FINANCIAL MANAGEMENT & INSURANCE

Question 1

YOU HAVE A PATIENT WHO IS COVERED BY BOTH TRICARE & MEDICARE. WHO WOULD BE THE PRIMARY PAYER?

Answer 1

medicare

Question 2

WHAT ARE SOME CONDITIONS OF MEDICARE COVERAGE

Answer 2

applicant must be over 65, must live in the usa for at least 5 years. Must have worked in a job with medicare covered employment for at least 10 years

Question 3

WHAT IS CO-PAY

Answer 3

co-pay is a set fee the insured must pay at the time service, after which point the insurance will pay for the rest of the remaining cost

Question 4

WHAT DO HCPCS LEVEL ll CODES COVER

Answer 4

non -physician services and products not covered in level 2 codes
Ambulance, and durable medical equipment

Question 5

TANGIBLE —— INCLUDE MEDICAL EQUIPMENT, REAL ESTATE OR LEASEHOLD IMPROVEMENT, INVENTORY AND PERSONAL PROPERTY

Answer 5

ASSETS

Question 6

WHAT FORM MUST BE PROVIDED TO EMPLOYEES ANNULALLY AND IS NECESSARY FOR THEM TO COMPLETE THEIR INDIVIDUAL TAX RETURN

Answer 6

W-2

Question 7

WHEN DISCUSSING CODING, FOR WHAT DOES THE ACRONYM CPT MEAN

Answer 7

CURRENT PROCEDURAL TERMINOLOGY– MOST WIDELY ACCEPTED CODE FOR REPORTING MEDICAL PROCEDURES AND SERVICES

Question 8

WHEN PATIENTS PAY A COPAY AT THE TIME OF THE SERVICE , ARE THEY CONSIDERED A THIRD- PARTY PAYER

Answer 8

NO

Question 9

WHAT DOCUMENTS MUST BE PROVIDED TO MEDICARE PATIENTS WHEN AN OFFERED SERVICE IS NOT COVERED BY MEDICARE

Answer 9

ADVANCE BENEFICIARY NOTICE– WRITTEN NOTICE THAT PROVIDES DETAILS ON ANY SERVICES OR ITEMS THAT ARE NOT COVERED

Question 10

WHAT FEDERAL LAW PROVIDES JOB- RELATED LEAVE TO EMPLOYEES FOR MEDICAL OR FAMILY REASONS

Answer 10

FMLA— family medical leave act

Question 11

IF A CLAIM DENIED AND THE PATIENT BELIEVES THE DENIAL IS UNJUSTIFIED, WHAT CAN THE PATIENT DO TO CONTEST THE DETERMINATION

Answer 11

REQUEST AN APPEAL–

Question 12

WHAT TERM DESCRIBES THE DIFFERENCE B/W THE ACTUAL MEDICAL CHARGE AND THE AMOUNT THE INSURANCE COMPANY IS WILLING TO PAY

Answer 12

WRITE - OFF AMOUNTSS

Question 13

WHAT FORM CONTAINS INFORMATION REGARDING THE NUMBER OF DEDUCTIONS AN EMPLOYEE CLAIMS

Answer 13

FORM W-4 lists employee elected withholdings and is completed at the time of hire

Question 14

WHAT IS THE TERM FOR MEDICAL CONDITIONS GROUPED TOGETHER FOR CODING PURPOSES

Answer 14

DIAGNOSIS RELATED GROUP- the system divides possible diagnosis into major body systems and further subdivides them into groups