Theory chapter 10 & 12
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 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
Charge capture relates to charges for missed appointments.
false
Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary
false
PHI stands for "private health information."
false
Subjective information is that which the provider observes during the physical examination of the patient.
false
The EMR relates to more than one healthcare organization.
false
The computer-based record has no disadvantages, whereas the paper-based record has numerous disadvantages.
false
The system is not capable of telling whether a certain procedure matches a specific diagnosis code.
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.
Someone who is poor, needy, or impoverished is considered:
indigent
The provider who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider
participating
The physical health record belongs to the:
physician or provider.
The process of moving an active file to inactive status is called:
purging
An organization that processes claims and provides administrative services for another organization is:
third-party administrator.
HITECH Act stands for Health Information Technology for Economic and Clinical Health Act.
true
Nearly all of the provider's income is derived from the insurance payments received for services rendered.
true
Reverse chronologic order is where the most recent item is on the top and older items are filed farther back.
true
The EHR system can allow patients to set their own appointments using the internet.
true
The patient's health record should never leave the office.
true
When documents are added to a patient's paper record, the most recent information should be placed on top.
true
Most of today's health insurance policies cover which of the following?
Preventive care and procedures deemed medically necessary
Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?
TRICARE
A provider can choose whether to accept Medicaid patients
True
Numeric filing provides extra confidentiality to medical records.
True
Which of the following services must be covered by Medicaid in each state?
all are correct
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
The patient owns the medical record.
false
Very little statistical information can be gleaned from an EHR system.
false
An order from a primary care provider for the patient to see a specialist is a(n):
referral
Files for patients who have died, moved away, or otherwise terminated their relationship with the physician are called _____________ files.
closed
A certain percentage of the allowed amount that the policyholder is responsible for is:
co-insuarnces
A document sent by the insurance company to the provider and the patient explaining the allowed charge, the amount reimbursed for services, and the patient's financial responsibilities is:
explanation of benefits
Services that are needed to improve the patient's current health are considered:
medically necessary.
The amount of money paid to keep an insurance policy in force is the
premium
The allowed amount for Medicare charges is determined using:
resource-based relative value scale.
Organizations that fund their own insurance programs offer their employees:
self-funded plans.
The health insurance model that offers the most flexibility for patients is:
traditional health insurance
A provisional diagnosis is not a final diagnosis and usually is made before test results are received.
true
By legal definition, if it is not documented, then it did not happen.
true
Health records offer protection to the provider during legal proceedings if they are accurate and complete.
true
Information contained in an electronic health record usually can be accessed from several different physical places.
true
Less storage space is needed for EHR systems.
true
TRICARE is a form of government insurance for veterans of the U.S. armed forces.
true
The EHR allows access to patient information in an emergency.
true
The software of an EHR system can be designed to be compatible with a medical specialty office, such as pediatrics or oncology.
true
The three basic filing methods are alphabetic, numeric, and alphanumeric.
true
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
Which of the following are not reviewed by a utilization review committee
Fees for services provided
Medigap polices cover which of the following?
all are correct
RBRVS consists of three parts, including which of the following?
all are correct
The Affordable Care Act includes which of the following categories of essential health benefits?
all are correct
Which of the following managed care plans require preauthorization for medical services such as surgery?
all are correct
A designated person who receives funds from an insurance policy is:
beneficiary
A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services is:
reauthorization.