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| 4333889289 | `Reimbursement specialist | an other name for health insurance specialist | 0 | |
| 4334038580 | The document submitted to the payer requesting reimbursement is called an.... | Health insurance claim. | 1 | |
| 4334504031 | The center for medicare and medicaid services CMS is called an | Department of health and human services | 2 | |
| 4335281480 | A healthcare practitioner is also called a | provider | 3 | |
| 4335315590 | Which is the most appropriate response to a patient who calls the office and asks to speak with the physician | Explain that the physician is with a patient, and ask if the patient would leave a messge | 4 | |
| 4335367561 | The process of assigning diagnoses, procedures, and services using numeric and alphanumeric characters is called | coding | 5 | |
| 4335402674 | If a health insurance plan's preauthorization requirements are not met by providers | Payment of the claim is denied | 6 | |
| 4335435695 | Which coding system is used to report diagnoses and conditions on claims | ICD | 7 | |
| 4335484377 | The CPT coding system is published by the | AMA | 8 | |
| 4335498383 | National codes are associated with | HCPCS | 9 | |
| 4335526764 | which report is sent to the patient by the payer to clarify the results of a claims processing | explanation of benefifits | 10 | |
| 4335542860 | a remittance advice contains | payment information about a claim | 11 | |
| 4335634700 | Which type of insurance guarantees repayment for financial losses resulting from an employees and their dependents against injury and death occurring during the course of employent | State | 12 | |
| 4342221171 | The document submitted to the payer requesting reimbursement is called a(N) | Health insurance claim | 13 | |
| 4342316050 | The centers for Medicare an Medicaid services (SMS) is an administration within the | Department of health and human services | 14 | |
| 4342417666 | A healthcare practitioner is also called a | provider | 15 | |
| 4342475905 | Which is the most appropriate response to a patient who calls the office and asks to speak with the physician | Explain that the physician is with a patient, and ask if the patient would leave a message. | 16 | |
| 4342519271 | The process of assigning diagnoses, procedures, and services using numeric and alphanumeric characters is called | coding | 17 | |
| 4342553836 | If health insurance plan's preauthorization requirements are not met by providers | payment of the claim is denied | 18 | |
| 4342573990 | which coding system is used to report diagnoses and conditions on a claims | ICD | 19 | |
| 4342590115 | The CPT Coding system is published by the | AMA | 20 | |
| 4342597950 | National codes are associated with | HCPCS | 21 | |
| 4342621901 | Which report is sent to the patient by the player to clarify the results of claims processing | Explanation of benefits | 22 | |
| 4342646132 | A remittance advice contains | payment information about a claim | 23 | |
| 4342690869 | Which type of insurance guarantees repayment for financial losses resulting from an employee's act or failure to act | bonding | 24 | |
| 4342706388 | Medical malpractice insurance is a type of----INSURANCE | liabililty | 25 | |
| 4342745777 | Which mandates workers' compensation insurance to cover employees an their dependents against injury and death occurring during the course of employment | State | 26 | |
| 4342767526 | The American Medical Billing Association offers which certifications exam | CMRS | 27 | |
| 4342789209 | The intent of managed health care was to | replace fee-for-service plans with affordable, quality care to healthcare insurance | 28 | |
| 4342848672 | Which term best describes those who receive managed healthcare plan services | enrollees | 29 | |
| 4342900914 | The medical center received a $100,000 capitation payment in January to cover the healthcare cost of $150 managed care enrollees.By the following January ,$80,000 had been expended to cover services provided. the remaining $$20,000 IS | retained by the Medical Center as a profit | 30 | |
| 4342947915 | A nonprofit organization that contracts with and acquires the clinical and business assets of physician practices is called | medical foundation | 31 | |
| 4342980177 | A.......is responsible for supervising and coordinating healthcare services for enrollees | primary care provider | 32 | |
| 4343114192 | the term that describes requirements created by accreditation organizations is | standards | 33 | |
| 4343161966 | arranging appropriate healthcare services for discharged patients | discharge planing | 34 | |
