I. Medical Office Management C. Financial Management

An inpatient is a term used to describe a bed patient in a hospital. This means that the patient is admitted to the hospital and stays overnight or for an extended period of time for medical treatment or observation. Unlike an outpatient who receives medical treatment without being admitted to the hospital, an inpatient requires a hospital bed and more intensive care. Therefore, the correct answer is inpatient.

Medicare is a health program specifically designed for individuals aged 65 and older under social security. It provides medical coverage and helps to cover the costs of hospital stays, doctor visits, prescription medications, and other healthcare services. Tri-Care is a healthcare program for military personnel and their families, Champva is a program for certain eligible veterans and their dependents, and Workers' Compensation provides medical benefits to employees who are injured or become ill due to their job. Therefore, Medicare is the correct answer in this context.

To correct a handwritten error in a patient's chart, it is only acceptable to draw a line through the error, insert the correct information, date, and initial it. This method ensures that the original error is still visible but crossed out, and the correct information is clearly indicated. By dating and initialing the correction, it provides a clear record of who made the correction and when it was done. This helps maintain the integrity and accuracy of the patient's chart.

An outpatient is a patient who receives ambulatory care at a hospital or other health facility without being admitted as a bed patient. This means that they visit the facility for medical treatment or consultation and then leave without being admitted or staying overnight. Unlike inpatients who are admitted and stay in the hospital, outpatients receive care on a non-residential basis.

An unexpected event which may cause injury is called an accident.

A form to itemize deposits made to savings or checking accounts is called a deposit slip. This slip is used to record the details of the deposit, such as the account number, the date, and the amount being deposited. It is typically provided by the bank to the account holder and is used as a proof of the deposit made. The deposit slip helps in ensuring that the funds are accurately credited to the correct account and also serves as a reference for both the bank and the account holder.

A person or institution that gives medical care is referred to as a "provider." This term is commonly used in the healthcare industry to describe healthcare professionals such as doctors, nurses, hospitals, clinics, and other healthcare facilities that offer medical services to patients. They are responsible for diagnosing and treating illnesses, injuries, and other medical conditions, and play a crucial role in delivering healthcare services to individuals in need.

Workers' Compensation is a form of insurance paid by the employer that provides cash benefits to workers who are injured or disabled while on the job. This insurance helps to cover medical expenses, lost wages, and rehabilitation costs for employees who are injured in the course of their employment. It is designed to protect both the employer and the employee by providing financial support and ensuring that injured workers receive the necessary care and compensation.

A previous injury, disease or physical condition that existed before the health insurance policy was issued is called a preexisting condition. This means that the condition was present before the individual obtained the insurance coverage, and it may have an impact on the coverage and benefits provided by the insurance policy.

A deductible is the amount that an insured person must pay out of pocket before their insurance policy benefits begin. This means that the insurer will only start covering the costs once the deductible has been met. It is a way for insurance companies to share the cost of insurance with policyholders and encourage responsible use of insurance benefits. The deductible amount can vary depending on the policy and is typically specified in the insurance contract.

A request for payment under an insurance contractor bond is called a claim. This is when the insured party requests compensation from the insurance company for a covered loss or damage. The claim is typically accompanied by supporting documentation and evidence to validate the request.

When a person signs the back of a check, it is known as an endorsement. This signature confirms that the person is authorizing the transfer of funds from the check to another party. Endorsements can be either blank (where only the signature is provided) or restrictive (where specific instructions are given). This step is necessary for the check to be legally valid and processed by the bank. The other options listed in the question (kiting, reconciliation, and signature card) do not accurately describe the act of signing the back of a check.

A participating physician is a doctor who agrees to accept an insurance company's pre-established fee as the maximum amount to be collected. This means that the doctor is willing to be part of the insurance company's network and has agreed to the terms and conditions set by the insurance company regarding payment for services rendered. By being a participating physician, the doctor can provide medical services to patients who have insurance coverage with that specific insurance company.

The correct answer is "explanation of benefits." This term refers to a recap sheet that accompanies a Medicare or Medicaid check and provides a breakdown and explanation of payment on a claim. It helps the recipient understand how their benefits were applied and what portion of the claim was covered by their insurance.

Tri-Care is the correct answer because it is a civilian health and medical program of the uniform services. It provides health benefits to military personnel and their families, as well as retirees and their families. Tri-Care offers a comprehensive range of health plans, including coverage for hospital stays, doctor visits, prescription medications, and specialty care. It is designed to ensure that military personnel and their families have access to quality healthcare services. Medicare, Medicaid, and Workers' Compensation are not specific to the uniform services and do not provide the same benefits as Tri-Care.

