Medical insurance billing FINAL EXAM review Flashcards

12035453840	Final determination involving settlement of an industrial accident is known as	adjudication	0
12035453841	Do you need prior employment to receive SSDI payments?	True	1
12035453842	OSHA	Occupational Safety and Health Administration	2
12035453843	SOAP	subjective, objective, assessment, plan	3
12035453844	NPI	National Provider Identifier	4
12035453845	NOS	Not otherwise specified	5
12035453846	Are worker's compensation records kept in a separate chart or the patients personal chart if they see their own provider for workers comp services?	True	6
12035453847	What are supplementary reports and when are they filed for temporary disability insurance claims?	Reports for current status of patient; after every visit	7
12035453848	In a worker's comp case, the contract and financial responsibility exists between who?	The physician and insurance company	8
12035453849	For patients receiving VA medical care, travel expenses to and from the facility are a benefit.	True	9
12035453850	Does California allow for state disability benefits in a normal routine pregnancy?	True	10
12035453851	Where is disability insurance available from, what sources?	Private insurance, group policies, and government policies	11
12035453852	What is one of the most important items needed on a state disability claim form?	Social security number	12
12035453853	When a case is rated for permanent disability and settled, this is called	compromise and release	13
12035453854	The simplest type of workers compensation claim is	Non-disability	14
12035453855	What do worker's comp benefits include?	Medical treatment, temporary disability indemnity, permanent disability indemnity, etc.	15
12035453856	In many states, worker's compensation laws have exemptions for certain occupations such as?	Domestic employees, babysitters, and gardeners	16
12035453857	Premiums for workers' compensation insurance are paid by the	Employer	17
12035453858	What are reasons for worker's' compensation laws?	Provide income, encourage workplace safety	18
12035453859	A person retired from a career in the armed forces is eligible for TRICARE until 65 years of age?	True	19
12035453860	What is CHAMPVA? How does a person qualify for it? Who can treat CHAMPVA patients?	A service benefit program; beneficiaries or a veteran, freedom of choice	20
12035453861	How and who administers Medicaid benefits? What individuals qualify forMedicaid benefits? What benefits are available through Medicaid?	State governments; federal guidelines; elderly, blind, disabled, low income; family planning & basic care.	21
12035453862	Who is eligible for Medicare benefits? Know the types of coverages Medicare provides? Who administers Medicare benefits?	65 or older; physician services; hospital care; administered by the CMS.	22
12035453863	Know the two types of personal bankruptcy.	Chapter 7; Chapter 13: liquidation and reorganization	23
12035453864	What is small claims court?	Allows laypeople to a court system without the use of an attorney	24
12035453865	When insurance carriers do not pay claims in a timely manner, what effect does this have on the medical practice?	decreased cash flow	25
12035453866	professional courtesy	Discount the provider gives the patient	26
12035453867	The first level of appeal in the Medicare program is	redetermination	27
12035453868	Routine use of too many nonspecific diagnostic codes may result in downcoding.	True	28
12035453869	An insurance claim submitted with errors is referred to as?	dirty claim	29
12035453870	A code or codes that further explain or add additional detail to a CPT code is known as a	Modifier	30
12035453871	What does bundling mean?	Grouping codes that are related to a procedure	31
12035453872	The key components that determine an evaluation and management code are documented by who?	The physician	32
12035453873	What are Z codes used for? How often are CPT and ICD codes updated?	Anything other than injury or illness. Updated annually.	33
12035453874	What are neoplasms?	new growths	34
12035453875	It is possible for the primary diagnosis and the principal diagnosis to be the same? Can we code for symptoms? Can a condition be both acute and chronic at the same time?	True. True. True.	35
12035453876	What is the term used as the name of a disease, structure, operation, or procedure, usually derived from the name of a place or a person who discovered or described it first called?	Eponym	36
12035453877	Burns are reported based on the depth of the burn, the extent of the burn, and the agent that caused the burn	True	37
12035453878	Primary, principle, secondary	Main reason for the encounter; diagnosis obtained after the study; contribute to the condition	38
12035453879	What do diagnostic and procedure codes explain?	Diagnostic: explains the reason the patient sought health care services; procedure: explains services provided	39
12035453880	Birthday rule	The guidelines that determines which of two married parents with medical coverage from different employers has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary	40
12035453881	The reason for a coordination of benefits statement in a health insurance policy is to	prevent duplication or overlapping of payments for the same medical expense.	41
12035453882	When does the physician/patient contract begin?	When the physician accepts the patient and agrees to treat the patient	42
12035453883	Most physician/patient contracts are	implied	43
12035453884	Confidentiality between the physician and the patient is automatically waived when the patient is being treated in a worker's comp case?	True	44
12035453885	Submitting a claim for services that is not medically necessary is a violation of what act? What penalties might be incurred for illegally coding claims?	False Claims Act; fines, imprisonment, or both.	45
12035453886	Are physicians legally responsible for any actions of their employees performed within the context of their employment?	True	46
12035453887	What does confidential information include? What are medical ethics?	Anything that identifies the patient; standards of conduct	47
12035453888	What does cash flow mean?	The amount of actual cash generated and available for use by the medical practice within a given period of time.	48
12035453889	What is an encounter form? Other names it could be called?	a list of procedures with the charges; charge slip, superbill, transaction slip	49
12035453899	What is an assignment of benefits?		50
12035453890	What are reasons to document patient encounters?	Coding, data, progressions	51
12035453891	What are the differences between a new patient and an existing patient?	New patient: has not received services within the past 3 years Existing patient: has received services within the past 3 years	52
12035453892	Is a problem focused examination more complex than a detailed examination?	False	53
12035453893	When a discussion takes place with a patient concerning the risks and benefits of treatment options, it is considered	counseling	54
12035453894	A daily record sheet used to record daily business transactions is called a(n)	day sheet	55
12035453895	An insurance billing specialist can escape liability by pleading ignorance.	False	56
12035453896	Personal insurance is usually less expensive than other health insurance	False	57
12035453897	Information such as the deductible, copayment, preapproval provisions, and insurance company address and telephone number usually can be found on the insurance card.	True	58
12035453898	Front office medical duties have become increasingly important because	Diagnostic and procedure coding must be reviewed for its correctness and completeness.	59