MED INS Word Scramble

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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	neccesity
Which is a typical responsibility of a health insurance specialist?	correcting claims processing errors
The mutual exchange of information bea tween providers and payers is called electronic	data interchange
The document submitted by provider to a third-party for purpose of requesting reimbursement for services provided is a(n)	claim
The process of classifying diagnoses, procedures, and services is called	coding
Which coding system is used for reporting procedures and services in physician's offices?	CPT
Diagnoses are coded according to	ICD-9-CM
Rules that govern the conduct of members of a profession are called	ethics
Physicians offices should bond employees who have which responsibilty?	financial
Which term is another word for stealing money?	embezzling
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	medical necessity not met
The type of healtha care that helps individuals avoid health and injury problems is	preventive
Which is a government-sponsored health program that provides benefits to low-income	medicaid
The standard claim developed by CMS and used to report procedures and services delivered by physicians is called the	CSM-1500
The act passed in 1996 that has had a great impact on confidentiality, electronic informatin transmission, and standardization is the	HIPPA
Which three components constitute the RBRVS payment system?	physician work, practice expense, and malpractice insurance expense
Insurance that is available through employers, labor unions, consumer health cooperatives, and other organizations is	Group health insurance
A provider's list of predetermined payments for healthcare services to the patients is known as	fee schedule
Which termin describe the process of developing patient care plans for coordination and provision of care for complicated cases in a cost=effective manner?	case management
Mandates are	laws
Employees and dependents who join a managed care plan are caler ed	subscribers
Which act or amendment established an employee's right to continue healthcare coverage beyond a scheduled benefit of termination date?	COBRA of 1985
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	pay higher out of pocket costs
The specified percentage or charges the patient must pay to the provider for each service received or for each visit is the	coinsurance
Data transmitted electronically or manually to payers or clearinghouses is claims	submission
W hen the provider is required to receive as payment in full whatever amount the insurance reimburses for services, the provider is agreeing to	accept assignment
The person responsible for paying the charges for services rendered by the provider is the	guarantor
Which document is used to generate the patient's financial and medical record?	patient registration form
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	birthday
The insurance industry is regulated by whom?	individual states
Federal and state statutes are	passed by legislative bodies
Breach of confidentiality can result from	discussing patient healthcare informatin with unauthorize sources
The recognized difference between fraud and abuse is the	intent
Undated signed forms are assumed to be valid until revoked by the patient or	guardian
When a Medicare provider commits fraud, which entity conducts the investigation?	Office of Inspector General
The diagostic statements "urinary tract infection due to E.Coli" require ...codes to be assigned	two
Which convention is used to display a series of terms that can modify the statement to its right?	braces-
In th Ce ICD-9-CM, italized codes signify that	more than one code is required to fully describe a diagnosis
Type 2 diabetic c cataract, right eye	250.50, 366.41
The ICD-9-CM syStem classifies	morbidity
The ICD-9-CM V codes classify	factors influencing healh status
When reporting CPT codes on the CMS-1500 claim,medical necessity is proven by	linking the CPT code to its ICD-9-CM counterpart
A black triangle located to the left of CPT code indicates that the code	has been revised from previous CPT publications
Initial office visit for a patient with left knee pain. Detailed history and examination ws documented, along with low-complexity medical decision making	99203
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	30 minutes
HCPCS is a multilevel coding system that contains	two levels; level one, level two
Which statement is true of durable medical equipment?	it can withstand repeated use
Which special codes allow payers the flexibility of establishing codes if they are needed before the next January 1 annual date?	temporary
Each relative value component is multiplied by the geographic cost practice (GCPI), and then each is further multiplied by a variable figure called the	conversion factor
Non-participating (nonPAR) providers are restricted to billing at or below the	limiting charge
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	write-off
"Indicent to" relates to services provided by nonPARs that are defined as services	provided incidental to other services provided by the physician
The prospective payment system dependent on the patient's principal diagnosis, comorbidities, complications, and principal and secondary procedures are called	diagnosis-related groups (DRGs)
What term is used to describe the types and categories of patients treated by a healthcare faciity or provider?	case mix
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	=$80
Th e first-listed diagnosis reported on a CMS-1500-CM claim form is the	major reason the patient sought medical care
The concept of linking diagnosis codes with the procedure/services codes is called	medical necessity
When a provider documents justification for a patient seeking healthcare services, but no disorder is documented, the health insurance specialist usually assigns a(n)	V code
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.	V26.51: 58673
The diagnosis code reported in item 1, Block 21, of the CMS-1500 claim form is	first-listed diagnosis
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	pointer
