Anatomy and Physiology
What system is responsible for carrying oxygen, nutrients, and waste through the body to all tissues?
Circulatory/Cardiovascular
Which of the following statements regarding copayments is NOT true?
Many insurance plans require the policyholder to pay a copayment for medical services rendered.
Most health insurance plans require a copayment for wellness exams.
Copayment amounts are typically disclosed to the policyholder before they select a plan.
A copayment is a fixed amount that an individual must pay for a specific medical service or medication.
B. Most health insurance plans require a copayment for wellness exam.
What is often photocopied during patient registration?
Drivers License
Insurance Card(s)
Patient demographics include a patient’s _____.
C Phone Number
Amari is covered by two insurance plans. Which statement regarding the coordination of benefits is true?
The primary insurance plan must be billed first.
The secondary insurance plan must be billed first.
Following coordination of benefits, reimbursement may exceed the initial/actual cost of services billed for.
Both insurances must be billed at the same time.
A. The primary insurance plan must be billed first.
How does undercoding differ from upcoding?
Undercoding does not report the full extent of services, whereas upcoding bills for more expensive services than those provided.
Which muscles are voluntary?
Skeletal
Melinda goes to her primary care physician for an annual physical exam. She has a $500 deductible and an 80/20 coinsurance plan. Her health insurance plan pays 100% of preventative-care costs, which are not applied to the yearly deductible. The charge for her visit is $750. How much will Melinda have to pay?
$0
At what stage of the revenue cycle is a clearinghouse involved?
claims submission
Verification of insurance in real time is done by ____.
EDI
The birthday rule is determined by the_____.
Parents or guardian's birth date and birth month.
______ occurs when providers do not report all the services provided or code for services that are lower than the level of care that was given to the patient.
undercoding
What term means "away from the point of attachment?"
Distal
Shreya has paid $250 toward her $500 deductible. She has an 80/20 plan. She sees her primary care physician for hypertension. The total allowed charge is $150. What is her payment responsibility?
$150
Why should a patient’s insurance coverage be recorded as primary, secondary, and tertiary?
to submit claims in the order in which each plan should pay.
A(n) _____ needs to be issued to a Medicare beneficiary when a service most likely will not be covered by insurance.
ABN
__________ is generally known as the payer of last resort.
Medicaid
HIPAA defines information such as patient names, addresses, dates of birth, IP addresses, and URLs as ___________
patient identifiers
What structure connects the kidneys and the bladder?
Ureter
Jessica sees a specialist for carpal tunnel syndrome. The total allowable charge is $150. She has met $400 of her $500 deductible and has an 80/20 coinsurance plan. How much is Jessica responsible for?
$110
Which action should a medical biller take when a claim has not been paid within 30 to 45 days?
contact the insurance plan
The ______________ should contact the insurance plan to obtain preauthorization for a referral.
Referring Provider
Medicaid, by law, will only pay claims that have exhausted all other sources of coverage. This regulation is known as _____________________.
Third-Party Liability
A physician’s office develops a user-friendly process for staff members to report suspected billing fraud and abuse. Which recommended component of a compliance program does this example demonstrate?
Open Lines of Communication
The wrist is ___ to the elbow.
distal
inferior
For his employer-sponsored health insurance plan, Marco is responsible for paying $798 a year, which is divided evenly by the number of pay periods in the year and automatically deducted from each paycheck. Marco is paid monthly. How much will be taken out of each monthly paycheck?
$66.50
$798 a year divided by 12 = $66.50
What information is provided to the healthcare provider on an electronic remittance advice (ERA)?
4 things, list at least 2
patients name
amount paid for service
amount charged by the provider
date of service
Which of the following statements regarding EDI is true?
C It is an electronic method of communicating standard transactions.
In certain circumstances, the _____ can decide which insurance will be billed first when a dependent has two insurance plans.
Court
A healthcare provider identifies several overpayments during the self-disclosure process outlined in the OIG provider self-disclosure protocol. What must the provider do?
Return all overpayments to the government
review a random sample of 100 claims to estimate damages