Test 4 Mod 2

Flashcard maker : Lily Taylor
Insurance is considered a federally regul;ated industry
B. False
The insured may not necessarily be the patient seen for the medical services
A. True
An insurance claims repersentative may also be known as the ajuster
A True
A coordination of benefits statement in as insurance policy refers to the waiting period
B False
Medicare is a program jointly sponsered by the federal and state governments for those eligible for public assistance
B False
Information such as the deductable, co payment, preapproval provisions, and insurance company address and telephone number can be usally found on the insurance card
A True
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
A True
A two or three part form that incorporates a combination bill, insurance form, and routing document used in both computer and pegboard systems is called an encounter form
A True
When a HMO is paid a fixed amount for each patient without vconsidering the actual number or nature of services provided to each person, this is know as
A Fee for Services
B. Capitation
C. usual charges
B. Capitation
An Organaization that gives members freedom of choice among phyicians and hospitals and providers a higher benefits if the provider listed on the plan are used is called
A. Health maintenance org (HMO)
B. Managed care Org. (MCO)
C. Preferred provider Org (PPO)
C. Preferred provider Org (PPO)
A program that offers a combinations of HMO style cost management and PPO style freedom choice is a
A. Point of Service (POS) plan
B. Managed care Org (MCO)
C. Physician provider group (PPG)
A. Point of Service (POS) plan
What is the correct procedure to collect a copayment on a managed care plan
A. There is no copayment with a managed care plan
B. Bil lthe plan for the copayment
C. Bill the patient for the copayment
D. Collect the copayment copayment when the patient arrives for the office visit
D. Collect the copayment copayment when the patient arrives for the office visit
The physician/patient contract begins
A After the physicians has examined the patient for the first time
B. When the patient steps into the examation room to be treated
C. When the physician acepts the patient and agrees to treat the patient
C. When the physician acepts the patient and agrees to treat the patient
When a patient carries medical insurance, the contract for treatment exists between
A The patient and ithe insurance company
B The physicians and the patient
C The physicians and the insurance company
C The physicians and the insurance company
An emancipated minor is
A. Person under the age of 18 who lives independently
B A person over the age of 21
C A person under 16 who lives with his parenrts
A. Person under the age of 18 who lives independently
The contract in a worker compensation case exists between
A The patient and the insurance company
B The physician and the patient
C The physician 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 abhove
D All of the abhove
The reason for coordination of benefits statement in a health insurance polisy is
A To prevent duplication or overlapping of payments for the same medical expense
B. To ensure adequate payment to the insured who holds more then one policy
C. To ensure payment for the physician
A To prevent duplication or overlapping of payments for the same medical expense
If a child has health insurance coverage from two parents, according to the birthday law
A The fathers insurance is always the porimary
B. The health plan of the pewrson whose birthday earlier in the calendar
C. The health plan of the person whose birthday (month, and day) falls earlier in the calendar year will pay first
C. The health plan of the person whose birthday (month, and day) falls earlier in the calendar year will pay first
Conditions that existed and where treated before the health insurance policy was issued are called
A Accidents
B Illnesses
C Preexisting conditions
D unforessen occurrences
C Preexisting conditions
A Patient intake sheet is also called a
A Patient form
B Patient report
C Patient registration form
D Medical record
C Patient registration form
Assignment of benefits is
A Only used by nonpartticipating physicians
B Never used by partticipating physicians
C Fee sharing between physicians
D. The transfer of ones right to collect an amount payable under an insurance contract
D. The transfer of ones 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 sheet
C. Communicator or super bill
D fact sheet or face sheet
C. Communicator or super bill
A daily record sheet used to record daily business transactions is called
A. Ledger
B. Encounter form
C. Day sheet
D. transaction slip
C. Day sheet
It is acceptable practice to use words “signature on file” in Block 12 of the CMS 1500 form under which of the following conditions
A. Only when the patient, parent or guardian neglects to sign the patient informatioon sheet and you know they meant to but forgot
B. When the patient forgets to sign but later verbally authorized the doctor or nurse practioner to sign on his behalf
