MEDA 160 Review Chapter 1,2,3

What does the abbreviation MSHP designate?
Multi-skilled Health Practitioner
Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring
MSHP’S
Administrative medical office responsibilities include
Claims Submission
A claims assistance professional
Both A & B; works for the consumer helps patients file insurance claims
What is “cash flow” in a medical practice?
The actual money available to a medical practice.
Front office medical duties have become increasingly important because
Diagnostic and procedure coding must be reviewed for its correctness and completeness.
Which level of education is generally required for one who seeks employment as an insurance coder?
Completion of an accredited program for coding certification.
Which organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirements for physician billing?
American Health info management Association (AHIMA)
The amount of money an insurance billing specialist earns is dependent on which of the following factors?
Knowledge, experience, and size of employing institution.
*All of the Above
A billing specialist is entrusted with
Holding the patients medical information in confidence, collecting money and being a
Medical etiquette refers to
Consideration for others
Medical ethics include
Standards of Conduct
The earliest written code of ethical principles for the medical profession is the
Code of Hammuriabi
What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?
The Principals of Medical Ethics
What should you do if you discover that a patient of your physician employer is under the care of another physician for the same ailment?
Notify your physician
Reporting incorrect information to private insurance carriers is considered
Unethical, illegal
Which code of ethics is most appropriate for an insurance billing specialist who handles medical records?
The American Health Information Association code of ethics
AHIMA publishes
Diagnostic and procedure coding competences for out patient services and diagnostic coding and reporting requirements

* All of the Above

A self-employed medical insurance biller who does independent contracting is responsible for
Advertising, billing, and accounting

* All of the Above

The Internet Healthcare Coalition has developed
The AHIMA code of ethics
Reporting incorrect information to government-funded programs is
Illegal
Insurance specialist certificate programs include
Anatomy, diagnostic coding, and computer technology
The doctrine stating that physicians are legally responsible for both their own conduct and that of their employees is known as
All of the Above
The AHIMA Code of Ethics is appropriate for
Health info, specialist, coders and insurance billing specialist.

*All of the above

Why are multiskilled health practitioners (MSHPs) in demand?
They’re cross trained to provide more than 1 function, they’re often competent in more than one discipline, and flexibility to their employer.

*All of the Above

Confidential information includes
What is read, what is heard, what is seen about the patient.

*All of the above

What is the correct response when a relative calls asking about a patient?
have the physician return the call
Nonprivileged information about a patient consists of the patient’s
City of residence
Exceptions to the right of privacy rule include
Gunshot wound cases and all infectious disease cases.
Confidentiality is automatically waived in cases of
Gunshot wounds, child rape, communicable diseases.

*All of the Above

When an insurance billing specialist bills for a physician and completes a Medicare claim form with information that does not reflect the true situation,
He/she maybe subject to fines and imprisonment.
What action could happen if an employee knowingly submits a fraudulent Medicare or Medicaid claim at the direction of the employer and subsequently the medical practice is audited?
The employee and the employer could be brought into litigation by the state or federal government.
To bill Medicare beneficiaries at a higher rate than other patients is considered
Abuse
Electronic media refers to
Computers, fax machines, internet, telephone, dial up telephone from one place to another.

*All of the above

The Office of Civil Rights enforces
Privacy Standards
What is the best response when telephoning a patient about an insurance matter and the patient’s voice mail is reached?
Use care in the choice of words when leaving the message
A uniform lexicon system used for managing patient electronic health records, information, indexing, and billing laboratory problems is called
SNOMED
The focus on the health care practice setting and reducing administrative costs and burdens are the goals of
HIPPA Title II Administrative simplification
Which statement is correct regarding the insurance industry?
The insurance industry is among the worlds largest business
Most legal issues of private health insurance claims fall under
Civil Law
When does the physician/patient contract begin?
When the physician accepts the patient and agrees to treat the patient
Most physician/patient contracts are
implied
When a patient carries private medical insurance, the contract for treatment exists between
The Physician and the patient
An emancipated minor is
a person younger than the age of 18 who lives independently
The contract in a workers’ compensation case exists between
The physician and the insurance company
In health insurance, the insured is also known as
The subscriber, the member, the policy holder

*All of the above

The insured is always
the individual enrollee or organization protected
The reason for a coordination of benefits statement in a health insurance policy is
to prevent duplication or overlapping of payments for the same medical expense
Mr. Talili has two medical insurance policies. To prevent duplication of payment for the same medical expense, the policies include a
Coordination of benefits statement
When a medical facility is sent correct reimbursement from an insurance company for professional services, the site receives
The idemnity, the payment, the check

*All of the above

If a child has health insurance coverage from two parents, according to the birthday law
The health plan of the persons whose birthday (month and day) falls earlier in the calendar year will pay first
According to the birthday law, if both the mother and the father have the same birthday
The plan of the person who has coverage longer is the primary payer
Conditions that existed and were treated before the health insurance policy was issued are called
Pre-existing
An attachment to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a/an
Waiver
What is the correct term used to determine if a procedure is covered and medically necessary?
Pre-authorization
Mrs. Thompsett leaves her place of employment. She is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as
Conversion Privilege
Why would conversion from a group policy to an individual policy be advantageous?
No physician examination is required
Mr. Ott was laid off from his job. He is protected by Consolidated Omnibus Budget Reconciliation Act (COBRA), which requires his employer to
extend group health insurance coverage for 18 months
What is the minimum number of employees a company must have to meet the criteria of the COBRA for continued medical benefits if an employee is laid off from a company?
20
The act created to protect workers and their families so that they can get and maintain health insurance if they change or lose their jobs is called the
Health Insurance Portability and Accountability Act (HIPPA)
An organization of physicians, sponsored by a state or local medical association, concerned with the development and delivery of medical services and the cost of health care is known as a/an
Foundation for Medical Care
A type of managed care organization created by the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA) that allows for enrollment of Medicare beneficiaries into managed care plans is a/an
Competitive Medical Plan
A state and federal program for children who are younger than 21 years of age and have special health care needs is
Maternal and Child Health programs (MCHP)
A patient intake sheet is also called a
Patient registration Form
The first document obtained in the initial patient visit is a/an
Patient information Form
Assignment of benefits is
The transfer of ones legal right to collect an amount payable under insurance contract.
An encounter form may also be known as a
Superbill
The source document for insurance claim data is the
Encounter Form
A daily record sheet used to record daily business transactions is called a/an
Daysheet
It is advisable to process insurance claims
in patches, grouping claims of patients who have the same type of insurance
An insurance claims register facilitates
follow up insurance claims
When the physician’s services have been submitted to the patient’s insurance company by the physician’s office, the patient should
send a monthly statement indicating the insurance company has been billed.