115 medical insurance

Health insurance designed for military dependents and retired military personnel is called:

TRICARE.

Employee group plans usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected. However, these employee group health insurance plans offer limited benefits, and healthcare access is limited to healthcare providers that are contracted with them.

The first statement is true; the second is false.

A formal request for payment from an insurance company for services provided is:

claim

A standard, nationwide rule must be followed in establishing a records retention schedule.

false

Color coding is used only for patients' records and not for business records.

false

Physicians performing consultations still must request paper records on a patient, even if both the referring physician and the consulting physician are using an EHR system

false

Subjective information is that which the provider observes during the physical examination of the patient.

false

There are no government managed care plans.

false

Usually, more staff members are needed when an office uses an EHR system.

false

The health insurance mode that offers the least flexibility for patients is:

health maintenance organizations

A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services is:

preauthorization.

An approved list of physicians, hospitals, and other providers is a(n)

provider network.

An order from a primary care provider for the patient to see a specialist is a(n):

referral

The advantages of using the color-coding filing system are the following:

the use of color visually restricts the area of search for a specific record. a misfiled record is easily spotted even from a distance. you can use either the alphabetic or numeric color-coding system.

An organization that processes claims and provides administrative services for another organization is:

third-party administrator.

The most frequently used follow-up method is a:

tickler file.

A provisional diagnosis is not a final diagnosis and usually is made before test results are received.

true

The patient's health record should never leave the office.

true

If Mr. Jones's insurance has a $500 deductible and then pays 80% of the charges, how much will his policy pay on his bill of $4,359?

$4359 - $500= $3859 $3,859 × 0.8 = $3,087.20.

How are corrections made to the electronic health record?

A new entry or addendum must be added close to the original entry with the correct information and then initialed

Which of the following is not an advantage of managed care?

Access to specialized care and referrals is limited.

Which of the following plans require healthcare providers to become participating providers?

All government-sponsored health plans and most privately sponsored health plans

Which of the following is not a disadvantage of managed care?

Authorized services usually are covered.

Veterans of the U.S. armed forces may be covered by:

CHAMPVA.

Which of the following functions of an electronic record can store lists of billing codes and current procedural terminology?

Charge capture

RBRVS consists of three parts, including which of the following?

Charge-based professional liability expenses Charge-based overhead Provider work

Which part of Medicare covers prescription drug services?

D

The medical assistant should always verify which of the following prior to the patient's appointment?

Effective date of insurance Eligibility Benefits and exclusions

Which of the following are common types of filing equipment found in a medical office?

Lateral files Rotary circular files Automated files

Medigap polices cover which of the following?

Medicare deductible Medicare co-insurance Services not covered under Medicare

Which of the following indirect filing systems is used by a majority of large clinics and hospitals?

Numeric filing

Which of the following is not a method of organizing a medical record?

Progressively

Which type of referral is usually processed immediately?

STAT

Which of the following referrals can be approved online when it is submitted through the provider's web portal to the utilization review department?

STAT referral

A payment method in which providers are paid for each individual enrolled in a plan, regardless of whether the person sees the provider that month, is called a ______ plan.

capitation

A certain percentage of the allowed amount that the policyholder is responsible for is:

co-insurance.

The amount of money the policyholder pays per claim before the insurance company will pay on the claim is known as the:

deductible.

The provider who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

participating

A written agreement between two parties, where one party agrees to pay another party if certain specified circumstances occur is a:

policy.

Medical facilities should keep records on minors for how long?

Until the minor reaches the age of majority, plus the statute of limitations

A review of individual cases by a committee to make sure that services are medically necessary is called a(n):

utilization review.

Which of the following is not an advantage of a numeric filing system?

Filing activity is greatest when the system is initiated.

The medical assistant should consider which of the following when selecting filing equipment?

Fire protection Cost of space and equipment Confidentiality requirements

Which section of the law, commonly known as the Economic Stimulus Package, pertains to healthcare?

HITECH Act

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

TRICARE

Who ultimately decides whether a medical record can be released?

The patient

What is the most important reason for telling the physician when a charting error is discovered later?

To protect the patient's health and well-being

For a record to be admissible as evidence in court, the person dictating or writing the entries must be able to attest that they were true and correct at the time they were written. The best indication of this is the provider's signature or initials on the typed or EHR entry.

both true

Information contained in an electronic health record usually can be accessed from several different physical places.

true

The software of an EHR system can be designed to be compatible with a medical specialty office, such as pediatrics or oncology.

true