Final Review
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| What are typical responsibilities of a health insurance specialist? | Review health-related claims to determine the medical necessity for procedures or services performed before payment is made to the provider.
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| Conduct and qualities that characterize a professional person are called? | Professionalism
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| Health insurance specialists play an important role in the ________ of denied or underpaid claims. | Protection
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| It is the Health Insurance Specialist role to conduct all of the following except: |
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| Rules that govern the conduct of members of a profession are called? | Ethics
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| Which is another name for professional liability insurance? | Errors and omissions insurance
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| Physician offices should bond employees who have which responsibility? | Financial
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| Breach of confidentiality can result from? | Unauthorized release of patient information to a third party
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| Which term describes an individual's right to keep healthcare information from being disclosed to others? | Privacy
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| The safekeeping of patient information by controlling access to hard-copy and computerized records is a form of ? | Security Management
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| Excessive charges for services, equipment, or supplies is an example of? | Abuse
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| The recognized difference between fraud and abuse is? | Individual's intent
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| When a Medicare provider commits fraud, which entity conducts the investigation? | Department of Health and Human Services
Office of Inspector General
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| As part of the administrative simplification provisions of HIPAA, which of the following unique identifiers is assigned to third party payers? | Health Plan Identifier (HPID)
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| A dispute resolution process in which a final determination is made by an impartial person who may not have judicial powers is known as? | Arbitration
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| Which type of HMO offers subscribers healthcare services by physicians who remain in their individual settings? | Closed-panel HMO
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| Provider services for inpatient medical cases are billed on what basis? | Fee for service
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| Disability insurance typically provides what type of insurance to the injured person? |
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| A participating provider is one who enters into a contract with a Blue Cross Blue Shield (BCBS) corporation and agrees to? | Bill patients for only deductible and copay/Coinsurance amounts
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| TRICARE is a healthcare program for? | Active duty members of the military and their qualified family members
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| Which act or amendment established an employees' right to continue healthcare coverage beyond a scheduled benefit termination date? | COBRA
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| Which is a government-sponsored health program that provides benefits to low-income patients? | Medicaid
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| The triple option plan can also be known as the cafeteria plan or a? | Flexible Benefit Plan
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| The Insurance Industry is regulated by whom? | Federal Insurance Office
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| According to the national standards mandated by HIPAA for the electronic exchange of administrative and financial care transactions, which would be a covered entity? | Managed care organization
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| The workers' compensation First Report of Injury form is completed when the patient | initially seeks treatment for a work-related illness or injury
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| The filing deadline for the First Report of Injury form is determined by? | Varies from 24 hours to 14 calendar days depending on state requirements
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| Workers' compensation premiums are paid by the? | Employer
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| Workers' compensation laws protect the employer by? | Limiting the award an injured employee can recover from an employer
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| The Veteran Healthcare Expansion Act of 1973 authorized the Veterans Affairs(VA) to establish to provide healthcare benefits for dependents of veterans rated as 100 percent permanently and totally disables as a result of service-connected conditions.. | 1973: CHAMPVA
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| Data entry of insurance information is important because ______ are rejected by insurance companies if data is missing or erroneous. | Claims
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| When is it appropriate to file a patient's secondary insurance claim? | After the primary insurance plan has paid its contracted amount
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| Practices that submit paper insurance claims obtain the patient's signature in block 12. Block 12 on the CMS-1500 claim form represents which of the following pieces of information? | Release of medical information
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