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Medical Billing Flashcards

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46691757451. Administrative medical office responsibilities includeClaims submissions0
46691757462. A claims assistant professionalWorks for the consumer and helps patients file insurance claims1
46691757473. The amount of money an insurance billing specialist earns is dependent on which of the following factorsKnowledge,experience, and size of employing institution2
46691757484. A billing specialist is entrusted withHolding patient's medical information in confidence, collecting monies, and being a reliable resource for coworkers3
46691757495. Medical etiquette refers toConsideration for others4
46691757506.Medical ethics includeStandards of conduct5
46691757517. 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?Notify your physician6
46691757528. A Self-employed medical insurance biller that does independent contracting is responsible forAdvertising, billing, and accounting7
46691757539. The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known asRespondeat superior, let the master answer, and vicarious liability8
466917575410. Why are multiskilled health practitioners in demand?They are cross-trained to provide more than one function, they are often competent in more than one discipline, and they offer more flexibility to their employer.9
466917575511. Confidential information includesEverything that is heard about a patient, everything that is read about patient, and everything that is seen regarding a patient10
466917575612. What is the correct response when a relative calls asking about a patient?Have the physician return the telephone call11
466917575713. Confidentiality is automatically waived in cases ofGunshot wounds, child abuse, and extremely contagious diseases12
466917575814. When an Insurance billing specialist bills for a physician and completes the Medicare claim form with the information that does not reflect the true situationHe or she may be subject to fines and imprisonment13
466917575915. Electronic media refers toRouters with-dial-up phones, the Internet, and transmissions that are physically moved from one location to another14
466917576016. When does the physician-patient contract to begin?When the physician accepts the patient agrees to treat the patient15
466917576117. Most physician patient contracts areImplied16
466917576218. When a patient carries private medical insurance, the contract for treatment exists betweenThe physician and the patient17
466917576319. Emancipated minor isIt person younger than the age of 18, and lives independently18
466917576420. Who does the contract exists between in a Worker's Compensation case?The physician and the insurance company19
466917576521. In health insurance the insured is also known asThe subscriber, the member, and the policyholder20
466917576622. The reason for the coordination of benefits statement in a health insurance policy isTo prevent duplication or overlapping of payments for this in a medical expense21
466917576723. When a medical facility is sent correct reimbursement for management company for professional services, the site receivesThe check22
466917576824. If a child has health insurance coverage from two parents according to the birthday lawThe plan of the person who has the coverage longer is the primary payer23
469329248825. According to the birthday law, if both the mother and the father have the same birthdayThe plan of the person who has coverage longer is the primary payer24
466917576926. Conditions that existed did before the health insurance policy was issued are calledPre-existing conditions25
466917577027. An attachment to an insurance policy excludes certain illnesses or disabilities that would otherwise be covered is referred to as aExclusion26
466917577128. What is the correct term used to determine if the procedure is covered and medically necessary?Preauthorization27
466917577229. Mr. Ott was laid off from his job. He is protected by cobra, which requires his employer toExtend group health insurance coverage for 18 months28
466917577330. What is the minimum number of employees that a company must have to meet the criteria of the consolidated Omnibus Budget Reconciliation Act (COBRA), for continued medical benefits if employee is laid off from a company?2029
466917577431. The patient intake sheet is also called aPatient registration form30
466917577532. The first document obtained in the initial patient visit is aPatient information form31
466917577633. Assignment of benefits isUsed only by nonparticipating physicians, never used by participating physicians, the transfer of the physicians right to collect an amount payable to the patient, and the transfer of ones legal right to collect an amount payable under an insurance contract32
466917577734. Encounter form may also be known as aPatient service slip33
466917577835. The Source document for insurance claim data is theCMS 150034
466917577936. It is advisable to process insurance claimsIn batches, grouping claims of patients who have the same type of insurance coverage35
466917578037. When the physician services have been submitted to the patient's insurance company by the physicians office, the patient shouldBe sent a monthly statement indicating the insurance company has been billed36
466917578138. A health record is consideredMedical information, and a medical record37
