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73 Cards in this Set

  • Front
  • Back
Insurance is considered a federally regulated industry?
True
An insurance billing specialist can escape liability by pleading ignorance?
False
Basic health insurance includes benefits for skilled nursing facilities?
False
A subscriber of an insurance policy may also be known as the policyholder?
True
The insured may not necessarily be the patient seen for the medical service.
True
Basic health insurance offsets large medical expenses caused by serious illnesses?
False
The insured in a health insurance policy may also be the patient.
True
An insurance claims representative also may be known as the claims adjudicator.
true
A coordination of benefits statement in an insurance policy refers to the waiting period.
False
Insurance claims may not be legally denied for payment even if submitted after the insurance company's time limit.
False
Medicare is a program jointly sponsored by federal and state governments for those eligible for public assistance.
False
Worker's compensation insurance covers off-the-job injuries.
False
Information such as the deductible, co-payment, per-approval provisions and the insurance company's address and telephone number can usually be found on the insurance card.
True
For Medicaid cases there is no assignment of benefits unless the patient has other insurance in addition to Medicaid.
True
A two or three part report that incorporates a combination bill, insurance form and routing document used in both computer and paper based systems is called an encounter form.
True
The efficient medical insurance specialist usually groups together all outstanding charges of patients who have the same type of insurance and processes these insurance claims at the same time.
True
State laws may bar the use of a signature stamp.
True
Most legal issues of private health insurance claims fall under
a. federal law
b. civil law
c. regional law
d. government law
b. civil
When does a patient/ physician contract begin?
a. after the physician has examined the patient for the first time.
b. when the patient steps into the examination room to be treated
c. when the physician accepts the patient and agrees to treat the patient.
c. when the physician accepts and agrees to treat the patient.
Most patient/physician contracts are
a. implied
b. expressed
c. written
d. verbal
a. implied
When a patient carries private medical insurance the contract is between
a. the patient and the insurance company
b. the physician and the patient
c. the physician and the insurance company
d. the policyholder and the insurance company
b. the physician and the patient
An emancipated minor is
a. a person younger than the age of 18 who lives independently
b. a person over the age of 21
a. a person under the age of 18 who lives independently
Who dose the contract exist between in a worker's compensation case?
a. the patient and the insurance company
b. the physician and the patient
c. the physician and the insurance company
d. the policyholder and the insurance company
c. 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
The insured is always the
a. patient
b. person at risk
c. the individual enrollee or organization protected
d. employer
c. the individual enrollee or organization protected
If a child has health insurance coverage from two parents, according to the birthday law
a. the father's insurance is always primary
b. the mother's insurance is always primary
c. the health plan of the person who's birthday falls earlier in the calendar year will pay first
d. It is only in effect if the parents are divorced
c. the health plan of the person who's birthday falls earlier in the calendar year
According to the birthday law, if both parents have the same birthday
a. hour of birth determins who pays first
b. the plan of the person who has had coverage longer is the primary payer
c. the plan that offers the best coverage is the primary payer
d. the father's policy is the primary payer
c. the health plan of the person who has coverage longer is the primary payer
Conditions that existed and were treated before the health insurance policy was issued are called
a. accidents
b. illnesses
c. preexisting
d. unforeseen occurrences
c. preexisting
An attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a
a. waiver
b. exclusion
a. waiver
What is the correct term used to determine if a procedure is covered and medically necessary?
