NCCT Billing certification extra study questions and answers

NCCT Billing certification extra study questions and answers Payment of premium deductible and coinsurance - Answer-Which conditions need to be met before payment is made under an Indemnity Plan? any provider - Answer-Under an Indemnity Plan, typically a patient may use the services of: after medical services are provided - Answer-Under a fee-for-service plan, the third party payer makes a payment: $680 - Answer-How much is owed for service of $1800 on an indemnity plan with a deductible of $400 and coinsurance rate of 80-20? percentage of each claim the insured pays - Answer-How is coinsurance defined? lower premiums charges and deductibles - Answer-Identify the advantages offered to patients in managed care plans as compared to indemnity insurance? patients and services provided by physician - Answer-Health care claims report data to payers regarding _______ and _______? first - Answer-When the coinsurance rates are stated, which number, the first or the second, represents the insurance companies rate? medical necessity - Answer-Correctly relating a patients condition and treatment refers to? HMO network or out of network - Answer-Patients who enroll in a point of service type of HMO may use the services of? choose out of network providers - Answer-When a POS option is selected under an HMO plan, the patient may? Open HMO - Answer-Identify another name for a POS plan. $2000 - Answer-If a physician has a contract to receive a capitation fee of $2000 monthly, based on a fee of $50 for each of 40 patients in the plan. If only 10 patients come within the month, how much will the physician receive? health related characteristics of the enrollees - Answer-On what is the PMPM rate usually based? not required - Answer-In a PPO plan, referrals are? medical bills - Answer-Consumer-driven health plans combine a health plan with a savings account that is used to pay what before the deductible is met? process of adjudication - Answer-The payers process of putting a claim through a series of steps designed to judge whether it should be paid? code of ethics - Answer-Professional organizations usually have a ____________ that its members should follow/possess. AMT (American Medical Technologists) - Answer-The designation of Registered Medical Assistant (RMA) is designated by? Type of treatment needed and duration - Answer-The progress report shows? cost reduction - Answer-EHR's have many advantages except? ARRA (American Recovery and Reinvestment Act) - Answer-Which Act contains additional provisions concerning the electronic transmission of healthcare data? address birthday and fax number - Answer-These are all examples of PHI. HIPAA Security Rule - Answer-_____________ requires CE's to establish safeguards to protect PHI. minimum necessary standard - Answer-When PHI is shared the ____________ should be observed. signature of person who shared PHI - Answer-An authorization to disclose PHI that a patient signs does NOT require? Alcohol abuse - Answer-Requires a specific authorization from the patient other that TPO. law enforcement - Answer-Must have patient authorization to release patient info to? No authorization is needed - Answer-To release PHI for Treatment, Payment and Operations (TPO): legal size of practices - Answer-Some state statutes differ except with: Attorneys - Answer-must have authorization to release PHI to: AHDI (Association for Healthcare Documentation Integrity) - Answer-Which agency advises against using the patients name in the body of the medical report? Description of what CE is doing to investigate breach - Answer-Breach notifications do not require ______________ to be included? Operating rules - Answer-The ACA requires the adoption of ____________ for each of the HIPAA Standard transactions. employers providers and health plans - Answer-When completely implemented, HIPAA National Identifiers will be available for: Identifiers - Answer-__________ are numbers of a predetermined length and structure such as a persons SSN.