466917578239. Reasons for documentation areDefense of a professional liability claim, and insurance carriers require accurate documentation that supports procedure and diagnostic codes38
466919162340. When a patient fails to return for Initial treatment, documentation should be madeIn the patient's medical record, in the appointment book, and on the financial record or ledger card39
466919162441. A diseased condition or state is known asMorbidity40
466919162542. What does co- morbidity stand for?Underlying diseases or other conditions present at the time of the visit41
466919162643. A new patient is one whoHas previously received professional services from a physician or another physician of the same specialty who belongs to the group practice within the past 3 years42
469329248944. And established patient is one who43
466919162745. In dealing with managed-care plans, a referral isBoth B AND C. The same as the consultation, the transfer of the total or specific care of a patient from one physician to another, and the term used when requesting an authorization for the patient to receive services elsewhere44
466919162846. When a discussion takes place with the patient concerning the risks and benefits of treatment options it is consideredCounseling45
466919162947. Once an individual has been found guilty of committing the Medicare or Medicaid problem related crimeExclusion from program participation is mandatory46
466919163048. Which of the following cases should not use fax transmission?Transmission of documents relating to information on sexually-transmitted diseases, any routine transmission of patient information, and transmission of documents relating to alcohol treatment47
466919163149. Who may accept the subpoenaThe prospective witness , or an authorized person48
466919163250. TRICAREGovernment sponsored program that provides hospital and medical services for dependence of active duty uniform service members, military retirees and their families, and survivors of uniformed services49
466919163351. CHAMPVAProvides coverage for spouses and children of veterans with total, permanent, service-connected disabilities or for the surviving spouses pand children of veterans who died as a result of service connected disabilities50
466919163452. Disability income InsuranceA form of health insurance that provides periodic payments to replace income when the insured is unable to work as a result of illness, injury, or disease51
466919163553. Health maintenance organization (HMO)And organization that provides a wide range of comprehensive health care services for a specified group at a fixed periodic payment52
466919163654. Independent practice association (IPA)A medical capitation plan in which treatment is delivered via a clinic or an independent physician that provides a number of basic medical services for a fixed capitation payment per month53
466919163755. MedicaidThe program sponsored jointly by federal and state governments for medically indigent persons, aged individuals who meet certain financial requirements, and the disabled54
466919163856. MedicareThe hospital insurance system and supplemental medical insurance for those older than 65 years of age created by the 1965 amendment to the Social Security act55
466919163957. State disability or unemployment compensation disability. (UCD)Insurance that covers off the job injury or sickness and is paid by deductions from a person's paycheck56
466919164058. Worker's Compensation insuranceThe contract that ensures a person against on-the-job injury or illness57
466920210759. Attending physicianProvider who sends the patient for tests or treatment58
466920210860. Consulting physicianProvider whose opinion is requested by another physician about evaluation and management of a specific problem59
466920210961. Attending physicianProvider who is the medical staff member legally responsible for the care and treatment given to a patient60
466920211062. Ordering physicianIndividual who directs the selection, preparation, administration of tests, medications, or treatment61
466920211163. Treating or performing physicianProvider who renders a service to a patient62
466920211264. ConsultationServices rendered by a physician whose opinion is requested by another physician for evaluating a patients Illness63
466920211365. ReferralTransfer of the title care of the patient from one physician to another64
466920211466. Concurrent careProviding similar services to the same patient by more than one physician on the same day65
466920211567. Continuity of careProviding treatment for patient and subsequent referral by the treating physician to another physician for treatment of the same condition66
466920211668. CounselingDiscussion with the patient, family, or both for diagnostic results and instructions for treatment67
466920211769. Critical careIntensive care provided during an acute life threatening condition that requires constant bedside attention by the physician68
466920211870. EmergencyCare provided during a life-threatening condition in the hospital emergency department69
46692021191. The health insurance claim form (CMS-1500)Universal claim form70
46692021202. An Insurance claim form contains no Staples or highlighted areas and on which the barcode area has not been deformed is calledA physically clean claim71
46692021213. An insurance claim submitted with errors is referred to asDirty claim72
46692021224. What is the protocol to follow up on receiving a request for an attending physician statement from insurance company on a patient who is applied for health insurance?Request a fee from the insurance company before sending the attending physicians statement73
