Medical Office Management C Flashcards
A bed patient in a hospital is called a (n) ________-
A. inpatient
B. outpatient
C. third party payer
D. provider
A. Inpatient
A person who represents either party of an insurance claim is the ______
A. doctor
B. adjuster
C. provider
D. subscriber
B. Adjuster.
A request for payment under an insurance contractor bond is called a (n) _______
A. insurance application
B. claim
C. dual choice request
D. total disability
B. Claim
Payment made periodically to keep an insurance policy in force is called ________
A. time limit
B. premium
C. coinsurance
D. fee-for-service
B. Premium
A person or institution that gives medical care is a (n) _________
A. third parter payer
B. provider
C. adjuster
D. insurance agent
B. Provider
Which of the following insurance plans provides a fixed payment per month to the physician regardless of the services rendered?
A. capitation
B. preferred provider
C. adjuster
D. insurance agent
A. Capitation
An amount the insured must pay before policy benefits begin is called ______
A. indemnity
B. extended benefits
C. deductible
D. catastrophic
C. Deductible
An organization that offers health insurance at a fixed monthly premium with little or no deductible and works through primary care provider is called a (n) ___________
A. preferred provider
B. health maintenance organization
C. member physician
D. private health provider
B. Health maintenance organization
Health insurance that provides protection against the high cost of treating severe or lengthy illnesses or disabilities is called ___________
A. catastrophic
B. severe
C. third-party payer
D. no correct answer
A. Catastrophic
A patient receiving ambulatory care at a hospital or other health facility without being admitted as a bed patient is called a (n) ___________
A. inpatient
B. outpatient
C. carrier
D. adjuster
B. Outpatient
An injury that prevents a worker from performing one or more of the regular functions of his job would be known as a _____________
A. partial disability
B. permanent disability
C. total disability
D. resultant disability
A. Partial disability
A previous injury, disease or physical condition that existed before the health insurance policy was issued is called __________
A. preexisting condition
B. prior exposure
C. foregoing condition
D. no correct answer
A. Pre-existing condition
one who belongs to a group insurance paln is called ___________
A. third -party payer
B. subscriber
C. carrier
D. no correct answer
B. subscriber
A sum of money provided in an insurance policy, payable for covered services is called ___________.
A. deductible
B. benefits
C. dues payable
D. premium
B. benefits
To prevent the insured from receiving a duplicate payment for losses under more then one insurance policy is called _______________
A. fee-for-service
B. hospital benefits
C. coordination of benefits
D. non duplication benefits
C. Coordination of benefits.
When a patient has health insurance, the percentage of covered services that is responsibility of the patient to pay is known as ___________
A. coinsurance
B. pre-defined policy
C. comprehensive
D. in percent policy
A. Coinsurance
Insurance that is meant to offset medical expenses resulting from a catastrophic illness is called __________
A. primary insurance
B. major medical
C. whole life policy
D. comprehensive
B. Major medical
An unexpected event which may cause injury is called ____________
A. dread disease rider
B. accident
C. adjuster
D. no correct answer
B. Accident
A doctor who agrees to accept an insurance companies pre-established fee as the maximum amount to be collected is called ___________
A. subscriber
B. claim representative
C. participating physician
D. adjuster
C. Participating physician
Insurance plans that pay a physician’s full charge if it does not exceed his normal charge or does not exceed the amount normally charged for the service is called ______________
A. usual, customary and reasonable
B. comprehensive
C. dual choice
D. no correct answer
A. Usual, customary and reasonable
A notice of insurance claim or proof of loss must be filed within a designated ___________ or it can be denied.