a. preauthorization
b. predetermination
a. preauthorization
The act created to protect workers and their families so that they can get and maintain health insurance if they change or loss their jobs is called
a. COBRA
b. HCFAA
c. BFHA
d. HIPPA
d. HIPPA
An organization of physicians, sponsored by a state or local medical association, concerned with the development and delivery of medical services and the cost of health care is known as a
a.CMP
b.EPO
c.foundation for medical care
D. IPA
c. foundation for medical care
A state and federal program for children who are younger than 21 years of age and have special health care needs is
a. Medicaid
b. Children's Protective Services
c. Medi-Medi
d. Material and Child Health Programs (MCHP)`
d. Material and Child Health Programs (MCHP)
A patient intake sheet is also called a
a. patient forms
b. patient reform
c. patient registration form
d. medical record
c. patient registration form
The first document obtained in the initial patient visit is a
a. encounter form
b. patient chart
c. patient information form
d. patient ledger
c. patient information form
Assignment of benefits is
a. used only by NPPs
b. never used by paticipating physicians
c.the transfer of one's legal right to collect an amount payable under an insurance contract
c. the transfer of one's legal right to collect an amount payable under an insurance contract
An encounter form may also be known as a
a. ledger card or patient account
b. day sheet or daily record sheet
c. patient service slips
d. fact sheet or face sheet
c. patient service slips
The source document for insurance claim data is the
a. ledger
b. day sheet
c. CMS-1500
d. super bill
d.super bill
A daily record sheet used to record daily buisness transactions is called a
a. ledger
b. encounter form
c. day sheet
d. transaction slip
c. day sheet
It is advisable to process insurance claims
a. in batches, grouping claims of patients who have the same type of insurance coverage
b. in batches, grouping claims according to the first letter of the patient's last name
a. in batches, grouping claims of patients who have the same type of insurance coverage
The first legal item in the business of handling medical insurance is the insurance _______ or policy
contract
When a contract is not manifested by direct words but is deducted from the circumstance, the general language or the conduct of the patient, it is referred to as a ______ contract
implied
The person who is applying for insurance coverage is called ______
applicant
An insurance policy is a legally enforceable agreement called a ______
contract
An insurance policy becomes effective only after the company offers the policy and the person accepts it and then pays the initial _______
premium
The amount that must be paid each year by the insured before policy benefits begin is known as the _______
deductible
When the insured is required to pay a percentage of the covered services' costs, this is referred to as ________
co-insurance
Duplicates of all insurance claim forms are retained in the office pending file, also called a suspense, follow-up or _______ file
Tickler
A financial accounting record that is maintained for each patient who receives professional services is referred to as a _________
ledger
Proper coding can mean financial success or failure of a medical practice.
True
Although diagnostic coding is important in medical insurance billing, payment is never based on it.
False
All diagnoses that affect the current status of the patient may be assigned a code
True
It is possible for the primary diagnosis and the principal diagnosis to be the same.
True
All decimal points in diagnostic codes are required for transmission of insurance claims
False
When the physician makes hospital visits, code the reason for the visit, which may not necessarily be the reason the patient was admitted to the hospital
True
Diagnosis that relate to a patient's previous medical problem that have no bearing on the patient's present condition should be ____ when coding
a. handled according to specific insurance guidelines
b. included
c. excluded
d. both a and b
d. both a and b
The diagnosis listed first in submitting insurance claims for the patients seen in a physician's office is the
a. principal diagnosis
b. primary diagnosis
c. secondary diagnosis
d. patient's presenting complaint
b. primary diagnosis
What is the diagnosis called that is the main reason for the patient encounter?
a. secondary diagnosis
b. principal diagnosis
c. primary diagnosis
d. procedure diagnosis
b. principal diagnosis
Why was diplomatic coding developed
a. for medical research
b. for evaluation of hospital service use
c. for tracking of disease processes
d. all of the above
d. all of the above
What is the consequence when a medical practice does not use diagnostic codes?
a. it effects the physician's level of reimbursement for impatient claims
b. claim can be denied
c. fines or penalties can be levied
d. all of the above
d. all of the above
The International Classification of Diseases, Ninth Revision, Clinical Modification was published by the department of Health Services in
a. 1956
b. 1968
c. 1979
d. 1986
c. 1979
The volumes of the ICD-9-CM used in the physician's office to code diagnoses are
a. volumes 1,2 and 3
b. volume 1
c. volume 2
d. volumes 1 and 2
d. volumes 1 and 2
Five digit codes appear
a. at the beginning of a chapter
b. at the beginning of a section
c. at the beginning of a three-digit category
d. all of the above
d. all of the above
E codes are used
a. when a person who is not currently sick encounters health services for some specific purpose
b. to show external cause of injury
c. to code neoplasms
d. to code hypertension
b. to show external cause of injury
An E code is used for a patient who is being treated for a side effect from taking a wrong drug. this should be coded as
a. an adverse effect
b. a poisoning
c. an intoxication
d. an illness
b. a poisoning
Diagnostic codes have from _____ to ______ digits.
Tree to Five
Notes, papers and memos regarding patient information should be disposed of using a shredding device
True
confidentiality between the physician and the patient is automatically waived when the patient is being treated in a worker's compensation case.
True
Confidentiality is automatically waived in cases of
a. gunshot wound
b. child abuse
c. extremely contagious disease
d. all of the above
d. all of the above
Illegal coding practices are subject to penalties, fines and/ or imprisonment.
True
Physicians are legally responsible for any actions their employees preformed within the context of their employment; therefore, an employee can not be sued
False
What is "cash flow" in a medical practice?
a. the actual money available to a medical practice
b. the amount of money received by the medical practice in one day
a. the actual money available to a medical practice
AHIMA publishes
a. diagnostic and procedure training code books
b. diagnostic coding and reporting requirements
c. diagnostic medical terminology
d. both a and b
d. both a and b