C When the patient refuses to sign but the doctor has already provided the service
D. None of the above
D. None of the above
It is acceptacle practice to use the words “signature on file” in Block 13 of the CMS 1500 form under which of the following conditions
A. When you are billing for a nonparticipating provider but doctors agrees to accept the same payment as a participating provider
B. When you know the patient will be paid directly
C. When you haver the patient, parent or legal guardian signature on a form assigned benefits to the provider
C. When you haver the patient, parent or legal guardian signature on a form assigned benefits to the provider
Because there is no assignment of benefits in a workers compensation case, the following occur
A. The carrier will pay the provider directly and the balance should be billed to the patient
B. The patient will be paid directly and wil then reimburse the provider for any and all of charges
C. The patient will pay the provider out of pocket and will be remibursed from the carrier when the case settles
D. None of the above. The patient is not responsable for payment of services for any work related injury or illness
D. None of the above. The patient is not responsable for payment of services for any work related injury or illness
Block 31 on the CMS 1500 form is reserved for the provider’s signature. Which of the following is acceptable to most insurance companies
A. An electronic signature
B. The provider[‘s handwritten signature
C. A rubber stamped signature
D. All of the above
D. All of the above
If prior authorization for a procedure is denied by an insurance company, the providers office should
A. Write a letter of appeal to the insurance company as well as a letter to the patient informing him/her of the denial
B. Advise the patient of the decision and have the patient file the appeal if he/she wishes, as the appeal is ultimately the patients responsabilty
C. Let the patient know the procedure will have to be paid out of pocket should he or she decide to have it done
D. All of the above are acceptable
D. All of the above are acceptable
A crave-out consists of
A. Only basic services covered under capitation agreement
B. Services not included within the capitation rate but may be contracted seperatly
C. Services not covered under the capitation agreement
B. Services not included within the capitation rate but may be contracted seperatly
The gatekeeper may issue a referral in the following manner
A. Formal written authorization that can be mailed or faxed
B. Formal written authorization that can be handed to the patient
C. Verbally authorize an appointment with another physician
D. All of the above
D. All of the above
The monthly, quarterly or annual fee necessary to keep a policy in force is called
A. A premium
B. An Indemnity
C. A renewal
D. A deductable
A. A premium
Medical necessity must be determined before a case can be
A. Precertified
B. Predetermined
C. Preauthorized
D all of the above
C. Preauthorized
Quality improvement is a process within a Quality Improvement Org., formerly known as professional review org. designed to
A. Evaluate the quilty and efficiency of services rendered by a practing physician or physicians within the speciatly group
B. Settle disputes on fees
C. Examine evidence for admissionand discahage of a hospital patient
D. all of above
D. all of above
TRICARE is a government sponsored program providing non-military hospital and medical services for
A Spouces and dependents of active service personal
B Active duty service members
C. Retired service personnel and their dependents
D. A and C only
D. A and C only
A divorced motrher brings a child for treatment and presents the divorce decree showing you the child’s father is responsable for all medical bills. Since she brought a legal document, you should
A Send the father the bill
B Have the mother pay the bill at time of service
C Call your divorced friend qho just went through the same situation
B Have the mother pay the bill at time of service
A new patient has shown up late for her appointment. Since very little information was taken at the time of the appointment
A. Let the patient call the office later with the information as the signature isnt really important once treatment is received
B. Let the patient see the doctor in an effort to get the office back on shedule
C. Very patiently, assit the patient in completing the form. knowing how important it will be later to have all the information
C. Very patiently, assit the patient in completing the form. knowing how important it will be later to have all the information
DNR
D. Do not resuscitate
DOA
E. Dead on arrival
DRG
A Diagnosis-related group
DX
D. Diagnosis
ECG
C. Electrocardiogram
ED
L Emergency Department
FDA
J. Food and Drug Administration
EEG
I. Electroencephalogram
ESRD
G. End stage renal disease
ETOH
H. Ethyl alchol
DIG
K. Digoxin, digitalis
ENT
F. Ear, nose, & throat
DVT
M. Deep vein thrombosis

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