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Medical office questions and answers

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
The flow of financial transactions in a business is a   show
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Money that flows into a business   show
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show billing cycle  
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a form of translating a description of a condition into a shorter, standardized code is   show
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A series of steps that determine whether a claim should be paid   show
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show coinsurance  
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show capitation  
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a small fixed fee paid by the patient at the time of an office visit   show
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show encounter form  
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type of managed care in which a high-deductible/low-premium insurance plan is combined with a pretax savings account to cover out-of-pocket medical expenses, up to the deductible limit   show
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show diagnosis  
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show diagnosis code  
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show Explanation of Benefits (EOB)  
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a managed health care system in which providers agree to offer health care to the organization's members for fixed periodic payments from the plan   show
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show managed care  
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A health plan that repays the policyholder for covered medical expenses   show
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a plan, program, or organization that provides health benefits   show
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show medical necessity  
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form that includes a patient's personal, employment, and insurance data needed to complete an insurance claim   show
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show medical coder  
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show policyholder  
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managed care network of providers that agree to perform services for plan members at discounted fees   show
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show payer  
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software program that automates many of the administrative and financial tasks required to run a medical practice   show
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a code that identifies a medical service   show
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show procedure  
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show statement  
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an EOB transmitted electronically by a payer to a provider   show
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the periodic amount of money the insured pays to a health plan for insurance coverage   show
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show Protected Health Information  
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What is TPO?   show
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show preauthorization or certification number  
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What guidelines ensure when a patient has more than one policy, maximum appropriate benefits are paid but, not duplications?   show
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show birthday rule  
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Who gets a walk out receipt or walkout statement?   show
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Why would a practice not want to accept a debit or credit?   show
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What is PPO?   show
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show Health Maintenance Organization  
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What are these examples of: Indemnity, Managed Care, HMO, and PPO   show
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a report that lists errors in a claim   show
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What is the information about a patient's past, present, or future physical or mental health or payment for health care that can be used to identify the person?   show
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What is an organization that receives claims from a provider - checks, and prepares them for processing - transmits them to insurance carriers in a standardized format?   show
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What is the use of computers & handheld devices to write & transmit prescriptions to a pharmacy?   show
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show electronic data interchange (EDI)  
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show national provider identifier (NPI)  
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What is Information Technology (IT)?   show
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show X12-837 Health Care Claim (837P)  
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show HIPPA electronic transaction & code sets standards  
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regulation guidelines that identify the safeguards required to prevent unauthorized access to electronic health care information   show
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show benefit payment information  
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show calendar year  
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show patient  
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The section of an EOB that identifies the total deduction, noncovered charges, and balance the patient may owe is the   show
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A provider that is able to balance-bill a patient for the amount over the allowed charge is referred to as a   show
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show downcoded  
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If an a claim is downcoded, the medical office assistant should   show
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show state insurance commissioner  
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show appeal  
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Medicare Part B says the main reason for returning an appeal is due to the lack of a   show
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show it didn't happen  
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show subjective, objective, assesment plan  
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show subjective  
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show subjective  
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When an objective, unbiased group of physicians determines what payment is adequate for services provided, the process is called   show
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Many _____ _____ may see re-billing as a duplicate claim, fraudulent billing, and a notice that payment is delinquent.   show
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What if some services on a claim were over looked by the provider's office; or if charges on the orginal claim were not detailed; or if the medical office specialist made a mistake on the claim? Would these be reasons to re-bill?   show
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show audit  
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show copy both sides  
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show Customer service number #, ID # or policy #, Group #, Co-pay, Co-insurance & Admission certification  
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show the policy that names them as the policyholder is the primary policy  
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show Physcian's note  
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show superbill  
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Confriming that the services will be covered by the patient's plan is   show
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Contacting the insurer to verify an active policy is   show
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show policy number or ID number  
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#'s or letters that connect the patient to an individual policy with a specfic group of other insureds is a   show
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show policyholder  
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show primary Insurance policy  
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