Exam 17: Insurance and Billing

If providers submit a claim for a simple procedure when in fact a more complicated procedure was documented in the medical record, ____ may occur.

Which of the following is correct regarding electronic claim submissions?

A husband and wife are both employed and have work-sponsored insurance plans that cover each other and their three children. Which insurance plan is the primary payer?

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities, such as ____, may be entitled to Medicare.

Which of the following is included in Medicare benefits for respite care?

The oldest and most expensive type of healthcare plans repay policyholders for costs of healthcare due to illness and accidents and are called ________ plans.

Which of the following is what the patient owes after the insurance company has paid?

Which of the following is not part of Medicare's resource-based relative value scale?

The benefit period for Medicare begins the day a patient goes into the hospital and ends when that patient has not been hospitalized for ____ days.

Eligibility for Medicaid is ____.

The total sum that the health plan will pay out over the patient's life is the lifetime ________ benefit.

Which of the following is not part of the process for verifying workers' compensation coverage?

The provider should have the patient sign a(n) ________ of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer.

The payment system used by Medicare is based on ____.

Patients who belong to a managed care health plan, such as an HMO, are responsible for a small per-visit fee collected at the time of the visit. This fee is commonly called a(n) ____.

Legal clauses in insurance policies that prevent duplication of payment are called ________ of benefits clauses.

The list of drugs approved by an insurance company is called a(n) ________.

A(n) ________ procedure is a medical procedure that is not required to sustain life and that is planned in advance to be done at the convenience of the physician or surgeon and the patient.

When entering data in medical billing programs, you should ____.