A. waiting period
B. policy date
C. time limit
D. grace period
C. Time limit
A health program for people age 65 and older under social security is called ____________
A. tri-care
B. Medicare
C. champva
D. workers compensation
B. Medicare
A civilian health and medical program of the uniform services is called__________
A. Tri-care
B. Medicare
C. Medicaid
D. Workers compensation
A. Tri-care
A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment is called _____________
A. Tri-care
B. champus
C. workers compensation
D. Medicaid
C. Worker’s compensation
A recap sheet that accompanies a Medicare or Medicaid check, showing breakdown and explanation of payment on a claim is called _________
A. fee-for-service
B. explanation of benefits
C. coordination of benefits
D. dual choices
B. Explanation of benefits
A type of insurance whereby the insured pays a specific amount per unit of service and the insurer pays the rest of the cost is called ____________
A. co-payment
B. coordination of benefits
C. deductible
D. indemnity
A. Co-payment
In insurance, greater coverage of diseases or an accident, and greater indemnity payment in comparison with a limited clause is called _____________
A. co-payment
B. comprehensive
C. deductible
D. major medical
B. Comprehensive
A rider added to a policy to provide additional benefits for certain conditions is called ______________
A. hospital benefits
B. dread disease rider
C. preexisting conditon
D. no correct answer
B. Dread disease rider
An interval after a payment is due to the insurance company in which the policy holder may make payments, and still the policy remains in effect is called ___________________
A. extended benefits
B. grace period
C. coordination of benefits
D. lapse time
B. Grace period
An agreement by which a patient assigns to another party the right to receive payment from a third party for the service the patient has received is called ____________
A. assignment of benefits
B. coordination of benefits
C.non duplication of benefits
D. no correct answer
A. Assignment of benefits
A skilled nursing facility for patients receiving specialized care after discharge from a hospital is called _____________
A. extended care facility
B. post care facility
C. nursing home
D. no correct answer
A. Extended care facility
Payment for hospital charges incurred by an insured person because of injury or illness is called __________
A. hospital benefits
B. catastrophic health benefits
C. extra help benefits
D. no correct answer
A. Hospital benefits
An agent of an insurance company who solicits or initiates contracts for insurance coverage and services, and is the policy holder for the insurer is called ___________
A. insurance agent
B. claim representative
C. carrier
D. member physician
A. Insurance Agent
A method of charging whereby a physician presents a bill for each service rendered is called ____________
A. non duplication of benefits
B. fee-for-service
C. monthly statement
D. no correct answer
B. fee-for-service
The tri-care fiscal year is from __________
A. January 1 to December 31
B. October 1 to September 1
C. October 1 to September 30
D. July 1 to June 30
C. October 1st to September 30th
The number on the Employees Withholding Exemption Certificate is ____________
A. W-2
B. W-4
C. 1040
D. W-3
B. W-4
FICA provides benefits for ___________
A. Medicare
B. social security
C. old age
D. aid to dependent children
B. Social security
As part of the office bookkeeping procedures, the physicians bank statement should be reconciled with the ____________
A. daily ledger
B. buisness ledger
C. personal ledger
D. checkbook
D. Checkbook
A record of debits, credits, and balances is referred to as a patient’s _____________
A. sheet
B. chart
C. ledger
D. slip
C. Ledger
A signature on the reverse side of a check is called ____________
A. kiting
B. endorsment
C. reconciliation
D. signature card
B. Endorsement
A form to itemize deposits made to savings or checking accounts is called _________
A. deposit slip
B.money order
C. check guarentee
D. no correct answer
A. Deposit slip
To correct a handwritten error in a patient’s chart, it is only acceptable to ____________
A. white it out neatly and insert the correct information
B. write over the error
C. scratch through the error so it cannot be read
D. draw a line through the error, insert the correct information. date and inital it.
D. draw a line through the error, insert the correct information, date and initial it
Low income patients can be covered by what type of insurance ___________
A. Medicaid
B. Medicare
C. Tri-care
D. blue cross/blue shield
A. Medicaid
The reference procedural code book that uses a numbering system developed by the AMA is called a (n) _____________
A. reference manual
B. current procedural terminology
C. insurance claim manual
D. manual for current procedures
B. Current procedural terminology.
_____________ is a method used for determining whether a particular service or procedure is covered under a patient’s policy.
A. informed consent
B. preauthorization
C. precertification
d. no correct answer
C. Precertification
The International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) is used to code ____________
A. procedures
B. diagnoses
C. services rendered
D. medications
B. Diagnoses
In insurance coding using an “E” code designates ________
A. a factor that contributes to a condition or disease
B. classification of enviormental events, such as poisioning
C. the primary diagnosis
D. cancers
B. classification of environmental events, such as poisioning.
E/M codes are located in the _________ manual
A. CPT
B. ICD-9-CM
C. ICD-10-CM
D. HCPC
A. CPT
Which codes can modifiers be added to, to indicate that a procedure or service has been altered in some way?
A. CPT
B. ICD-9-CM
C. ICD-10-CM
D. all of the choices
A. CPT
The _______________ form is used by non-institutional providers and suppliers to bill Medicare, part B covered services?
A. HCPA-1000
B.CPT
C.CMS-1500
D.UB92
C. CMS-1500
