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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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Question
Answer
The concept that every procedure or service reported to a third-pary payer must be linked to a condition that justifies the procedure or service is called   show
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show correcting claims processing errors  
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show data interchange  
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show claim  
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The process of classifying diagnoses, procedures, and services is called   show
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Which coding system is used for reporting procedures and services in physician's offices?   show
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Diagnoses are coded according to   show
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show ethics  
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Physicians offices should bond employees who have which responsibilty?   show
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Which term is another word for stealing money?   show
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A claim was submitted for a left shoulder x-ray on an elderly patient, and the diagnosis reported on the claim was urinary tract infection. The claim was rejected because   show
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The type of healtha care that helps individuals avoid health and injury problems is   show
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Which is a government-sponsored health program that provides benefits to low-income   show
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show CSM-1500  
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show HIPPA  
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Which three components constitute the RBRVS payment system?   show
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show Group health insurance  
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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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show laws  
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show subscribers  
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Which act or amendment established an employee's right to continue healthcare coverage beyond a scheduled benefit of termination date?   show
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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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The specified percentage or charges the patient must pay to the provider for each service received or for each visit is the   show
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Data transmitted electronically or manually to payers or clearinghouses is claims   show
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W hen the provider is required to receive as payment in full whatever amount the insurance reimburses for services, the provider is agreeing to   show
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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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show birthday  
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The insurance industry is regulated by whom?   show
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Federal and state statutes are   show
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show discussing patient healthcare informatin with unauthorize sources  
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show intent  
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Undated signed forms are assumed to be valid until revoked by the patient or   show
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When a Medicare provider commits fraud, which entity conducts the investigation?   show
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The diagostic statements "urinary tract infection due to E.Coli" require ...codes to be assigned   show
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show braces-  
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In th Ce ICD-9-CM, italized codes signify that   show
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Type 2 diabetic c cataract, right eye   show
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show morbidity  
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show factors influencing healh status  
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When reporting CPT codes on the CMS-1500 claim,medical necessity is proven by   show
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show has been revised from previous CPT publications  
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show 99203  
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show 30 minutes  
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show two levels; level one, level two  
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Which statement is true of durable medical equipment?   show
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show temporary  
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Each relative value component is multiplied by the geographic cost practice (GCPI), and then each is further multiplied by a variable figure called the   show
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show limiting charge  
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show write-off  
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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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What term is used to describe the types and categories of patients treated by a healthcare faciity or provider?   show
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The Medicare physician fee schedule amount for code 99210 is $100; the participating provider's usual charge for this service is $125. Calculate Medicare reimbursement amount   show
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show major reason the patient sought medical care  
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The concept of linking diagnosis codes with the procedure/services codes is called   show
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show V code  
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show V26.51: 58673  
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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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The maximum number of CPT/ and or HCPCS modifiers that can be reported in block 24 on CMS-1500 is   show
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show EIN  
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What is reported in Block 24EE of the CMS-1500?   show
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show who has birthday that occurs first in the calendar year  
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show The patient's" own policy is primary  
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show the services provided were related to auto-accident injury  
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show Sign Block 12 of the CMS-1500 claim form  
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show diabetes mellitus  
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show by entering X in NO block 20  
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show Aetna  
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show liablity  
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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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Enter an X in the YES Block 27 to indicate   show
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Disability insurance typically provides what type of compensation to the injured person?   show
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show bill patients only deductible and copay/coinsurance amounts  
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Which offers discounted healthcare services to subscribers who use designated healthcare providers but who also provides coverage for services rendered by healthcare providers who are NOT part of the network?   show
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Which concept applies to BCBS directly reimburses participating providers for healthcare services rendered to subscribers?   show
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show for-profit  
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tA special clause written into a contract that stipulates addtional coverage over and above the standard contract is a(n)   show
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Which feature makes BCBS plan different from other commercial plans?   show
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show 10 years in Medicare-covered employment, is at least 65 years of age, and is citizen of USA  
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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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Individuals automatically enrolled in Medicare Part A are those who   show
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show Medigap  
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The purpose of the advance beneficiary notice is to alert the patient that   show
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The deadline for filing Mediare claims is   show
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show qualified Medicare beneficiaries  
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show temporary assistance to needy families  
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How frequently should a patient's Medicaid eligibility be verified?   show
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States rarely require Medicaid recipients to pay a   show
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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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show active duty members of the military and their qualified family members  
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TRICARE Standard enrollees are responsible for paying aor n annual.......as well as copayments   show
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A comprehensive healthcare program for which the Department of Veteran Affairs (VA) theshares the costs of covered healthcare services and supplies/supports with eligible beneficiaries is called   show
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show Defense Enrollment Eligibilty Reporting System  
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show the name and credentials of the provider  
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show patiens first seeks treatment for work-related injury or illness  
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What is the definition of temporary partial disability?   show
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show medical treatment  
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The person responsible for completing the First Report of Injury is the   show
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A worker's compensation progress report is filed when   show
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show drug or alcohol intoxication  
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Worker's compensation premiums are paid by the   show
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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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Created by: IndyGirl89