The maximum number of CPT/ and or HCPCS modifiers that can be reported in block 24 on CMS-1500 is	four
Block 25 claim requires entry of either provider's soc.securty number or	EIN
What is reported in Block 24EE of the CMS-1500?	diagnosis pointer number
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	who has birthday that occurs first in the calendar year
The is covered by two health insurance policies, his own employer's group plan and his spouses' employer's group health plan. Which is primary policy?	The patient's" own policy is primary
When an "X" appears in the YES box in Block 10a of CMS-1500 claim, it indicates	the services provided were related to auto-accident injury
To prevent breach of confidentiality, the patient must either sign an "Authorization for Release of Medical Information" (ROM) or	Sign Block 12 of the CMS-1500 claim form
Which diagnosis is considered a chronic- icondition that would always affect the patient care?	diabetes mellitus
If laboratory procedures are performed in provider's office, how is it indicated on the CMS-1500 form?	by entering X in NO block 20
Which of following is considered commercial health insurance company:	Aetna
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	liablity
Which term describes the contractual right of third-party payer to recover healthcare expenses from liable party?	subrogration
The amount commonly charged for a specific medical service by providers within a particular geographic region is known as	usual,customary, and reasonable rate
Which is considered a place of service for purposes of Block 2	nursing facility
Enter an X in the YES Block 27 to indicate	accept assignment
Disability insurance typically provides what type of compensation to the injured person?	financial
A participating provider is one who enters into a contract with BlueCrossBlueShield corporation and agrees to	bill patients only deductible and copay/coinsurance amounts
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?	preferred provider organization
Which concept applies to BCBS directly reimburses participating providers for healthcare services rendered to subscribers?	assignment of benefits
Business entities that pay taxes on profits generated by the corporation and distribute after-tax profits to shareholders and officers are .......organizations	for-profit
tA special clause written into a contract that stipulates addtional coverage over and above the standard contract is a(n)	Rider
Which feature makes BCBS plan different from other commercial plans?	BCBS provides billing manuals and newsletters to keep PARs up-to-date on insurance procedures
Medicare is available to an individual who has worked at least	10 years in Medicare-covered employment, is at least 65 years of age, and is citizen of USA
The general enrollment period for Medicare Part B coverage	is held January 1 through March 31st each year
A Medicare benefit period begins	with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days
A Medicare private contract is an agreement betwee the Medicare beneficiary and physician who has "opted out" of Medicare for two years.	the physician cannot bill for any service or supplies provided to any Medicare beneficiary for two years
Individuals automatically enrolled in Medicare Part A are those who	already receive Social Security, Railroad Retirement Board, or disability benefits and are not yet 65
Medicare Supplementary Insurance is also called	Medigap
The purpose of the advance beneficiary notice is to alert the patient that	a service is unlikely to be reimbursed by Medicare and that the patient must guarantee payment for services
The deadline for filing Mediare claims is	December 31 of the year in which the service was provided
Certain individuals who have resources at or below twice the standard allowed under the SSI program and income who have resources at or below 100% of the FPL do not have to pay mon Medicare premiums, deductibles,and coinsurance; are categorized as	qualified Medicare beneficiaries
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	temporary assistance to needy families
How frequently should a patient's Medicaid eligibility be verified?	with each visit to provider
States rarely require Medicaid recipients to pay a	premium
Medicaid will conditionally subrogate claims	when there is liability insurance to cover a person's injuries
Block 23 of CMS-1500 claim contains the Medicaid......number, if applicable	preauthorization
Which of the following practices is prohibited by law?	balance billing of Medicaid patients
TRICARE is a healthcare program for	active duty members of the military and their qualified family members
TRICARE Standard enrollees are responsible for paying aor n annual.......as well as copayments	deductible
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	CHAMPVA
What system is used to confirm TRICARE eligibility for sponsors and their dependents?	Defense Enrollment Eligibilty Reporting System
Block 31 of CMS-1500 claim submitted to TIRCARE must contain	the name and credentials of the provider
The worker's compensation First Report of Injury fos rm is completed when the	patiens first seeks treatment for work-related injury or illness
What is the definition of temporary partial disability?	the employee's wage earning capacity is partially lost but only on a temporary basis
The type of worker's compensation claim that is the easiest to process is	medical treatment
The person responsible for completing the First Report of Injury is the	treating physician
A worker's compensation progress report is filed when	there is any significant change in the worker's medical or disability
An employee will lose the right to worker's compensation coverageif the injury results solely from	drug or alcohol intoxication
Worker's compensation premiums are paid by the	employer
What information is entered Block 11 of CMS-1500 form for workmen's compensation	the worker's compensation claim number
Worker's compensation laws protect the employer by	limiting the award an injured employee can recover from an employer

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