46746704635. If you receive a request with accompanied with the correct authorization asking to abstract medical information from a patient's medical recordSend only the information requested74
46746704646. Office visits may be grouped on the insurance claim form if each visitIs consecutive, uses the same procedure code, and results in the same fee75
46746704657. OCR Is the acronym forOptical character recognition76
46746704668. OCR Guidelines for the CMS-1500 claim form stateIt should not be be photocopied because it cannot be scanned77
46746704679. To conform to CMS - 1500 OCR guidelinesDo not fold insurance claims forms when Mailing, do not use symbols with data on insurance claim forms, do not strike over errors when making a correction78
467467046810. How should blocks be treated on an OCR CMS-1500 claim form that do not need any information?Leave the block blank79
467467046911. The CMS - 1500 claim form is divided into which of the following major sections?Patient and physician information80
467467047012. A group of insurance claims sent at the same time from one facility is known as aBatch81
467467047113. A clearinghouse is aAnd entity that receives the transmission of insurance claims, separates the claims, and sends each one electronically to the correct insurance payer82
467467047214. Insurance claims transmitted electronically are usually paid inTwo weeks or less83
467467047315. The most important function of a practice management system isAccounts receivable84
467467047416. The employers identification number is assigned byThe IRS85
467467047517. A clearinghouseTransmits claims to the insurance pear, performs software edits, and separates the claims by Carrier86
467467047618. Insurance claims form data are gatheredBefore the service is rendered, during the time the service is rendered, and after the service is rendered87
467467047719. Back up copies of office records should be storedAway from the office88
467467047820. When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier the system is known asCarrier direct89
467467047921. A computer printout that is used to look for errors below an insurance claim is transmitted electronically is calledAn Insurance Billing Worksheet90
467467048022. Back and forth communication between user and computer that occurs during online real time is calledInteractive transmission91
467467048123. The CMS-1500 is also known asThe basic paper claim92
467467048224. ASCA RequiredAll claims sent to Medicare should be submitted electronically93
467467048325. The uniform claim form task force was replaced byThe national uniform claim committee94
467467048426. In 2012, the CMS - 1500 claim form was revised to version 02-12 to accommodateICD-10 diagnosis codes95
469337213627. An insurance claim form that contains no Staples or highlighted areas and on which the barcode area has not been deformed is calledA physically clean claim96
469337213728. An insurance claim submitted with errors is referred to asA dirty claim97
469337213829. When I patient has dual coverage, the insurance that is considered the primary insurance isGenerally, the policy held by the patient98
469337213930. When completing a claim form, if any question is on answerableLeave the Space blank99
467467048631. The appropriate method for entering the date of service on a claim form is: January 4, 201601042xxx100
469337214032. Office visits may be grouped on the insurance claim form if each visitIs consecutive uses the same procedure code, and results in the same feet101
467467048733. The number issued to physicians by the Internal Revenue Service for income tax purposes is known as:TIN102
467467048834. Which which of the following is a lifetime 10 digit number issue to physicians that replaces all other numbers assigned by various health plans?NPI103
467467048935. Medicare providers who charge patients a fee for supplies and equipment such as crutches, urinary catheters, and walkers must send the claims two:A specific DM E fiscal intermediary104
467467049036. When medications are considered to be experimental the claim should be sent to the:Insurance carrier with the copy of the invoice from the supply house105
469337214137. 0CR is the acronym forOptical character recognition106
469337214238. OCR guidelines for the See CMS - 1500 claim form stateIt should not be photocopied because it cannot be scanned107
469337214339. To conform to CMS 1500 OCR guidelinesD all of the above. Do not fold insurance claim forms when mailing, do not use symbols with data on insurance claims forms, and do not strike over errorswhen making a correction on and insurance claim form108
469337214440. The CMS- 1500 claim form is divided into which of the following major sections?Patient and physician information109
467467049141. Data that is made unintelligible to unauthorized parties is referred to as:Encrypted110
469337214542. Insurance claims transmitted electronically her usually paid inTwo weeks or less111
469337214643. A clearinghouse isInto tea that receives transmission of insurance claims, separates the claims, and since each one electronically to the correct insurance payer112
469337214744. A group of insurance claims sent at the same time from one the facility is known asBatch113
467467049245. A provider is not considered a covered entity under HIPPA under which of the following circumstances?For the provider has fewer than 10 employees and submit claims only on paper to Medicare114
