Chapter 12 and 13 Test

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

Claim

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

Co-insurance

A set dollar amount that the policyholder must pay for each office visit is:

Copayment

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

Deductible

Determined the cause of a conditions, illness, disease, injury, or congenital defect describes which of he following terms?

Diagnosis

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

Eligibility, Benefits and exclusions, Effective date of insurance

The branch of medicine dealing with the incidence, distribution, and control of disease in a population and prevalence of disease in large population and with detection of the source and cause of epidemics of infections diseases describes which of the following terms

Epidemiological

The study of the causes or organ of disease describes which of the following terms?

Etiology

A document sent by the insurance company to the provider and the patient explaining the allowed charge, the amount reimbursed for service, and the patient's financial responsibilities is:

Explanation of benefits

Which of the following are not reviewed by utilization review committee?

Fees fro services provided

A policy that covers a number of people under a single contract issued to the employer:

Group Policy

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

HMOs

Which of the following managed care plans require preauthorization for medical services such as surgery?

HMOs, PPOs, EPOs

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

Health maintenance organizations

The medical assistant should never code a patient as having________unless it is clearly documented as confirmed in the medical record.

Human Immunodeficiency Virus

Accepted e healthcare services appropriate fro evaluation and treatment of a disease, conditioning, illness, or injury and consistent with the applicable standard of care describes which of the following terms?

Medically necessary

Medigap policies cover which of the following?

Medicare deductible Medicare co-insurance Services not covered under Medicare

Which of the following expenses would be paid by Medicare Part B?

Physician's office visits

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

Policy

The amount of money paid to keep an insurance policy in force is the:

Premium

Most of today's health insurance policies cover which of the following?

Preventive care and procedures deemed medically necessary

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

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

ICD-10-CM uses up to______ characters to identify a disease or injury:

Seven

Burns are coded by:

Site and degree and the body surface involved

At times, the medical assistant must code a(n)____________if the physician is not yet sure of the diagnosis.

Symptoms

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

TRICARE

The code for HIV indicates which of the following

The HIV virus is present

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

Utilization review

To make repayment to for expense or loss incurred describes which of the following terms?

reimbursement

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

CHAMPVA

The signs and symptoms of a disease are its_____________

Manifestations

The Federal and state-sponsored health insurance program for the medically indigent is called:

Medicaid

The health insurance model that offers the most flexibility for patients is:

Traditional health insurance

A type of insurance that protects workers form loss of wages after an industrial accident that happened on the job is called:

Workers' compensation

The international classification of disease was establishes by:

World Health Organization