EHR 9
When did Medicare health coverage begin?
1965
The official name for Obamacare is
Affordable Care Act.
Which of the following is included in the revenue cycle management?
All of the answers are correct
Which report lists every patient account, allowing the billing staff to identify claims that need to be billed or rebilled and insurance payers that need to be contacted regarding lack of payment?
Billing/Payment Status Report
Which of the following would be used to bill for services provided in a physician's office?
CMS-1500
A federal law that may allow individuals to temporarily keep health coverage after their employment ends is known as:
COBRA.
The RBRVS sets fees for which of the following codes?
CPT® and HCPCS
Which of the following is an example of a third-party payer?
Commercial insurance
A fee schedule is a national price list of services and procedures that must be adopted by all healthcare providers.
False
A health record serves as legal documentation as long as it is in a paper format.
False
Fee for service is the average or maximum amount that may be reimbursed per service, procedure, or item to the provider from the insurance payer.
False
Healthcare facilities typically only receive reimbursement from patients and the government payors such as Medicare and Medicaid.
False
Medicaid is a federal-administered health insurance program for low-income families and children, pregnant women, the elderly, people with disabilities, and in some states, other qualified adults.
False
Medicare Part B help cover hospital inpatient stays and outpatient physician office visits.
False
A type of health insurance plan that usually limits coverage to include care only from doctors who work for or contract with the HMO is known as a(n):
HMO
When do healthcare facilities initiate the billing process for patient visits or admissions?
Immediately following a patient's visit or patient's admission
Which of the following Medicare programs helps pay for prescription drugs?
Medicare Part D
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers is called a(n):
PPO
Which of the following reports lists a practice's daily activity?
Patient Day Sheet
Frequent and routine of monitoring of billing and collections reports is necessary to ensure the practice is receiving the correct monies owed.
True
HIPAA regulations require that most claims now be processed electronically.
True
Health coverage is the legal entitlement to payment or reimbursement for healthcare costs, under a contract with a health insurance company or other payer.
True
Not all healthcare providers are able to receive reimbursement from all insurance payers.
True
Which of the following would be used to bill for services provided in a hospital?
UB04
Which of the following best describes Medigap?
a health insurance that supplements Medicare coverage
Which of the following services would be most likely covered by Medicare Part A?
a hospital admission
Which of the following services would be most likely covered by Medicare Part B?
a visit to a physician
Patient bills are checked for errors via a process called
claim scrubbing
According to the revenue cycle management, which process(es) should be done before the claims submission?
coding and billing
The amount that the insured individual must pay to the healthcare provider before the health insurance company pays their portion is called which of the following?
deductible
The Production by Provider Report may be used for a variety of reasons, including all except
determining the amount due to insurance payers.
An itemized form that allows charges to be captured from a patient visit is called a(n):
electronic superbill.
TRICARE is an example of a(n):
government-sponsored healthcare program.
The legal entitlement to payment or reimbursement for healthcare costs is known as
health coverage.
The billing aspect of a medical practice includes all of the following, except:
hiring billing personnel.
A traditional insurance plan is also
indemnity plan.
Which of the following includes expenses for medical care that aren't reimbursed by the insurance company?
out-of-pocket amount
Kaiser Foundation Group is an example of a(n):
private payer plan
A _____ is an activity that is performed on an individual to improve health, treat disease or injury, or identify a diagnosis.
procedure
Medicare uses the _____ to create the CMS Medicare Physician Fee Schedule (MPFS).
resource-based relative value scane (RBRVS)
The ACA provides Americans with better health security by putting in place comprehensive health insurance reforms that will do all of the following except:
restrict coverage
A ______ is the person who pays for health insurance premiums; _______ are the people who benefit from the health insurance.
subscriber; covered dependents
Which of the following best describes integrated care?
systematic coordination of healthcare for patients
A subscriber is
the person who usually pays for the cost of the insurance.
What is a characteristic of preferred provider organizations?
they provide more physician options for patients