BASICS FROM 1.1 Flashcards
The document submitted to the payer requesting reimbursement is called a(n)
B. Health Insurance Claim
The Centers for Medicare and Medicaid Services (CMS) is an administrative agency within the
B. Department of Health and Human Services
A healthcare practitioner is also called a health care
B. A Healthcare Provider
Which is the most appropriate response to a patient who calls the office and asks to speak with the physician
B. Explain that the physician is unavailable and ask if the patient would like to leave a message.
The process of assigning diagnoses, procedures, and services using numeric and alpha numeric characters is called
A. coding
Which coding system is used to report diagnoses and conditions on claims?
C. ICD-10-CM
If the health insurance plan’s prior approval requirements are not met by providers and the claim is submitted for reimbursement,
C. payment of the claim is denied.
Which organization publishes the CPT coding system?
C. AMA
National codes are associated with
C. HCPCS Level II.
The process of linking procedure/service and condition codes on a CMS-1500 claim justifies
C. medical necessity.
The medical practice that employs a health insurance specialist is legally responsible for their actions when performed within the context of their employment, which is called
C. respondeat superior. Latin translation is “Let the Master answer.”
Which type of insurance guarantees repayment for financial losses resulting from an employee’s act or failure to act?
B. Medical Malpractice Insurance
Rules that govern the conduct of members of a profession are called professional
A. Ethics
Which requires health insurance specialists to differentiate among the technical descriptions of similar procedures in the CPT coding manual?
A. Critical thinking
The American Association of Medical Assistants offers which certification exam?
B. CMA, Certified Medical Assistant
