medical insurance
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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| show | neccesity
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| Which is a typical responsibility of a health insurance specialist? | show 🗑
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| The mutual exchange of information bea tween providers and payers is called electronic | show 🗑
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| The document submitted by provider to a third-party for purpose of requesting reimbursement for services provided is a(n) | show 🗑
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| show | coding
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| Which coding system is used for reporting procedures and services in physician's offices? | show 🗑
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| show | ICD-9-CM
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| show | ethics
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| Physicians offices should bond employees who have which responsibilty? | show 🗑
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| show | embezzling
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| show | medical necessity not met
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| The type of healtha care that helps individuals avoid health and injury problems is | show 🗑
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| show | medicaid
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| The standard claim developed by CMS and used to report procedures and services delivered by physicians is called the | show 🗑
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| show | HIPPA
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| show | physician work, practice expense, and malpractice insurance expense
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| Insurance that is available through employers, labor unions, consumer health cooperatives, and other organizations is | show 🗑
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| A provider's list of predetermined payments for healthcare services to the patients is known as | show 🗑
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| show | case management
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| Mandates are | show 🗑
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| Employees and dependents who join a managed care plan are caler ed | show 🗑
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| show | COBRA of 1985
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| If a plan allows enrollees to seek care from non-network providers, what effect will this have on the enrollees who sees a non-network provider? The enrollee will | show 🗑
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| show | coinsurance
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| Data transmitted electronically or manually to payers or clearinghouses is claims | show 🗑
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| show | accept assignment
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| show | guarantor
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| Which document is used to generate the patient's financial and medical record? | show 🗑
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| The rule stating that the policyholder whose birth month and day occur earlier in the calendar year holds the primary policy for dependent children is the ...rule | show 🗑
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| show | individual states
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| show | passed by legislative bodies
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| show | discussing patient healthcare informatin with unauthorize sources
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| The recognized difference between fraud and abuse is the | show 🗑
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| Undated signed forms are assumed to be valid until revoked by the patient or | show 🗑
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| show | Office of Inspector General
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| The diagostic statements "urinary tract infection due to E.Coli" require ...codes to be assigned | show 🗑
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| Which convention is used to display a series of terms that can modify the statement to its right? | show 🗑
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| In th Ce ICD-9-CM, italized codes signify that | show 🗑
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| show | 250.50, 366.41
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| The ICD-9-CM syStem classifies | show 🗑
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| The ICD-9-CM V codes classify | show 🗑
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| show | linking the CPT code to its ICD-9-CM counterpart
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| A black triangle located to the left of CPT code indicates that the code | show 🗑
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| Initial office visit for a patient with left knee pain. Detailed history and examination ws documented, along with low-complexity medical decision making | show 🗑
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| According to CPT, prolonged services codes are assigned in addition to other E/M services when treatment exceeds the time included in the CPT description by | show 🗑
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| show | two levels; level one, level two
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| show | it can withstand repeated use
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| Which special codes allow payers the flexibility of establishing codes if they are needed before the next January 1 annual date? | show 🗑
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| show | conversion factor
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| Non-participating (nonPAR) providers are restricted to billing at or below the | show 🗑
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| Medicare participating providers commonly report actual fees to Medicare but adjust fees after payment is received. The difference between the fee reported and the payment received is a | show 🗑
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| show | provided incidental to other services provided by the physician
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| The prospective payment system dependent on the patient's principal diagnosis, comorbidities, complications, and principal and secondary procedures are called | show 🗑
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| show | case mix
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| show | =$80
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| show | major reason the patient sought medical care
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| show | medical necessity
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| show | V code
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| The patient is a 39-year old female patient on lithium who is unable to discontinue the medication and does not desire to become pregnant while on medication. The patient therefore desires surgical sterilization. | show 🗑
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| The diagnosis code reported in item 1, Block 21, of the CMS-1500 claim form is | show 🗑
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| Items 1-4 Block 21 of CM-1500 claim link listed diagnosis codes to their appropriate procedure service codes reported Block 24; known as....numbers | show 🗑
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| show | four
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| Block 25 claim requires entry of either provider's soc.securty number or | show 🗑
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| show | diagnosis pointer number
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| The birthday rule applies when dependent children living at home are covered by more than one health insurance policy. The primary policy is determined by the parent | show 🗑
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| show | The patient's" own policy is primary
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| When an "X" appears in the YES box in Block 10a of CMS-1500 claim, it indicates | show 🗑
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| To prevent breach of confidentiality, the patient must either sign an "Authorization for Release of Medical Information" (ROM) or | show 🗑
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| Which diagnosis is considered a chronic- icondition that would always affect the patient care? | show 🗑
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| If laboratory procedures are performed in provider's office, how is it indicated on the CMS-1500 form? | show 🗑
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| show | Aetna
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| Losses to third-party caused by the insured, by an object owned by the insured, or on the premises of the insured are covered by ....insurance | show 🗑
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| Which term describes the contractual right of third-party payer to recover healthcare expenses from liable party? | show 🗑
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| show | usual,customary, and reasonable rate
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| show | nursing facility
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| show | accept assignment
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| show | financial
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| A participating provider is one who enters into a contract with BlueCrossBlueShield corporation and agrees to | show 🗑
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| show | preferred provider organization
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| show | assignment of benefits
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| show | for-profit
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| show | Rider
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| Which feature makes BCBS plan different from other commercial plans? | show 🗑
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| Medicare is available to an individual who has worked at least | show 🗑
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| show | is held January 1 through March 31st each year
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| show | with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days
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| show | the physician cannot bill for any service or supplies provided to any Medicare beneficiary for two years
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| show | already receive Social Security, Railroad Retirement Board, or disability benefits and are not yet 65
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| Medicare Supplementary Insurance is also called | show 🗑
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| show | a service is unlikely to be reimbursed by Medicare and that the patient must guarantee payment for services
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| The deadline for filing Mediare claims is | show 🗑
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| show | qualified Medicare beneficiaries
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| The Medicaid program that makes cash assistance available on a time-limited basis for children deprived of support because of parent's death,incapacity,absence, unemployment is the | show 🗑
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| How frequently should a patient's Medicaid eligibility be verified? | show 🗑
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| show | premium
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| show | when there is liability insurance to cover a person's injuries
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| show | preauthorization
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| Which of the following practices is prohibited by law? | show 🗑
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| TRICARE is a healthcare program for | show 🗑
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| show | deductible
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| show | CHAMPVA
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| What system is used to confirm TRICARE eligibility for sponsors and their dependents? | show 🗑
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| Block 31 of CMS-1500 claim submitted to TIRCARE must contain | show 🗑
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| The worker's compensation First Report of Injury fos rm is completed when the | show 🗑
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| What is the definition of temporary partial disability? | show 🗑
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| The type of worker's compensation claim that is the easiest to process is | show 🗑
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| show | treating physician
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| show | there is any significant change in the worker's medical or disability
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| show | drug or alcohol intoxication
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| show | employer
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| show | the worker's compensation claim number
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| Worker's compensation laws protect the employer by | show 🗑
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