| 4343186899 | Review for medical necessity of inpatient care prior to admission | pre- admission review | 35 | |
| 4343212851 | Review for medical necessity of test/procedures ordered during inpatient hospitalization | concurrent review | 36 | |
| 4343236323 | Grants prior approval for reimbursement of a healthcare services | preauthorization | 37 | |
| 4343274822 | Contracted network of healthcare providers that provides that provide care to subscribers for a discounted fee. | PPO | 38 | |
| 4343324203 | Organization of affiliated providers' sites that offer joint healthcare services to subscribers. | IDS | 39 | |
| 4343364819 | Provides benefits to subscribers who are required to receive services from network providers. | EPO | 40 | |
| 4343394960 | Providers comprehensive healthcare services to voluntarily enrolled members on a prepaid basis. | HMO | 41 | |
| 4343397928 | Patients are free to use the manage care panel of providers or self-refer to non-managed. | POS | 42 | |
| 4343494936 | Which means that the patient and/or insures has authorized the payer to reimburse the provider directly | Assignment of benefits | 43 | |
| 4343535995 | Providers who do not accept assignment of medicare benefits do not receive information include on the...... which is sent to the patient | encounter form | 44 | |
| 4343557749 | The transmission of claims data to payers or clearinghouses is called claims | processing | 45 | |
| 4343592748 | Which facilitates processing of nonstandard claim data elements into standard data elements | clearinghouse. | 46 | |
| 4343635550 | A series of fixed-length records submitted to payers to bill for healthcare services is a electronic | flat file format. | 47 | |
| 4343652198 | Which is considered a covered entity | private-sector payers that process electronic claims | 48 | |
| 4343920783 | A claim that is rejected because of an error or omission is considered a (N) | OPEN CLIAM | 49 | |
| 4343935753 | An electronic claim is submitted using .......as its transmission media. | 50 | ||
| 4343979553 | Which supporting documentation is associated with submission of an insurance claim | claims attachment | 51 | |
| 4344016020 | Which is a group health insurance policy provision that prevents multiple payers from reimbursing benefits covered by other policies. | coordination of benefits | 52 | |
| 4344049282 | The sorting of claims upon submission to collet and verify information about the patient an provider is called claims. | processing | 53 | |
| 4344065335 | Which of the following steps would occur first | Health insurance specialist completes electronic or paper-based claim. | 54 | |
| 4344144135 | Comparing the claim to payer edits and the patient's health plan benefits is part of claims | processing | 55 | |
| 4344176019 | Which describes any procedure or service reported on a claim that is not included on the payer's master benefit list | noncovered benefit. | 56 | |
| 4344211825 | Which is an abstract of all recent claims filed on each patient, used by the payer to determine whether the patient Is receiving concurrent care for the same condition by more than one provider | common data file. | 57 | |
| 4344267225 | Which is the fixed amount patients pay each time hey receive healthcare services | copayment | 58 | |
| 4344282401 | Which of the following steps would occur first | clearinghouse transmits claims data to payers. | 59 | |
| 4344297758 | Which must accept whatever a payer reimburses for procedures or services performed | participating provider | 60 | |
| 4344430312 | Which is an interpretation of the birthday rule regarding to group health insurance policies when the parents of a child covered on both policies are married to each other and live in the same household. | the parent whose birth month and day occurs earlier in the calendar year is the primary policyholder . | 61 | |
| 4344480203 | Which is the financial record source document usually generated by a hospital | chargemaster | 62 | |
| 4344518053 | Refer to figure 4-20 in this chapter. which payer's claim should be followed up first to obtain reimbursement | 63 | ||
| 4344546890 | Which requires providers to make certain written disclosures concerning all finance charges and related aspects of credit transactions | 64 | ||
| 4344663194 | Which protects information collected by consumer reporting agencies | 65 | ||
| 4344677449 | Which is the best way to prevent delinquent claims | 66 | ||
| 4344691026 | Which is characteristic of delinquent commercial claims awaiting payer reimbursement. | 67 |
