Chapter 1

Question 1

Which of the following statements describes a major trend in the healthcare industry

Answer 1

There is a shift of payment responsibility from employers and and insurance companies to patients

Question 2

Accounts receivable are

Answer 2

Monies owed to a practice

Question 3

Which of the following statements are true of insurance specialist careers

Answer 3

The work of an insurance specialist is an increasing complex job

Good, experienced billing/coding specialist are in short supply

Employment in positions that help providers handle insurance demands is growing

Question 4

Which of the following statements are true of a medical insurance policy

Answer 4

Its a written policy

Question 5

A person or entity that supplies medical or health services and bills for them is called a

Answer 5

Providers

Question 6

Which of the following is true of current trends in the healthcare industry

Answer 6

Knowledgeable medical office employees are in demand

Question 7

Which of the following are reasons why the work of insurance specialists is an increasingly complex job

Answer 7

Providers deal with many health plans

Healthcare practices work with managed care contracts

Providers must follow federal and state regulation

Question 8

Movement of monies into or out of the business is called

Answer 8

Cash flow

Question 9

True about group plans

Answer 9

Dependents are customarily covered under the plans.

They cost less than individual plans

Question 10

A healthcare plan that covers the cost of hospitals and medical care is called

Answer 10

Medical insurance

Question 11

A service that has met BLANK is considered reasonable and consistent with generally accepted standards for the diagnosis or treatment

Answer 11

Medical necessity

Question 12

What type of insurance pays benefits and provides medical care for employees who are injured in job related accidents

Answer 12

Workers compensation insurance

Question 13

Which of the following is true about healthcare plans

Answer 13

There are two essential types

Question 14

A health plan that offers protection against loss is called a(n)

Answer 14

Indemnity plan

Question 15

Which of the following is true if the patient has a 70-30 coinsurance

Answer 15

The payer pays 70% and the patient pays 30%

Question 16

What are the two essential types of insurance plans

Answer 16

Indemnity and managed care

Question 17

What of the following are examples of patient premiums

Answer 17

Thomas Franks pays $500 a month for each of his employees so they can keep their insurance benefits.

Cindy Harrison pays $200 a month to maintain her insurance benefits.

Question 18

A(n) is an electronic or paper document that is filed to receive benefits

Answer 18

Healthcare claim

Question 19

What does it mean when a payment is retroactive

Answer 19

The fee is paid after the patient received medical services from physician

Question 20

Which type of plan is usually bought together by employer or organization

Answer 20

Group plan

Question 21

As system combining the financing and delivery of healthcare services is called

Answer 21

Managed care

Question 22

The amount the insured pays before benefits is called

Answer 22

Deductible

Question 23

What are the following examples of deductible

Answer 23

Alison Forrester must pay $2000 out-of-pocket before her benefits begin.

Anesha Wilks has to pay $500 out-of-pocket for herself and each of her dependents before her health plan will pay for services.

Question 24

An organization that pays for health insurance directly and sets up a fund from which to pay is called a(n)

Answer 24

Self funded health plan

Answer 25

Medicare Covers individuals who are age sixty-five and older, are disabled, or have end-stage renal disease Medicaid Covers low-income people who cannot afford medical care TRICARE Covers medical expenses for active-duty or retired members of the uniformed services and their dependents CHAMPVA Covers medical expenses for veterans with 100 percent service-related disabilities and their dependents

Question 26

Identify the statements that are true of managed care plans.

Answer 26

They are the predominant type of insurance. Thousands of different plans are offered.

Question 27

A series of steps that leads to maximum, appropriate, and timely payments for patients' medical services is called the

Answer 27

Revenue Cycle

Question 28

Which of the following are true of self-funded health plans

Answer 28

An account is set up by the organization from which to pay claims. The organization assumes the risk of paying directly for medical services. The organization establishes the benefit level and the types of plans to be offered.

Question 29

Which of the following policies defines when bills have to be paid by patients in a medical practice?

Answer 29

Practices' financial policy

Question 30

Which of the following are objectives in the revenue cycle?

Answer 30

Ensure timely payment for medical services Ensure maximum reimbursement for services rendered Bill payers appropriately for services rendered

Question 31

Which of the following are part of step 3 (check in patients) of the revenue cycle?

Answer 31

Returning patient information is updated. The front and back of insurance cards are copied for the patient's record. Detailed information is collected for new patients.

Question 32

Which of the following tasks are part of step 1 (preregistering patients) of the revenue cycle

Answer 32

Demographic and insurance information is collected. Patients are asked about the medical reason for the visit upon scheduling. Appointments are scheduled and updated.

Question 33

A(n) is a code that identifies medical treatment or diagnostic services

Answer 33

Procedure code

Question 34

Actions that satisfy official requirements are considered

Answer 34

Compliance

Question 35

Which of the following procedures are followed to determine financial responsibility

Answer 35

Determine the first payer if there is more than one health plan Verify patients' eligibility for their health plan Check the health plan's coverage Meet the payers' conditions for payment

Question 36

Which of the following are true of patient billing

Answer 36

Most practices have a standard fee schedule that lists usual fees. Following billing rules ensures billing compliance. Whether a code can be billed depends on the payer's rules.

Question 37

Which of the following are true of compliance in the area of coding

Answer 37

Diagnoses and services documented should be linked for medical necessity. Official guidelines should be followed when codes are assigned. Diagnostic and procedure codes must be checked for errors.

Question 38

Accounts receivable

Answer 38

Monies owed to a medical practice used to run the practice