Chapter 3 Quiz Flashcards
The insurance claim process begins with:
(A) Patient information.
(B) Charge entry.
(C) Scheduling an appointment.
(D) Submitting a claim.
(C) Scheduling an appointment.
All the above processes are necessary for an encounter- the scheduling of the appointment is the initial step of processing a claim.
The parent with which the child resides is considered to be a:
(A) Step-parent.
(B) Non-custodial parent.
(C) Custodial parent.
(D) Natural parent.
(C) Custodial parent.
A custodial parent is one with which the child resides. A natural parent is also called a biological parent, a step-parent is one that is married to a natural parent.
Child presents for care with the father. Both parents have coverage, date of birth for mother is 3/21 and date of birth for father is 6/20. The mother is covered by a COBRA. What is the primary coverage for the child?
(A) The mother’s coverage is primary based on the birthday rule.
(B) The father’s insurance is primary because the mother has COBRA.
(C) The father is primary because he is older.
(D) The father’s is primary because he consented for care.
(B) The father’s insurance is primary because the mother has COBRA.
When following the birthday rule the parent with the birthday closest to the first day of the calendar year is primary. An exception to that rule states if one of the plans is COBRA, COBRA is secondary.
Which of the following statements is TRUE regarding patient demographics?
(A) Demographic information can only be provided by the patient.
(B) Patient demographic information can be released to a third party.
(C) Patient demographic information entered incorrectly can result in claim denials.
(D) Claim processing is not affected by patient demographic information.
(C) Patient demographic information entered incorrectly can result in claim denials.
It is important that data entry is entered correctly. Lack of completion or transposed information can result in claims denials.
HIPAA Section 164.508 states that covered entities may not use or disclose protected information without a valid authorization. In what circumstances can a practice NOT release protected information?
(A) Records sent to a physician asked to consult with the patient.
(B) Payment or claims.
(C) Records requested by the health department for communicable diseases.
(D) Records requested for life insurance.
(D) Records requested for life insurance.
HIPAA allows for release of records for treatment of the patient, payment of claims, and clinical operations. It does not allow for release of records for life insurance. This would need to be authorized by the patient.
A child brought in by the mother to be seen. The mother (DOB 02/08/83) is the custodial parent and is remarried. She has an individual policy. The father (DOB 10/10/83) is covered by a policy from work. The step-father is also covered at work. Which of the following is CORRECT?
(A) The mother’s insurance is primary.
(B) The step-parent is primary.
(C) The father is always primary.
(D) Either the mother or the father can be primary.
(A) The mother’s insurance is primary.
In divorce cases where the custodial parent has remarried-the custodial parent coverage is primary, with the step-parent being secondary. The non-custodial parent is the payer of last resort.
Listed below are examples of patient reminders for appointments. Which one is HIPAA compliant?
(A) “This is the obstetrical office calling to remind you of your appointment Tuesday, April 12 at 9 a.m. for your annual exam.”
(B) “This is Dr. Smith’s office calling to remind you of your appointment Tuesday, April 12 at 9 a.m. for your annual exam.”
(C) “This is to confirm your appointment for your first prenatal visit with Dr. Jones. Please notify us if you are no able to keep this appointment.”
(D) “This is the doctor’s office calling to remind you of your appointment Tuesday, April 12 at 9 a.m.”
(D) “This is the doctor’s office calling to remind you of your appointment Tuesday, April 12 at 9 a.m.”
HIPPA allows calls to verify appointments but the information should be the minimum necessary to accomplish the task. Giving the reason for the appointment is not necessary.
Which of the following does NOT qualify a patient for coverage under Medicare?
(A) End Stage Renal Disease (ESRD).
(B) Age 65 or older.
(C) Under age 65 with disabilities.
(D) Low income individual.
(D) Low income individual.
Medicare beneficiaries are eligible at age 65 or older, under 65 with certain disabilities, and those of all ages with ESRD. Low income individuals are covered by Medicaid.
A claim that is sent for reimbursement that contains all the required data elements to process the claim is referred to as a:
(A) Submitted.
(B) Adjudicated.
(C) Clean Claim.
(D) Medically necessary.
(C) Clean Claim.
A clean claim contains all required data elements needed to process and pay the claim.
Patient insurance card will contain vital information that will allow a claim to be processed, Which of the following is NOT provided on the insurance card?
(A) Policy holder, group number.
(B) Claim number, CPT code, diagnosis.
(C) Policy holder, copay, deductible.
(D) Claims address, group number.
(B) Claim number, CPT code, dianosis.
The insurance card will not contain specific information regarding the encounter. It will contain information regarding the policy holder, group number, copay, deductible, and address to mail the claim.