467467049346. ASC X12Version 5010 allows providers to submit claimsWith ICD-10-CM/PCS codes115
467467049447. Supplemental documents that provide additional medical information to a claim or referred to asClaim attachments116
469337214848. The employers if Acacian number is assigned byThe internal revenue services117
469337214949. The most important function of a practice management system isAccounts receivable118
469337215050. Back and forth communication between user and computer that occurs during online real time is calledInteractive transaction119
469337215151. When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known asBlah blah blah blah blah ha ha Ha ha ha120
467467049552. A transmission report which identifies the most common reasons for claim denial is theRejection analysis report121
4674670496In correct sequencing of patient information on an electronic claim results in inaccuracies that violate the HIPPA standard transaction for Matt and I are known asSyntax errors122
4674670497The HIPPA security rule addresses security of electronic PHI in what area?Administrative safeguards, technical safeguards, and physical safeguards123
4674670498The most common type of physical access control to limit access to areas where medical charts are kept isLocks on doors124
4674670499To maintain confidentiality, individuals should develop passwords composed ofMore than five characters, with upper and lowercase characters125
4674670500To ensure that the data has been effectively backed up on the practice management system, verification of original records to stored information should be performedWeekly126
4674670501Which of the following is the best way to protect computer is it from prevent data file man damage during Power outages?All offices should install uninterruptible Power supplies127
4674670502Clean claimAn insurance claim that is submitted with in the program or policy time limit and correctly completed128
4674670503Dirty claimAn insurance claim that is submitted with errors129
4674670504Electronic claimAn insurance claim that is submitted via a dial-up modem or direct data entry130
4674670505Incomplete claimHey Medicare claim that is missing required information131
4674670506In valid claimA Medicare claim that contains complete necessary information, but is not logical or incorrect132
4674670507Paper claimAn insurance claim that is submitted on paper including optically scanned claims133
4674670508Pending claimAn insurance claim held in suspense do to review or other reason134
4674670509Rejected claimAn insurance claim that requires investigation and needs further clarification135
4674670510Operative report is missing from the insurance claimSubmit all attachments with patients name and insurance identification number136
4674670511America's oldest to privately owned, prepaid medical group is theRoss-Loos medical group137
4674670512Which plan allows members of kaiser Permanente medical care program to seek medical help from non-Kaiser physician's?Point of service (POS)138
4674670513Kaiser Permanente's medical plan is a closed panel program, which meansIt limits the patient's choice of personal physician139
4674670514A significant contribution to HMO development was theHealthcare maintenance act of 1973140
4674670515How does an HMO receive payment for the services it's physicians provide?Pre-paid health plan141
4674670516When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known asCapitation142
4674670517How are positions paid who work for a prepaid group practice?Salary paid by independent group143
4674670518The name of an organization of physicians sponsored by a state or local medical Association that is concerned with the development and delivery of medical services and the cost of healthcareFoundation for medical care144
4674670519In an independent practice association (IPA) physicians areNot employees and are not paid salaries145
4674670520And organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are you used is calledPPO- preferred provider organization146
4674670521A physician owned business that has the flexibility to deal with all forms of contract medicine and also offers its own plans is aPPG147
4674670522A program that offers a combination of HMO style cost management and PPO style freedom of choice is aPoint of service plan148
4674670523practitioners in an HMO program may come under peer review by a professional group calledQuality improvement organization149
4674670524When a physician sees a of patient more than is medically necessary it is calledChurning150
4674670525Referral of a patient recommended by one specialist to another specialist is known asTertiary care151
4674670526What is the correct procedure to collect a co-pay on a managed-care plan?Collect the copayment when the patient arrives for the office visit152
4674670527Medicare part A is run byThe Center for Medicare and Medicaid services153
4674670528Medicare is aFederal health insurance program154
4674670529The letter D following the identification number on the patient's Medicare card indicates aWidow155
4674670530The letters preceding the number on the patient's Medicare ID card indicateA railroad retiree156
4674670531Part A of medicare coversBlood transfusions157
4674670532Part B of Medicare coversDiagnostic tests158
4674670533Medicare part A benefits period ends when a patientHas not been a bed patient in any hospital or nursing facility for 60 consecutive days159
4674670534Part B Medicare annual deductible is160
