question

civil law

answer

most legal issues of private health insurance claims fall under

question

when the physician accepts the patient and agrees to treat the patient

answer

when does the physician/patient contract begin?

question

implied

answer

most physician/patient contracts are

question

the physician and the patient

answer

when a patient carries privatemedical insuranc, the contract for treatment exist between

question

the physician and the insurance company

answer

who does the contract exist between in a worker' compensation case?

question

the individual enrollee or organization protected ( work)

answer

the insured is always

question

to prevent duplication or pverlappimg of pymts for the same medical expense

answer

the reason for a condination of benefites statement is a health insurance policy is

question

condition of benefits statement

answer

Mr. Talili has two medical insurance policies.to prevent duplication of payment for the same medical expense, the policies include a

question

all the above: the indemnity the payment the check

answer

when a medical facility is sent correct reimbursment from a insurance company for professional services, the sites receives

question

the health plan of the person whos bday ( month and day) falls earlier in the calendar year will pay first

answer

if a child has health insurance coverage from two parents, aconding to the birthday law

question

the plan of the person who has cover longer is the primery payer

answer

acconding with the bday law, if both the mother and the father have the same bday

question

prexisting

answer

conditions that existed and were treated before the health insurance policy was issued and called

question

exclusion

answer

an attachment to an insurance policy that excludes certain illlinesses or disabilities that would otherwise be covered is referred to as a/an

question

preauthorization

answer

what is the correct term to used to determine if a procedure is covered and demically necessary?

question

conversion privilage

answer

Mrs. Thompsett leaves her place of employment. she is eligible to reansfer her medical insurance coverage from a gropu to an induvidual contract. this is know as

question

no physician examination required

answer

why would conversion from a griopu policy to an individual policy be advantageous?

question

extend group health insurance coverage for 18 months

answer

Mr. Ott laid laid off from his job. he is protected by COBRA which requires his employer to

question

consolidated omnibus budget reconciliation act ( COBRA)

answer

the act created to protect workers and their families so that they can get maintain health insurance if they change or lose their jobs is called the

question

comperirive medical plan (CMP)

answer

a type of managed care organization created by the 1982 Tax Equality and Fiscal responsibility act (TEFRA) that allows for enrollemnt of medicare beneficiaries into managed care plans is a/an

question

maternal and child heatlh programns (MCHP)

answer

a state and federal program for chindrens who are younger than 21 years of age and have special heatlh care need is

question

the transfer of one of legar right to collect the amount payable under an unsurance contract

answer

Assigment of benefits is

question

patient service slip

answer

a ecounter form may also be know as a

question

superbill

answer

the source documets for insurance claims data is the

question

day sheet

answer

a daily record sheet used to record daily business transactions is called a /an

question

in batches, grouping claims of patients who have the same ty[e of insurance

answer

it is advisable to process insurance claims

question

follow up insurance claims

answer

an insurance claims register facilites

question

be send a monthly statements indicating the insurance company has been billed

answer

when the physician services have been submitted to the patient's insurance company by the physician's office, the patient should

question

medical information medical record BOTH A AND B

answer

a health record is considered

question

permanet legal document part of the health record both a and c

answer

a medical report is a

question

supporting documentation on the health record

answer

the key to substant procedure and idagnostic code selections for proper reimbursement is

question

defence to a professional liability claim insurance carries require accurate documentation that supports procedure and diagnostic codes BOTH A AND B

answer

reasons for documentation are

question

Sunbjective, Objective, Assasekent Plan

answer

the SOAP in a patient medica record charting may be define as

question

in the patient medical record in the appoiment book on the financial record or ledger card ALL THE ABOVE

answer

when a patient fails to return for needed treatment, documentation should be made

question

cross out the incorrect entry, substitute the correct information, date and initial

answer

how sould an entry a patien's medical record be corrected

question

CC

answer

a concise statement describing the symptoms, problems, condition, diagnosis physician-recommended return, or other factor that is the reason for the encounter is abbreviated

question

problem focused

answer

levels of evaluation and management services are based on type(s) of physical examination that may be

question

limited examinaation of single organ or system

answer

an expanded problem-focused examination is a/an

question

discharge summaries

answer

the official american hospital association policy states that "abbreviations should be totally eliminated from the more vital sections of the record, such as the "

question

mortality

answer

a diseased condition or state is know as

question

uderlying diseases or other conditions present att the time of the visit

answer

what does comorbidirty mean?

question

has not received any professional service with the physician witing the past 3 years

answer

a new patient is one who

question

has previously received professional service from a physician or another physician of the same specialtly who belongs to the group practice within the past 3 years

answer

an stablished patient is one who

question

the transfer or the total or specific care of a patient from one phyician to another the term used when requesting an authorization for the patient to receive services elsewhere BOTH B AND C

answer

in dealing with manages care plans, a referral is

question

counseling

answer

when a discossion takes place with a patient concerning the risjs and benefits of treatment option, it is considered

question

right lower quadrant

answer

parts of the small and large intestines, right ovary, right uterine tube, appendix and right uterer are found in the

question

intermediate

answer

repair of lacerations that require layered closure of one or more or more of the deeper layer of skin and tissues is known as

question

simple

answer

the code to repair a superficial laceration is found in the CPT intergumentary/surgery sectoion

question

exclusion from the program participation is mandatory

answer

once an individual has been found guilty of committing a medicare or medical program-related crime,

question

the person prospectice witness and autorized person BOTH A AND B

answer

who may acept a subpoena

question

patients medical records, xray films, and inactive patients medical records

answer

records that must be retained indefinitely include

question

universal claim form

answer

the health insurance claims (CMS-1500) is know as the

question

a physical clean claim

answer

an insurance claim form that contains no staples or highlighted areas and on which the bar code are has not been deformed is called

question

a dirty claim

answer

an insurance claim submitted with erros is referred to as

question

request a fee form the insurance company before sending the attending physical statement

answer

what is the protocol to follow on receiving request for an attending ohysician statements from an insurance company on a patient who has applied for health insurance

question

send only the information requested

answer

if you received, a request, accomopainedwith the correct autorization, asking to substract medical information from a patient medica record,

question

is consecutive and uses the same procedure code

answer

office visits may be grouped on the insurance claims form if each visit

question

optical character recognition

answer

OCR is the acromym for

question

it should not be fotocopied by the physician office to save an expenseve of nuying huge quantities

answer

OCR guidelines for the CMS-1500 claim form state

question

leave the block blank

answer

how should blocks be treated on an OCR CMS-1500 claim form that does not need any information?

question

patient and physician information

answer

the CMS-1500 claim form is divided into which of the following major sections?

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