medical insurance
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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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