4674670535Medicare provides a one time baseline mammographic examination for women ages 35 to 39 and prevented mammograms for women for 40 years or olderOnce a year161
4674670536The frequency of Pap tests that may be billed for a Medicare patient who is a lower risk isOnce every 24 months162
4674670537Medigap insurance may coverThe deductible not covered under Medicare163
4674670538When in Medicare beneficiary has employer supplemental coverage, medicare referrals to these plans asMSP164
4674670539Some senior HMO's may provide services not covered by Medicare, such asI glasses and prescription drugs165
4674670540A state-based group of doctors working under government guidelines reviewing cases for hospital admission and discharge is known asA PRO166
4674670541A participating physician with the medical Medicare plan agrees to except80% of the Medicare approved charge167
4674670542In the Medicare program there is a mandatory assignment forClinical laboratory tests168
4674670543A Medicare pre-payment screenIdentifies claims to review for medical necessity, and monitors the number of times given procedures can be built during one year169
4674670544When a Medicare patient signs an advance beneficiary notice, the procedure code for the service provided must be modified using the HCPCS Level two modifier-GA170
4674670545Under the prospective payment system (PPS) hospitals treating Medicare patients are reimbursed according toPre-established rates for each type of illness treated based on diagnosis171
4693210158Payments to hospitals for Medicare services are classified according toDRG's172
4693210159The 1987 omnibus Budget reconciliation act (OBRA) established theMAACC173
4693292490The HCPCS national alpha numeric codes are referred to asLevel II codes174
4693292491Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are calledFiscal intermediaries175
4693292492The time limit for submitting a medical claim isThe end of the calendar year following the fiscal year in which services were performed176
4693292493When a Medicare carrier transmits a medigapCarrier, it is referred to as aCrossover claim177
4693292494And explanation of benefits document for a patient under the Medicare program is referred to as theMedicare remittance advice document178
4693292495A claims assistance professional (CAP)May act on the Medicare beneficiaries behalf as a client representative179
4693292496When a remittance advice (RA) is received from Medicare, the insurance billing specialist shouldPost each patients name and the amount of payment on the day sheet and the patients ledger card180
4693292497If a check is received from Medicare and it is obvious that it is an overpayment, the insurance billing specialist shouldDeposit the check and then right to Medicare notifying them of the overpayment181
4693292498The Social Security act of 1935Set up the public assistance programs182
4693292499The federal emergency relief administration made funds available to pay forMedical expenses of the needy unemployed183
4693292500The Medicaid program was a direct result ofA law passed by Congress in 1950184
4693292501In the Medicaid program, Congress authorized vendor payments for Medicare, which are payments from theWelfare agency directly to the physician185
4693292502The medically needy and geriatric population (aged)Require help in meeting costs of medical care186
4693292503DEFRA and CHAP we're responsible forExpanding Medicaid eligibility requirements187
4693292504Medicaid is administered by theState government with partial federal funding188
4693292505The federal aspects of Medicaid are the responsibility ofCMS189
4693292506State children's health insurance programs (SCHIPs)Operate with federal grant support under title V of the Social Security act190
4693292507The Omnibus budget reconciliation act (OBRA)Provided assistance for the aged and disable who are receiving Medicare and who's incomes are below the poverty level191
4693292508Medicaid is available to needy and low income people such asAll of the above. The blind, the disabled, and The aged ( 65yrs or older192
4693292509Basic maternal and Child health program MCHP provisions offered in all states include193
4693292510If a physician excepts Medicaid patients, the physician must exceptThe Medicaid allowed amount194
4693292511Medicaid eligibility must always be checked for theBoth a and B. The month of service and the type of service195
4693292512The Medicaid service for prevention, early detection, and treatment for welfare children is known asEPSDT196
4693292513To control escalating health care costs by curbing unnecessary emergency department visits and emphasizing preventive care, Medicaid reform has involvedManaged care programs197
4693292514Medicaid managed care patient claims should be sent to theManaged care organization and not the Medicaid fiscal agent198
4693292515The time limit to the pillar claim varies from state to state, but is usually30 to 60 days199
4693292516Hey program that contracts with CMS to review medical necessity and appropriateness of inpatient medical care is known as aQIO200
4693292517A participating position with the Medicare plan agrees to accept80% of the Medicare approved charge201
4693292518In the Medicare program, there is mandatory assignment forClinical laboratory tests202
4693292519A Medicare pre-payment screenBoth A and B. Identifies claims to review for medical necessity, and monitors the number of times given procedures can be billed during a specific time frame203

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