth communication between user and computer that occurs during online real time is called...   show
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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....   show
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show EOB.  
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show follow up procedure for insurance claims.  
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show tickler file.  
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show inquiry and tracer.  
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show ask if there is a backlog of claims at the insurance office, submit a copy of the original claim, and verify the correct mailing address.  
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An example of a technical error on an insurance claim is...   show
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show rejected.  
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An insurance claim for a service that has been bundled with other services would be...   show
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An insurance claim for which prior approval was not obtained would be...   show
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show Send the patient a statement with a notation of the response from the insurance company.  
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What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?   show
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When down-coding occurs, payment will...   show
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show pay the physician within 2 to 3 weeks and honor the assignment even before the company recovers its money from the patient.  
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show five.  
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show certified mail with return receipt requested.  
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A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least...   show
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show Three.  
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show $300 or more.  
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show Decreased cash flow & decreased co-payments.  
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show Accounts receivable.  
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show Send a patient information brochure, send a confirmation letter, and discuss fees & policies at the time of the initial contact.  
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show before any services are provided.  
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Professional courtesy means...   show
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show collect the full amount.  
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show call the bank or patient.  
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Messages included on statements to promote payment are called...   show
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show Computer billing.  
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show outsourcing.  
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The first telephone call to the patient to try to collect on an account should be made...   show
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show Debit card.  
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show Four or more.  
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show 15-18%.  
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What is the name of the federal act that prohibits discrimination in all areas of granting credit?   show
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What is the name of the act designed to address the collection practices of third-party debt collectors and attorneys who regularly collect debts for others?   show
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show after 8am and before 9pm.  
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In making collection telephone calls to a group of accounts, how should the accounts be organized to determine where to begin?   show
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show Flex time.  
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show use a friendly tone and ask why payment has not been made.  
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If an insurance company seems to be ignoring all efforts to trace a claim, send a copy of the...   show
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show people's court, justice court, and small claims court.  
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show unsecured debt.  
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show Chapter 13  
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True or false: In times past, physicians in private practice billed indemnity insurance plans and professional service were reimbursed on a fee-for-service basis.   show
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True or false: Ross-Loos Medical Group, America's oldest privately owned prepaid medical group, started in Texas.   show
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True or false: The Health Maintenance Organization Act of 1973 required most employers to offer HMO coverage to their employees as an alternative to traditional health insurance.   show
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show False.  
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show True.  
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True or false: Exclusive provider organizations (EPOs) are regulated by the federal government.   show
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True or false: The difference between an IPA and a PPG is that a PPG may not be owned by its member physicians, whereas an IPA is physician owned.   show
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True or false: In a point of service (POS) program, members may choose to use a non-program provider at any time.   show
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show True.  
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True or false: If a primary care physician sends a patient to a specialist for consultation and the specialist is not in the managed care plan, the specialist may bill the primary care physician for payment.   show
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show True.  
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True or false: Managed care plans allow laboratory tests to be performed at any facility the patient chooses.   show
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True or false: Managed care plans never require a CMS-1500 claim form to be completed and submitted.   show
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show True.  
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show True.  
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What is America's oldest privately owned, prepaid medical group?   show
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show Point of service (POS)  
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show it limits the patient's choice of personal physicians.  
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show Health Maintenance Organization Act of 1973  
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show capitation.  
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show Foundation for medical care.  
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show preferred provider organization (PPO).  
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show Point of service (POS) plan.  
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When a physician sees a patient more than is medically necessary, it is called...   show
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show tertiary care.  
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show Managed Care Organization.  
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show 25 people or more.  
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show gatekeeper.  
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Benefits under the HMO Act fall under two categories...   show
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show Utilization Review, which is necessary to control costs in the health care setting.  
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show stop loss limit section of the managed care contract or agreement.  
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When a certain percentage of the monthly capitation payment is held out of the premium fund to pay for operating an IPA, it is known as a/an...   show
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show Patient registration form.  
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show embezzlement.  
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Title of a nurse practitioner, clinical nurse specialist, licensed social worker, nurse midwife, physical therapist, speech therapist, audiologist or physician assistant who consults or treats patients for specific medical problem?   show
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show interactive transaction.  
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An insurance claim for a service that has been bundled with other services would be...   show
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show be less.  
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show unsecured debt.  
