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Insurance, Billing, and Coding Fundamentals Flashcards | StudBud
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Insurance, Billing, and Coding Fundamentals
Insurance, Billing, and Coding Fundamentals
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Answers
1
Which health program's member eligibility depends of the individual's income:
Medicaid
Medical
ChampVA
Tricare
2
What is Medicaid ?
Program who pays hospitals and healthcare facilities
Program that covers 80% of allowed charges
Program for low income individuals and children
Program that helps elderly veteran patients
3
What are the two major types of health plans ?
Manage care organizations
Fees for scheduling
Fees for service
Dual Coverage
4
T/F: A claims clearinghouse reviews information for errors (called scrubbing) before sending to insurance for payment:
False
True
5
How is eligibility for ChampVA determined ?
Patients with work related disabilities
Patients of ALL ages
Patients nearest to VA facility
Elderly patients who are veterans
6
Define PAR:
Provider who participates in an insurance plan
Patients who pay for their own insurance
Patients who have co-pay for their insurance.
Provider who pays for the whole procedure
7
An insurance policyholder can also be called what:
Copayer
Insured
Subscriber
Authorizer
8
ICD-10 Manual is for Diagnosis
True
False
9
Define co-insurance
Percentage of charges that the insurance pays the patient
Percentage of charges shared between the insurance plan and the patient.
Percentage of charges that the patient pays
Percentage of charges between the patient and the clinic
10
What are the TWO main sections of the ICD-10 manual:
Deductibles
Alphabetical Index
Benefits
Tabular List
11
What health care reform was enacted in 2010 to make healthcare more affordable ?
Affordable Care Act
Medicare
Tricare
Medical
12
When a person becomes eligible for social security they are also automatically enrolled in what health benefits program?
Medicaid
Medicare Part A
Medicare Part B
Tricare
13
Who is eligible for Tricare ?
Active Duty Personnel
New-to be - Mothers
The Olderly
Retired Military Personnel
14
What is the patient's coinsurance with Medicare Part B:
40%
20%
80%
30%
15
T/F: Medicare Part B covers Outpatients Services
True
False
16
Define assignment of benefits
Insures provider not to receive payments directly from the insurance
Insures provider receive payments directly from the insurance
17
Define Fee Schedule
Providers list of charges for services and procedures
Providers list of the fees within the schedule
Office list of ICD-10 codes
Providers list of charges during the day
18
T/F: When a claim is submitted electronically, the Remittance Advice will be received electronically
True
False
19
List all the government sponsored health insurance plan:
Tricare and ChampVA
Medicare
All of the abpve
Medicaid
20
What is coordination of benefits ?
The basic annual cost of healthcare insurance.
A health plan that agrees to carry the risk of paying for patient services
Prevents payment duplication when patient has more than one policy
A major type of health plan, it repays policyholders.
21
The type of managed care that requires you to use your PCP as the "gatekeeper" is :
HMO: Health Maintenance Organization
PPO: preferred provider organization
EOB: Explanation of Benefits
EOP: explanation of payment
22
What entity is considered a third-party payer ?
Fee Schedule
Preauthorization
Dual Coverage
Health Plan
23
Who is covered by ChampVA ?
All of the above
Veterans with total disabilities
Veterans with permanent disabilities
Veterans with service-related disabilities
24
What is a review of allowable benefits ?
Comparing office fees with online prices
Comparing physicians fee to patient plan health benefits
Comparing physicians with other physician plans
Comparing patient plan health benefits with other clinics
25
The majority of demographic information used on a claim is entered when:
After the appointment time
Day before the appointment
During the appointment time
Before the appointment time
26
What managed care program requires members to receive treatment only from one of it's participating providers ?
HMO
PPO
EOP
EOB
27
What do we code for using the CPT Manual ?
DRG Codes
National Drug Codes
ICD-10 Codes
Procedural Codes
28
What is Medi/Medi and who qualifies for it:
NONE OF THESE
Patients of all patients unable to pay for Medicare
Elderly patients who can get Medicare
Elderly patients but CANNOT pay for medicare
29
An EOB is also called:
Utilization Review (UR)
Remittance Advice (RA)
Allowed charge
Fee for service
30
When a patient has Medi/Medi coverage, which insurance is the primary prayer:
ChampVA
Medicare
Tricare
Medical
