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A practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? - Answer Qui Tam In which of the following circumstances ...
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Add to cartA practice agrees to pay $250,000.00 to settle a lawsuit alleging that the practice used x-rays of one patient to justify services on multiple other patients' claims. The office manager brought the civil suit. What type of case is this? - Answer Qui Tam In which of the following circumstances ...
The term for the set payment that the member pays to the healthcare provider on the day of service is the: a. office visit fee. b. co-insurance. c. copay. d. co-signer. - Answer c. copay. Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare insurance covera...
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Add to cartThe term for the set payment that the member pays to the healthcare provider on the day of service is the: a. office visit fee. b. co-insurance. c. copay. d. co-signer. - Answer c. copay. Blue Cross/Blue Shield identifies the individual or employee who pays for healthcare insurance covera...
Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. ...
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Add to cartJoe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. ...
Health plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: - Answer covered entity Which of the following is not a covered entity in the Privacy Rule - Answer healthcare consulting firm A request for medical records is received fo...
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Add to cartHealth plan, clearinghouses, and any entity transmitting health information is considered by the Privacy Rule to be a: - Answer covered entity Which of the following is not a covered entity in the Privacy Rule - Answer healthcare consulting firm A request for medical records is received fo...
Which statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 da...
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Add to cartWhich statement is TRUE regarding the Prompt Payment Act? a. Patients are required to pay patient balances within 30 days. b. Patient balances are dismissed if a statement is not sent to the patient within 30 days. c. Federal agencies are not required to respond to all clean claims within 30 da...
What does the acronym PHI stand for? a. Patient Healthcare Information b. Patient History of Illness c. Protected Health Information d. Protected Healthcare Index - Answer c. Protected Health Information A new radiology company opens in town. The manager calls your practice and offers to ...
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Add to cartWhat does the acronym PHI stand for? a. Patient Healthcare Information b. Patient History of Illness c. Protected Health Information d. Protected Healthcare Index - Answer c. Protected Health Information A new radiology company opens in town. The manager calls your practice and offers to ...
WHO IS COVERED BY CHAMPVA? A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES B) ACTIVE DUTY MILITARY AND THEIR FAMILIES C) RETIRED MILITARY AND THEIR FAMILIES D) ACTIVE DUTY MILITARY OVER THE AGE OF 65 - Answer A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR F...
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Add to cartWHO IS COVERED BY CHAMPVA? A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR FAMILIES B) ACTIVE DUTY MILITARY AND THEIR FAMILIES C) RETIRED MILITARY AND THEIR FAMILIES D) ACTIVE DUTY MILITARY OVER THE AGE OF 65 - Answer A) VETERANS WITH SERVICE - CONNECTED DISABILITIES AND THEIR F...
TPO - Answer Treatment, Payment & Operations CMPs - Answer Civil Monetary Penalties EDI - Answer Electronic Data Interchange HHS - Answer Health and Human Services TILA - Answer Truth in Lending Act ROI - Answer Release of Information OCR - Answer Office of Civil Righ...
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Add to cartTPO - Answer Treatment, Payment & Operations CMPs - Answer Civil Monetary Penalties EDI - Answer Electronic Data Interchange HHS - Answer Health and Human Services TILA - Answer Truth in Lending Act ROI - Answer Release of Information OCR - Answer Office of Civil Righ...
Abuse - Answer Actions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment - Answer Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable - Answer The a...
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Add to cartAbuse - Answer Actions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment - Answer Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable - Answer The a...
Local Coverage Determinations are administered by whom? a. State Law b. NCDs c. Each regional MAC d. LMRPs - Answer c. Each regional MAC ABN stands for _____. a. Advanced Benefits Notification b. Advisory Beneficial Notice c. Admitting Beneficiary Notice d. Advance Beneficiary N...
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Add to cartLocal Coverage Determinations are administered by whom? a. State Law b. NCDs c. Each regional MAC d. LMRPs - Answer c. Each regional MAC ABN stands for _____. a. Advanced Benefits Notification b. Advisory Beneficial Notice c. Admitting Beneficiary Notice d. Advance Beneficiary N...