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Medicare part A is run by...   show
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Medicare is a...   show
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show widow.  
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show railroad retiree.  
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show hospice care.  
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show diagnostic tests.  
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The Medicare part A benefit period ends when a patient...   show
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Medigap insurance may cover...   show
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When a Medicare beneficiary has employer supplemental coverage, Medicare refers to these plans as...   show
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show eyeglasses and prescription drugs.  
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A program that contracts with CMS to review medial necessity and appropriateness of inpatient medical care is known as a...   show
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show 80% of the Medicare approved charge.  
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In the Medicare program, there is mandatory assignment for...   show
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When a Medicare patient signs an advanced beneficiary notice, the procedure code for the service provided must be modified using the HCPCS level II modifier...   show
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Under the prospective payment system (PPS), hospital treating Medicare patients are reimbursed according to...   show
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The 1987 Omnibus Budget Reconciliation Act (OBRA) established the...   show
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show fiscal intermediaries.  
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When a Medicare carrier transmits a Medigap claim electronically to the Medigap carrier, it is referred to as a/an...   show
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show Medicare remittance advice document.  
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When a remittance advice (RA) is received from Medicare, the insurance billing specialist should...   show
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show green card/resident alien status.  
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Do you need to apply for Medicaid?   show
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What did CHAMPVA become?   show
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What does OSHA (1970) do for employees?   show
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show Industrial Medical Council.  
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show Legal claim on the property of another for the payment of debt. Null and void at the end of a specified time limit. A subsequent/amended lien can be field. Should be signed by patient/employee & patient's attorney.  
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show transfers claims from workers comp. insurance carrier to third-party liability carrier.  
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How should you handle health information record keeping in worker's comp. cases?   show
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Explain a double indemnity policy...   show
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show long term plan provides benefits to workers and self employed who meet eligibility criteria. Insured may be eligible for Medicare after 24 months. Converts to retirement benefits at age 65.  
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show federal compensation laws and state compensation laws.  
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An unexpected, unintended event that occurs at a particular time and place, causing injury to an individual not of his or her own making, is called a/an...   show
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show occupational illness/disease.  
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show Workmen's comp law of D.C., Federal coal mine health & safety act, Federal employees' compensation act (FECA), and Longshoremen's ad harbor workers' compensation act.  
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State compensation laws that require each employer to accept its provisions and provide for specialized benefits for employees who are injured at work are called...   show
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State compensation laws that may be accepted or rejected by the employer are known as...   show
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State five methods used for funding workers' compensation:   show
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show employer  
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What is the time limit in your state for submitting the employers' and/or physicians' report on an industrial accident?   show
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show second injury fund.  
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show laborers, babysitters, newspaper vendors, charity workers, gardeners, and domestic/casual employees.  
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show One.  
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show Three days.  
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show medical treatment, temporary disability indemnity, permanent disability indemnity, death benefits for survivors, and rehabilitation benefits.  
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Who can treat an industrial injury?   show
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show Non-disability claims, temporary disability and permanent disability.  
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show involves minor injury where patient seen by a doctor, but able to continue working.  
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Explain temporary disability:   show
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Explain permanent disability:   show
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show Percent of employee's earnings at the time of the injury.  
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show Work hardening.  
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When an industrial case reaches the time for rating the disability, this is accomplished by what state agency?   show
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Can an injured person appeal his/her case if he/she is not satisfied with the rating? Whom do they appeal to?   show
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show their insurance carrier.  
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Explain third-party subrogation:   show
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When an individual suffers a work-related injury or illness, the employer must complete and send a form called a/an...   show
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If an employee is sent to a physician's office for medical care, the employer must complete a form called a/an...   show
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Employers are required to meet health and safety standards for their employees under federal and state statues known as...   show
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show litigation.  
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show deposition.  
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The legal promise of a patient to satisfy a debt to the physician from proceeds received from a litigated case is termed a/an...   show
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When a physician treats an industrial injury, he/she must complete a First Treatment Medical Report or Doctor's First Report of Occupational Injury or Illness and send it to the following:   show
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show True.  
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Are family/friends covered under workers' compensation insurance if they are injured at the employee's job?   show
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show False, the physician MUST sign the form.  
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show True.  
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True or false: If an individual seeks medical care for a workers' compensation injury from another state, the state's regulations are followed in which the injured person's clam was originally filed.   show
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show True.  
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