question

What does the abbreviation MSHP designate?

answer

Multi-skilled Health Practitioner

question

Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring

answer

MSHP'S

question

Administrative medical office responsibilities include

answer

Claims Submission

question

A claims assistance professional

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Both A & B; works for the consumer helps patients file insurance claims

question

What is "cash flow" in a medical practice?

answer

The actual money available to a medical practice.

question

Front office medical duties have become increasingly important because

answer

Diagnostic and procedure coding must be reviewed for its correctness and completeness.

question

Which level of education is generally required for one who seeks employment as an insurance coder?

answer

Completion of an accredited program for coding certification.

question

Which organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing?

answer

American Health info management Association (AHIMA)

question

The amount of money an insurance billing specialist earns is dependent on which of the following factors?

answer

Knowledge, experience, and size of employing institution. *All of the Above

question

A billing specialist is entrusted with

answer

Holding the patients medical information in confidence, collecting money and being a

question

Medical etiquette refers to

answer

Consideration for others

question

Medical ethics include

answer

Standards of Conduct

question

The earliest written code of ethical principles for the medical profession is the

answer

Code of Hammuriabi

question

What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?

answer

The Principals of Medical Ethics

question

What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment?

answer

Notify your physician

question

Reporting incorrect information to private insurance carriers is considered

answer

Unethical, illegal

question

Which code of ethics is most appropriate for an insurance billing specialist who handles medical records?

answer

The American Health Information Association code of ethics

question

AHIMA publishes

answer

Diagnostic and procedure coding competences for out patient services and diagnostic coding and reporting requirements * All of the Above

question

A self-employed medical insurance biller who does independent contracting is responsible for

answer

Advertising, billing, and accounting * All of the Above

question

The Internet Healthcare Coalition has developed

answer

The AHIMA code of ethics

question

Reporting incorrect information to government-funded programs is

answer

Illegal

question

Insurance specialist certificate programs include

answer

Anatomy, diagnostic coding, and computer technology

question

The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as

answer

All of the Above

question

The AHIMA Code of Ethics is appropriate for

answer

Health info, specialist, coders and insurance billing specialist. *All of the above

question

Why are multiskilled health practitioners (MSHPs) in demand?

answer

They're cross trained to provide more than 1 function, they're often competent in more than one discipline, and flexibility to their employer. *All of the Above

question

Confidential information includes

answer

What is read, what is heard, what is seen about the patient. *All of the above

question

What is the correct response when a relative calls asking about a patient?

answer

have the physician return the call

question

Nonprivileged information about a patient consists of the patient's

answer

City of residence

question

Exceptions to the right of privacy rule include

answer

Gunshot wound cases and all infectious disease cases.

question

Confidentiality is automatically waived in cases of

answer

Gunshot wounds, child rape, communicable diseases. *All of the Above

question

When an insurance billing specialist bills for a physician and completes a Medicare claim form with information that does not reflect the true situation,

answer

He/she maybe subject to fines and imprisonment.

question

What action could happen if an employee knowingly submits a fraudulent Medicare or Medicaid claim at the direction of the employer and subsequently the medical practice is audited?

answer

The employee and the employer could be brought into litigation by the state or federal government.

question

To bill Medicare beneficiaries at a higher rate than other patients is considered

answer

Abuse

question

Electronic media refers to

answer

Computers, fax machines, internet, telephone, dial up telephone from one place to another. *All of the above

question

The Office of Civil Rights enforces

answer

Privacy Standards

question

What is the best response when telephoning a patient about an insurance matter and the patient's voice mail is reached?

answer

Use care in the choice of words when leaving the message

question

A uniform lexicon system used for managing patient electronic health records, information, indexing, and billing laboratory problems is called

answer

SNOMED

question

The focus on the health care practice setting and reducing administrative costs and burdens are the goals of

answer

HIPPA Title II Administrative simplification

question

Which statement is correct regarding the insurance industry?

answer

The insurance industry is among the worlds largest business

question

Most legal issues of private health insurance claims fall under

answer

Civil Law

question

When does the physician/patient contract begin?

answer

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

question

Most physician/patient contracts are

answer

implied

question

When a patient carries private medical insurance, the contract for treatment exists between

answer

The Physician and the patient

question

An emancipated minor is

answer

a person younger than the age of 18 who lives independently

question

The contract in a workers' compensation case exists between

answer

The physician and the insurance company

question

In health insurance, the insured is also known as

answer

The subscriber, the member, the policy holder *All of the above

question

The insured is always

answer

the individual enrollee or organization protected

question

The reason for a coordination of benefits statement in a health insurance policy is

answer

to prevent duplication or overlapping of payments for the same medical expense

question

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

answer

Coordination of benefits statement

question

When a medical facility is sent correct reimbursement from an insurance company for professional services, the site receives

answer

The idemnity, the payment, the check *All of the above

question

If a child has health insurance coverage from two parents, according to the birthday law

answer

The health plan of the persons whose birthday (month and day) falls earlier in the calendar year will pay first

question

According to the birthday law, if both the mother and the father have the same birthday

answer

The plan of the person who has coverage longer is the primary payer

question

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

answer

Pre-existing

question

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

answer

Waiver

question

What is the correct term used to determine if a procedure is covered and medically necessary?

answer

Pre-authorization

question

Mrs. Thompsett leaves her place of employment. She is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as

answer

Conversion Privilege

question

Why would conversion from a group policy to an individual policy be advantageous?

answer

No physician examination is required

question

Mr. Ott was laid off from his job. He is protected by Consolidated Omnibus Budget Reconciliation Act (COBRA), which requires his employer to

answer

extend group health insurance coverage for 18 months

question

What is the minimum number of employees a company must have to meet the criteria of the COBRA for continued medical benefits if an employee is laid off from a company?

answer

20

question

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

answer

Health Insurance Portability and Accountability Act (HIPPA)

question

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/an

answer

Foundation for Medical Care

question

A type of managed care organization created by the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA) that allows for enrollment of Medicare beneficiaries into managed care plans is a/an

answer

Competitive Medical Plan

question

A state and federal program for children who are younger than 21 years of age and have special health care needs is

answer

Maternal and Child Health programs (MCHP)

question

A patient intake sheet is also called a

answer

Patient registration Form

question

The first document obtained in the initial patient visit is a/an

answer

Patient information Form

question

Assignment of benefits is

answer

The transfer of ones legal right to collect an amount payable under insurance contract.

question

An encounter form may also be known as a

answer

Superbill

question

The source document for insurance claim data is the

answer

Encounter Form

question

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

answer

Daysheet

question

It is advisable to process insurance claims

answer

in patches, grouping claims of patients who have the same type of insurance

question

An insurance claims register facilitates

answer

follow up insurance claims

question

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

answer

send a monthly statement indicating the insurance company has been billed.

MEDA 160 Review Chapter 1,2,3

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