A ______ indicates the location or type of service provided for an inpatient and is reported with _______. a. Revenue code; four-digit code b. Revenue code; three-digit code c. CPT code; five-digit code d. MSDRG code; three-digit code - Answer a. Revenue code; four-digit code Which of the...
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Add to cartA ______ indicates the location or type of service provided for an inpatient and is reported with _______. a. Revenue code; four-digit code b. Revenue code; three-digit code c. CPT code; five-digit code d. MSDRG code; three-digit code - Answer a. Revenue code; four-digit code Which of the...
What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? - Answer A deductible is the amount a policyholder pays for health care services before the health insurance begins to p...
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Add to cartWhat is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? - Answer A deductible is the amount a policyholder pays for health care services before the health insurance begins to p...
Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. ...
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Add to cartJoe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. ...
MUE is the acronym for: a. Medicare Unlikely Edits b. Medically Unnecessary Edits c. Medicare Unnecessary Edits d. Medically Unlikely Edits - Answer d. Medically Unlikely Edits Based on NCCI edits, when a procedure is bundled and has a CCM indicator of 0 - which of the following Modifiers...
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Add to cartMUE is the acronym for: a. Medicare Unlikely Edits b. Medically Unnecessary Edits c. Medicare Unnecessary Edits d. Medically Unlikely Edits - Answer d. Medically Unlikely Edits Based on NCCI edits, when a procedure is bundled and has a CCM indicator of 0 - which of the following Modifiers...
What is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? - Answer Deductible Which type of insurance covers physicians and other healthcare professionals for liability as to ...
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Add to cartWhat is the term for the total amount of covered medical expenses a policyholder must pay each year out-of-pocket before the health insurance company begins to pay any benefits? - Answer Deductible Which type of insurance covers physicians and other healthcare professionals for liability as to ...
What form is provided to a patient to indicate a service may not be covered by medicare and the patient may be responsible for the charges? - Answer ABN Under HIPAA what would be a policy requirement for "minimum necessary"? - Answer Only individuals whos job requires it may have access to ...
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Add to cartWhat form is provided to a patient to indicate a service may not be covered by medicare and the patient may be responsible for the charges? - Answer ABN Under HIPAA what would be a policy requirement for "minimum necessary"? - Answer Only individuals whos job requires it may have access to ...
When a claim has been paid, an EOB is sent to: a. the clearinghouse. b. the patient. c. the provider. d. the insurance company. - Answer b. the patient. Cost based fee schedules are developed using which of the following: a. RBRVS methodology b. total costs of every procedure or servi...
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Add to cartWhen a claim has been paid, an EOB is sent to: a. the clearinghouse. b. the patient. c. the provider. d. the insurance company. - Answer b. the patient. Cost based fee schedules are developed using which of the following: a. RBRVS methodology b. total costs of every procedure or servi...
Which coverage under TRICARE is a Medicare wrap around plan? a. TRICARE for Life b. TRICARE Reserve Select c. TRICARE Prime d. CHAMPVA - Answer a. TRICARE for Life A patient has Medicare and a Medigap policy. Box 13, signature on file, is checked off on the electronic claim submission. An...
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Add to cartWhich coverage under TRICARE is a Medicare wrap around plan? a. TRICARE for Life b. TRICARE Reserve Select c. TRICARE Prime d. CHAMPVA - Answer a. TRICARE for Life A patient has Medicare and a Medigap policy. Box 13, signature on file, is checked off on the electronic claim submission. An...
A physician received office space at a reduced rate for referring patients to the hospital's outpatient physical therapy center. What Law does this violate? 1. Anti-kickback Statute 2. Stark Law 3. False Claims Act 4. Truth in Lending Act - Answer Anti-Kickback Statute Rationale: The ant...
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Add to cartA physician received office space at a reduced rate for referring patients to the hospital's outpatient physical therapy center. What Law does this violate? 1. Anti-kickback Statute 2. Stark Law 3. False Claims Act 4. Truth in Lending Act - Answer Anti-Kickback Statute Rationale: The ant...
A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? A. Mother's insurance plan B. Father's insurance plan C. The policy that has the best benefits ...
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Add to cartA 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? A. Mother's insurance plan B. Father's insurance plan C. The policy that has the best benefits ...
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