Computers Final

Front 1

Each time a pt. comes to the clinic, the medical assistant must verify which of the following insurance information?

Back 1

*Whether insurance covers the procedure

*What the patients insurance plan is

*Whether a referral is required

Front 2

What is the purpose of screening new patients for insurance coverage?

Back 2

To verify patient has coverage and obtain vital billing information.

Front 3

Health insurance was designed for what reason?

Back 3

To help individuals and families compensate for high medical cost.

Front 4

Term that means an insurance policy pays a percentage of the balance after application of the deductible

Back 4

Co-insurance

Front 5

Term applied when more than one policy covers an individual

Back 5

Coordination of benefits

Front 6

Applied to determine primary coverage for a dependant child when both parents are covered by health insurance

Back 6

the birthday rule

Front 7

Best describes insurance polocies that provide coverage on a fee for service basis

Back 7

traditional

Front 8

Type of insurance coverage covers a specific dollar amount for providers fees, hospital care and surgery

Back 8

Basic

Front 9

Best describes insurance policies that require policy holders to select a primary care provider

Back 9

Traditional

Front 10

Best describes policies that are supplementary to medicare insurance

Back 10

medigap

Front 11

Best describes the state or regional organization that handles medicare claims

Back 11

Fiscal intermediary

Front 12

Large companies non profit organizations and governments frequently use what kind of insurance to reduce cost and gain more control of their finances

Back 12

self-insurance

Front 13

Best describes the managed care organization model having the freedom of obtaining medical services from an HMO provider or by self referral to the non HMO providers

Back 13

Point of service plan

Front 14

The amount of money that the insured must incure for the medicare services before the policy begins to pay is known as what?

Back 14

Deductible

Front 15

Best describes a network of providers and hospitals who have a contract withy insurance companies to provide discounted health care

Back 15

Preferred provider organization

Front 16

Before certain procedures or visit can be made some insurances require

Back 16

Preauthorization

Front 17

Medicare coverage that pays for outpatient services

Back 17

Part B

Front 18

Insurance coverage for persons injured on the job

Back 18

Workers compensation

Front 19

Persons who are eligable for medicare

Back 19

Receive disability income

Front 20

Medical insurance for dependents of active duty or retired military

Back 20

Tri-care

Front 21

Method of containing hospital cost that is based on an average cost for treatment of a patients condition

Back 21

Diagnostically related groups

Front 22

Medical insurance for a spouse and un married dependant children of a veteran with permanent total disability resulting from a service related injury

Back 22

CHAMPVA

Front 23

Dr. Chad is a participating provider in medicare does this mean Dr. Chad will accept assignment and what percent of the allowed amount

Back 23

yes, 100%

Front 24

Considering the amount that medicare reimburses for medical care what does the patient and medicare pay

Back 24

Patient - $12

Medicare - $48

Front 25

Statement mailed to the patient summarizing how the insurance carrier determined the reimbursement is known as what?

Back 25

Explanation of benifits

Front 26

Medicare coverage that covers prescription drugs

Back 26

Part D

Front 27

Not a category for referrals

Back 27

Post dated

Front 28

Common type of referral used by managed care

Back 28

Regular

Front 29

fee system that defines allowable charges that will be accepted by insurance carriers

Back 29

UCR

Front 30

Amount of charges the provider would have to write off if insurance didn't cover it is known as what?

Back 30

adjustment

Front 31

Insurance fraud and abuse may be involved in as many of what percentage of submitted medical claims

Back 31

10%

Front 32

Why is it important for a medical assistant to understand medicare insurance coding

Back 32

Serves as basis for information on the claim form

Front 33

What is necessary to authorize release of medical information to an insurance carrier?

Back 33

a medical release from the patient

Front 34

Which organizations developed ICD-9-CM

Back 34

World Health Organization

Front 35

Which applies to the coding book used to specify services and procedure preformed in the medical office?

Back 35

CPT

Front 36

How many major sections are in the current procedural terminology reference book

Back 36

Seven

Front 37

Not included in the recommended procedure for researching CPT code #s using the index

Back 37

Choose a modifier for all diagnoses and procedures

Front 38

Which section of the CPT book includes coding of lacerations?

Back 38

Surgery

Front 39

Which volume is the alphabetic index of ICD-9-CM?

Back 39

Volume 2

Front 40

Which ICD-9-CM volume is recommended as the 1st reference when coding diagnoses?

Back 40

Volume 2

Front 41

What is a convention used when there is not enough information to find a more specific code?

Back 41

NEC

Front 42

What codes are applied to an injury or poisoning?

Back 42

E codes

Front 43

Best describes the purpose of a physians fee profile

Back 43

To reflect charges for services and reimbursement rates

Front 44

Not affected by coding accuracy

Back 44

Resubmissions

Front 45

Completed using data from the pts electronic health record in most offices today

Back 45

CMS 1500

Front 46

Information not included in coding

Back 46

counseling

Front 47

Should be used to check for patient eligability

Back 47

Explanation of benifits

Front 48

A record of claims sent to the insurance carrier

Back 48

Claims register

Front 49

Not included in the insurance carriers role

Back 49

Collect co-pay from physician

Front 50

On completion of the processing of the claim , the insurance company sends what to the insured person

Back 50

Explanation of benifits

Front 51

Which is recommended to do first when claim is not paid within 4-6 weeks

Back 51

Call insurance carrier and ask about the delay

Front 52

Occurs when the insurance carrier is deliberately billed a higher rate service than what was preformed to obtain greater reimbursements

Back 52

*upcoding

*bundling

*down coding

*unbundling

Front 53

Applies to codes used as supplements to the basic CPT systemand are required when reporting services and procedures to care/caid pts

Back 53

HCPCS

Front 54

Volume of ICD-9-CM known as a tabular list

Back 54

Volume 2

Front 55

Diagnosis codes primarily with cancer registries

Back 55

M codes

Front 56

Claim form used to filing inpatient admission claims

Back 56

Ub-04

Front 57

The ICD-CM 10th revision will utilize alphanumeric codes that will consist up to how many characters

Back 57

7

Front 58

Separating the components of a procedure and reporting them as billable codes with charges to increase reimbursement rates is known as

Back 58

unbundling

Front 59

The new CMS-1500 form is distinguishable from the old form in that the 1500 symbol and date are located where?

Back 59

Top left margin

Front 60

When completing the patient and insured information section on the CMS-1500 form, you should use what to seperate parts of the name?

Back 60

Commas