MA2 CH. 14 HW

The standard electronic format of the​ CMS-1500 is the​ ___________.

837P

Which statement about covered entities is true​?

A covered entity is anyone who submits electronic claims to Medicare.

Which of the following situations would not require a claim to be filed with property and casualty​ (P/C) insurance​ company?

An injury occurring at work

Mary has seen a gastroenterologist who prescribes an upper GI series. When should the precertification for the upper GI series be​ obtained?

Before Mary goes to the hospital for the procedure.

Which of the following reasons is least likely to qualify as a medical​ necessity?

Cosmetic

What is the first step in verifying a​ patient's eligibility of​ services?

Determine the​ patient's relationship to the insured.

Which of the following is a false statement regarding the Health Insurance Exchange​ (HIE)?

Each state must establish their own HIE for its residents.

Which form of private insurance is usually the least​ expensive?

Group insurance

Which of the following terms​ can't be interchanged with the​ others?

Health Insurance Exchange​ (HIE)

In which of the following cases would CHAMPVA be billed​ first?

If the patient has Medicaid

Which of the following is correct about Item 12 on the​ CMS-1500, Patient's or Authorized​ Person's Signature?

It allows the release of any medical information to the insurance company for billing purposes.

Which of the following is considered a disadvantage of managed​ care?

It has preauthorization requirements.

Which of the following statements is false regarding genetic predisposition to developing a disease in the​ future?

It is legal for health insurance companies to charge higher premiums if a person has a genetic predisposition to future disease.

Which of the following is a government insurance program designed primarily for​ low-income people?

Medicaid

Which of the following statements about the​ CMS-1500 is incorrect​?

Medical assistants use one source document to complete the​ CMS-1500.

Prescription drug coverage is covered in which of the​ following?

Medicare Part D

Which of the following is a characteristic of an​ HMO?

Members must seek care from a list of providers who have contracted with the HMO.

Which managed care plan gives subscribers a list of network providers whom they may see for a lower​ cost?

PPO

What is the assignment of​ benefits?

Patient authorization for the insurance company to pay the provider for services

In​ 2008, Congress passed GINA which stands for

The Genetic Information Nondiscrimination Act.

A referral was never obtained for Mary to see a specialist for her stomach pains. She was still seen by the specialist. Which of the following statements it true in regards to her managed care​ plan?

The insurance company can deny the service and Mary​ won't be billed for the service.

What happens if a preauthorization or precertification is​ denied?

The patient may begin an appeal process.

With managed care​ plans, who is responsible for providing a referral for a visit to a​ specialist?

The primary care provider

Which of the following is NOT a true statement about the verifying​ eligibility?

Verification of benefits guarantees payment.

When verifying a​ patient's insurance​ eligibility, the medical assistant may not need to do which of the​ following?

Verify coordination of benefits rules

All of the following questions are commonly listed on a verification of benefits worksheet except​:

What is the appointment date and​ time?

When does the insurance process​ begin?

When the patient makes an appointment

An individual who qualifies for a government health insurance policy is known as​ a(n) ______.

beneficiary

​A(n) ____________ is an example of an​ out-of-pocket expense that a patient is responsible for paying for health care services.

deductible

During the process of gathering patient information for reimbursement​ purposes, the medical assistant​ should:

determine if the patient has both primary and secondary insurance coverage.

An​ _______________ procedure is treatment that is not critical but may benefit the patient.

elective

Electronic transactions are also called EDI which stands for

electronic data interchange.

The medical assistant who is completing the​ CMS-1500 uses the​ ___________ to obtain information about date of​ service, services​ rendered, and treating provider.

encounter form

Each of the following is considered the role of a medical assistant in insurance claim processing except​:

establishing a fee schedule of charges by service.

By developing medical insurance related​ skills, the medical assistant can do all of the following except​:

identify as a certified professional medical coder.

An HMO that is formed by an association of physicians with separately owned practices that contracts with managed care plans is called​ a(n) __________.

independent provider association​ (IPA)

​GINA, an Act passed by Congress in​ 2008:

makes it illegal for health plans to deny individuals health care coverage because that person may have a genetic predisposition to developing a disease in the future.

In relation to​ workers' compensation​ insurance, an occupational​ injury:

may include an injury that occurs during a paid break.

The person who owns the health insurance policy is called the​ _______

member

The​ _____________ is a​ unique, ten-digit number assigned to health care providers by the CMS.

national provider identifier

The first step in gathering patient information is​ to:

obtain accurate patient demographics.

A patient who has a diagnosis prior to beginning coverage with a new insurance plan is said to have​ a(n) _______________.

pre-existing condition

An insurance policyholder pays​ a(n) ___________ to the insurance carrier to purchase commercial health insurance.

premium

A precertification​ number:

should be documented in the​ patient's medical record.

A worker who is able to return to modified work at a later time following an injury would post which type of​ workers' compensation​ claim?

temporary disability

The individual mandate places the burden of acquiring health insurance on

the individual.

Which of the following individuals is most likely to complete a​ CMS-1500 Claim Form in a small physician​ office?

the ma

When completing the​ CMS-1500 for an urgent care​ facility, the place of service code​ __________ would be entered in item​ _______________.

​20; 24B

Which of the following is a false statement about Blue​ Cross/ Blue Shield​ (BC/BS)?

​BC/BS does not offer​ fee-for-service plans.

When calling to obtain a precertification for services. What piece of information is NOT​ needed?

​Patient's diagnosis date

Which piece of information is not required when processing a​ referral?

​Patient's emergency contact information

Which of the following regulates property and casualty​ insurance?

​States' Departments of Insurance

Which of the following statements is incorrect​?

​Workers' compensation programs are​ HIPAA-covered entities.

The goal of PPACA is to help​ ___________________ the number of uninsured Americans and​ ___________________ the overall costs of health care.

​decrease; reduce