Ass. 3&4 Flashcards
In Canada, health-care plans pay only health-care services normally defined as “ medically necessary”.
T
The list of insured services is updated every 5 years.
F
Services considered “ medically necessary” are the same services in all provinces and territories.
F
A service that is no longer insured is deregulated.
T
Medical procedures that are done in conjunction with a physician visit are billed at a lesser amount than those done separately.
T
The Fee Schedule resource manual in Ontario is called the Medical Payment Schedule.
F
As a student, you can legally download the OHIP fee schedule for your province or territory, from the internet for study purposes
T
In Ontario, residents pay a health insurance premium.
T
In Ontario, each person has an OHIP card number for life.
T
It is legal to ask someone to show a health card for identification purposes when cashing a cheque.
F
In Ontario, “snowbirds” who spend the winter in warmer climates , may be away from Ontario for 212 days in any 12 month period and still maintain continuous OHIP health coverage.
T
The Workplace Safety and Insurance Board (WSIB) is the worker’s compensation board in Ontario.
T
Clients may randomly be asked to show their health card before receiving care in their physician’s office.
F
Family practice is a specialty area of medicine
T
The AHP is primarily responsible for the claims submission in a medical office.
T
EDT stands for External Data Transcription.
F
If a health card will not swipe , putting a thin paper over the magnetic strip may help.
T
Information from a health card may be manually entered if swiping the card does not work.
T
When a client requests that their medical records be transferred, OHIP is charged.
F
After three notices of an unpaid account, the account goes either to small claims court or to a collection agency.
F
Canada Health Infoway is a provincially funded organization with a mandate to facilitate the national implementation of electronic health records.
F
An “ electronic medical records system” is a legal health record in digital format.
F
An “ electronic health record “ EHR is an accumulation of essential information from an individual’s electronic medical records
T
” Open text” clinical records allows the provider of care to record the findings on a blank page or on a template such as one for SOAP charting.
T
A “ fob”’ is a small security device added to a computer, displaying a randomly generated access code which changes every few seconds.
T
Backups of system data should be performed at least once a week.
F
As an AHP your responsibilities will likely include creating the basic EMR.
T
Individuals who are not providing care for a specific client can be fired or suspended for accessing the client’s medical record.
T
Numeric filing systems almost always require an index.
T
n Canada, no provincial/territorial or federal privacy legislation states how long health information must be kept.
T
In Ontario, physician’s must retain client’s health information for 7 years from the date of the last entry.
F
There is no minimum age for consent to the disclosure of personal health information.
T
Clients have a right to access all information contained in their medical chart.
T
“Private” health care facilities means that patients pay for services.
F
Chronic care facilities provide long-term inpatient medical care for people with little or no potential for rehabilitation.
T
Federal hospitals provide health care services for First nations people, veterans and military personnell.
T
A tertiary care hospital offers basic care , including health promotion and prevention of illness only.
F
Accreditation is the process by which facilities are granted recognition for meeting certain preset standards of care.
T
Clinical /secretarial responsibilities include processing diet changes for clients.
T
Included in a clinical secretary’s scope of practice is the ability to give basic patient care such as helping a patient get up to the bathroom.
F
Mr. T , a senior citizen , has been prescribed a generic medication from a provincial drug benefit formulary. It is not managing his pain and makes him feel sick and lethargic. Previously he was using a brand name medication with good results and fewer side effects, but it was not listed in the drug benefit formulary and so was not paid for by the plan. How can the doctor attempt to get the more effective drug paid for by the provincial drug benefits plan when it is not on the list of selected drugs covered by the drug benefit plan?
a) the doctor can call the pharmacy and explain the situation
b) the doctor can call the Minisrty of Health and demand they allow the client the use of the best drug
c) the doctor can submit a limited use form for some drugs or write a letter and submit a different form for other drugs
d) the doctor can call the local media and put out a call for help in funding the more effective drug
C
Which of the following is the best description of drug benefit formulary?
a) a provincial/territorial list of selected drugs covered by the drug benefit plan
b) a manual listing the recommended use and dosage of common medications
c) a provincial/territorial list of recommended retail cost of prescription drugs
d) a multi-discipline manual that describes the action, use, route of administration and recommended dose of medications
A
Which of the following statements about health card validation is true?
a) the red and white OHIP cards are no longer valid
b) in Ontario, claims submitted with an invalid version code will be rejected.
c) information about a client’s health card can be obtained by calling the Ministry of health
d) Clients no longer have to show their health card each visit if their OHIP number is on file.
B
Which of the following statements is the best example of deregulation?
a) provincial plan covers in-patient physiotherapy
b) health insurance covers physician examination to investigate patients’ symptoms
c) routine eye examinations have been removed from the provincial fee schedule
d) only medically necessary health services are covered by the provincial plan
C
Which of the following care services can be billed as physician encounters with the provincial care plans?
a) Sadie visits the office to get a back to school note for her daughter.
b) Susan has the nurse take her blood pressure and sees the doctor to have her medications renewed.
c) Charlie comes to the office to have the nurse change his dressing and assess his wound.
d) Martha comes to the office to have the nurse administer her monthly vitamin B6 ( pyridoxidine ) injection.
B
What should the AHP do, if unsure whether a service is insured by the provincial health plan?
a) ask the physician in charge
b) check with the office nurse
c) call another practice and check with their AHP
d) contact the health ministry regional information service
D
Is it necessary to have the patient sign a “ permission to release information form” before submitting a billing claim which includes the required personal information?
Yes/No
No
In Ontario, what does the three number service code represent?
a) the type of assessment
b) the provider rendering the service
c) the assistant rendering the service
d) the type/complexity of the service rendered
D
The suffix in a service or billing code has a specific meaning in codes for diagnostic tests. What are the two insurable components related to diagnostic tests?
a) therapeutic and diagnostic
b) technical and professional
c) physician and assistant initiated
d) hospital or nursing home initiated
B
In which of the following circumstances must the AHP mark the MR field on the computer when submitting a claim?
a) When a hand-written hard copy of a claim is submitted
b) when a new client has been added to the practice
c) when a physician has examined a client without using any diagnostic technology
d) when a manual review of the claim is requested because the service provided contravenes the provincial billing guidelines
D
Which of the following methods of claims submission is the method of choice across Canada?
a) billing cards
b) electronic transfer
c) tape cartridge and disk
d) machine readable input/output
B
What does shadow billing refer to?
a) it is used in third party payment situations
b) it is the type of billing used for physicians opted out of OHIP
c) it is used in practices that have entered into primary care reform
d) it is a billing method used for doctors who offer services at more than one facility
C
