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33 Cards in this Set

  • Front
  • Back
When did the AMA adopt a code of ethics?
1980
How dose CCI detect improperly coded claims?
Through the use of computer edits.
When is patient confidentiality waved?
In the case of a gun shot wound, child abuse, during workman's compensation and
Insurance is considered a federally regulated industry
T
An insurance billing specialist can escape liability by pleading ignorance.
F
If the physician no longer wishes to treat an HMO or a PPO patient, termination is handled according to the same method that is used when discharging patients who are under private insurance.
T
Basic health insurance coverage includes benefits for skilled nursing facilities.
F
A subscriber of an insurance policy may also be known as the policy holder.
T
The insured may not necessarily be the patient seen for the medical service.
T
Basic health insurance offsets large medical expenses caused by serious illness.
F
The insured in a health insurance policy may also be the patient.
T
An insurance claims rep. may also be known as the claims adjudicator.
T
A coordination of benefits statement in an insurance policy refers to the waiting period.
F
Insurance claims may not be legally denied for payment even if submitted after the insurance company's time limit.
F
Personal insurance is usually less expensive than other health insurance.
F
Medicare is a program jointly sponsored by federal and state governments for those eligible for public assistance.
F
Worker's Compensation insurance covers off the job injuries.
F
Information such as the deductible, co-payment, pre-approval provisions and insurance company address and telephone number usually can be found on the insurance card.
T
If a patient has an individual insurance policy, a release of information does not have to be signed before the physicians office submits a claim to the insurance company.
T
Private insurance companies with whom the provider does not have a contractual agreement will send the check to the patient regardless of whether the patient has signed an assessment of benefits.
F
For Medicaid cases there is no assignment of benefits unless the patient has other insurance in addition to Medicaid.
T
A two or three part form that incorporates a combination bill, insurance form and routing document used in both computer and paper based systems is called an encounter form.
T
Hospital patients' insurance claims should be submitted on a monthly basis regardless of there discharge status.
F
The efficient medical insurance specialist usually groups together all outstanding charges of patients who have the same type of insurance and process these insurance claims at the same time.
T
Sate laws may bar the use of a signature stamp.
T
Which statement is correct regarding the insurance industry?

a. the insurance industry is among the worlds largest business
b. the insurance industry has provided health insurance since the mid 1900s
c. the insurance industry is a dying industry
a. The insurance industry is among the worlds largest business
Most legal issues of private health insurance claims fall under
a. federal law
b. civil law
c. regional law
d. government laws
b. civil laws
When does a physician/patient contract begin?
When the physician accepts the patient and agrees to treat the patient
Most physician/patient contracts are
a. implied
b. expressed
c.written
d.verbal
a. implied
When a patient carries private medical insurance, the contract for treatment exist between?
The patient and the physician
An emancipated minor is
A person younger than the age of 18 that lives independently
Who does the contract exists between in a worker's compensation case?
The physician and the insurance company.
In health insurance, the insured is also known as
a. the subscriber
b. the member
c. the policyholder
d. all of the above
d. all of the above