exam 1
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| What does the abbreviation MSHP designate? | Multiskilled health practitioner
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| Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring | multiskilled health care practitioners
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| Administrative medical office responsibilities include | claims submission
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| A claims assistance professional | works for the consumer, helps patients file insurance claims (Both A and B)
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| What is “cash flow” in a medical practice? | The actual money available to a medical practice
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| Front office medical duties have become increasingly important because | Diagnostic and procedure coding must be reviewed for its correctness and completeness
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| Which level of education is generally required for one who seeks employment as an insurance coder? | Completion of an accredited program for coding certification
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| Which organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing? | American Health Information Management Assoiciation (AHIMA)
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| The amount of money an insurance billing specialist earns is dependent on which of the following factors? | Knowledge, Experience, Size of employing institution (All of the above)
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| A billing specialist is entrusted with | Holding patients' medical information in confidence, collecting monies, being a reliable resource for coworkers.
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| Medical etiquette refers to | Consideration for others
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| Medical ethics include | Standards of conduct
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| The earliest written code of ethical principles for the medical profession is the | Code of Hammurabi
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| What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980? | The principles of medical ethics
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| What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment? | Notify your physician
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| Reporting incorrect information to private insurance carriers is considered | Unethical
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| Which code of ethics is most appropriate for an insurance billing specialist who handles medical records? | AHIMA code of ethics
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| AHIMA publishes | diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements (All of the above)
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| A self-employed medical insurance biller who does independent contracting is responsible for | Advertising, billing, accounting, (All of the above)
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| The Internet Healthcare Coalition has developed |
the eHealth Code of Ethics
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| Reporting incorrect information to government funded programs is | Fraud
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| Insurance specialist certificate programs include | (anatomy, diagnostic coding, computer technology, all of the above)
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| The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as | respondeat superior, let the master answer, vicarious liability (All of the above)
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| The AHIMA Code of Ethics is appropriate for | health information specialists, coders, insurance billing specialists (All of the above)
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| Why are multiskilled health practitioners (MSHPs) in demand? | They are cross-trained to provide more than one function, they are often competent in more than one function, and they offer more flexibility to their employer.
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| Confidential information includes | everything that is heard about a patient, everything that is read about a patient, everything that is seen regarding a patient (all of the above)
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| What is the correct response when a relative calls asking about a patient | have the physician return the telephone call
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| Nonprivileged information about a patient consists of the patient’s | city of residence
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| Exceptions to the right of privacy rule include | gunshot wound cases
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| Confidentiality is automatically waived in cases of | gunshot wounds, child abuse, extremely contagious diseases (all of the above)
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| When an insurance billing specialist bills for a physician and completes a Medicare claim form with information that does not reflect the true situation, | he or she may be subject to fines and imprisonment
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| What action could happen if an employee knowingly submits a fraudulent Medicare or Medicaid claim at the direction of the employer and subsequently the medical practice is audited? | 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 | abuse
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| Electronic media refers to | leased telephone or dial-up telephone lines, the Internet, transmissions that are physically moved from one location to another, (all of the above)
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| The Office of Civil Rights enforces | privacy and security rules
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| What is the best response when telephoning a patient about an insurance matter and the patient’s voice mail is reached? | Use care in the choice of words when leaving the message.
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| A uniform lexicon system used for managing patient electronic health records, information, indexing, and billing laboratory problems is called | SNOMED
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| The focus on the health care practice setting and reducing administrative costs and burdens are the goals of | HIPAA Title II Administrative Simplification
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| Which statement is correct regarding the insurance industry? | The insurance industry is among the world's largest businesses
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| Most legal issues of private health insurance claims fall under | civil law
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| When does the physician/patient contract begin? | when the physician accepts the patient and agrees to treat the patient
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| Most physician/patient contracts are | implied
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| When a patient carries private medical insurance, the contract for treatment exists between | physician and the patient
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| An emancipated minor is | younger than the age of 18 who lives independently
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| The contract in a workers’ compensation case exists between | physician and the insurance company
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| In health insurance, the insured is also known as | subscriber, ,member, policy holder
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| The insured is always | the individual enrollee or organization protected
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| The reason for a coordination of benefits statement in a health insurance policy is | prevent duplication or overlapping of payments for the same medical expense.
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| Mr. Talili has two medical insurance policies. To prevent duplication of payment for the same medical expense, the policies include a | coordination of benefits statement.
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| When a medical facility is sent correct reimbursement from an insurance company for professional services, the site receives | the indemnity or also known as the payment or also known as the check. Basically the payment, just how the payment is made may be know by different terms.
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| If a child has health insurance coverage from two parents, according to the birthday law | the health plan of the person whose birthday (month and day) falls earlier in the calendar year will pay first
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| According to the birthday law, if both the mother and the father have the same birthday | plan of the person who has coverage longer is the primary payer
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| Conditions that existed and were treated before the health insurance policy was issued are called | preexisting
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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 | exclusion/waiver
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| What is the correct term used to determine if a procedure is covered and medically necessary? | preauthorization
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| Mrs. Thompsett leaves her place of employment. She is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as | conversion
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| Why would conversion from a group policy to an individual policy be advantageous? | Benefits would increase
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| Mr. Ott was laid off from his job. He is protected by Consolidated Omnibus Budget Reconciliation Act (COBRA), which requires his employer to | extend group health insurance coverage for 18 months
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| What is the minimum number of employees a company must have to meet the criteria of the COBRA for continued medical benefits if an employee is laid off from a company? | 20
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| The act created to protect workers and their families so that they can get and maintain health insurance if they change or lose their jobs is called the | Consolidated Omnibus Budget Reconciliation Act (COBRA
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| An organization of physicians, sponsored by a state or local medical association, concerned with the development and delivery of medical services and the cost of health care is known as a/an | foundation for medical care
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| A type of managed care organization created by the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA) that allows for enrollment of Medicare beneficiaries into managed care plans is a/an | competitive medical plan
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| A state and federal program for children who are younger than 21 years of age and have special health care needs is | Maternal and Child Health Programs (MCHP).
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| A patient intake sheet is also called a | patient information form
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| The first document obtained in the initial patient visit is a/an | patient information form
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| Assignment of benefits is | transfer of one of ledger right to collect the amount payable under an insurance contract
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| An encounter form may also be known as a | patient service slip
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| The source document for insurance claim data is the | superbill
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| A daily record sheet used to record daily business transactions is called a/an | daysheet
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| It is advisable to process insurance claims | in batches, grouping claims of patients who have the same type of insurance
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| An insurance claims register facilitates | follow up insurance claims
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| When the physician’s services have been submitted to the patient’s insurance company by the physician’s office, the patient should | be sent a monthly statements indicating the insurance company has been billed
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