Medicaid is a type of insurance that provides coverage for low-income individuals and families. It is a government program that helps to cover medical expenses for those who cannot afford private insurance. Medicaid is specifically designed to assist low-income patients by offering them access to healthcare services, including doctor visits, hospital stays, prescription medications, and other necessary treatments. This program is funded jointly by the federal and state governments and is administered by each state individually. Therefore, Medicaid is the correct answer for covering low-income patients.

A payment made periodically to keep an insurance policy in force is called a premium. This payment is typically made on a monthly, quarterly, or annual basis and is required to maintain coverage under the insurance policy. The premium amount is determined by various factors such as the type of insurance, coverage limits, and the insured individual's risk profile.

Fee-for-service is a method of charging where a physician presents a bill for each service rendered. This means that the physician charges for each individual service provided to the patient, rather than charging a flat fee or a monthly statement. This method allows for more flexibility in billing and ensures that the physician is compensated for each specific service they provide. Non-duplication of benefits and monthly statement are not relevant to this method of charging.

An injury that prevents a worker from performing one or more of the regular functions of his job is known as partial disability. This means that the worker is still able to perform some of their job duties, but not all of them. It may require accommodations or adjustments to their work tasks or environment in order for them to continue working. This is different from permanent disability, where the worker is unable to perform any of their job functions, and total disability, where the worker is unable to perform any work at all. "Resultant disability" is not a recognized term in this context.

The International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) is used to code diagnoses. This coding system provides a standardized way to classify and categorize diseases, injuries, and other health conditions. By assigning specific codes to each diagnosis, healthcare professionals can accurately document and communicate information about a patient's condition. This coding system is used in medical billing, research, and healthcare data analysis.

A record of debits, credits, and balances is referred to as a patient's ledger. A ledger is a book or a computerized system that contains all the financial transactions of an individual or organization. It is used to track and record the movement of money, including debits (expenses) and credits (revenues or payments received). In the context of a patient, the ledger would contain all the financial transactions related to their medical expenses, payments, and balances.

A dread disease rider is a rider added to a policy to provide additional benefits for certain conditions. This rider typically covers specific serious illnesses or diseases, such as cancer, heart disease, or stroke. It offers financial protection by providing a lump sum payment or additional coverage if the policyholder is diagnosed with one of the covered conditions. This rider is designed to help policyholders cope with the high costs associated with treating these serious illnesses.

An agreement by which a patient assigns to another party the right to receive payment from a third party for the service the patient has received is called "assignment of benefits". This means that the patient authorizes someone else, such as a healthcare provider or insurance company, to collect payment from the third party on their behalf. This is a common practice in healthcare billing and insurance claims processing.

The CMS-1500 form is used by non-institutional providers and suppliers to bill Medicare, Part B covered services. This form is specifically designed for healthcare professionals and suppliers to submit claims for services rendered to Medicare beneficiaries. It includes important information such as patient demographics, diagnosis codes, procedure codes, and billing information. The CMS-1500 form is widely accepted and recognized by Medicare and other insurance payers, making it the correct answer in this context.

A health maintenance organization (HMO) is an organization that offers health insurance at a fixed monthly premium with little or no deductible and works through a primary care provider. HMOs typically require members to choose a primary care physician (PCP) who coordinates their healthcare and refers them to specialists if needed. This model focuses on preventative care and aims to keep healthcare costs low by emphasizing primary care and reducing the need for expensive specialist visits.

A subscriber refers to an individual who belongs to a group insurance plan. They are the primary policyholder and are responsible for paying the insurance premiums. The subscriber may also be responsible for enrolling other individuals, such as dependents, into the group insurance plan.

An agent of an insurance company who solicits or initiates contracts for insurance coverage and services, and is the policyholder for the insurer is called an insurance agent. They work on behalf of the insurance company to sell insurance policies to individuals or businesses, provide information and advice on insurance coverage, and assist with claims processing and policy renewals. They act as intermediaries between the insurance company and the policyholder, ensuring that the policyholder's needs are met and that they have the appropriate coverage for their specific requirements.

Insurance plans that pay a physician's full charge if it does not exceed his normal charge or does not exceed the amount normally charged for the service are referred to as "usual, customary, and reasonable." This means that the insurance company will cover the full cost of the service as long as it falls within the standard charges for that specific procedure or service. This ensures that the physician is paid fairly for their services and prevents excessive charges from being passed on to the patient.

Catastrophic health insurance provides coverage for severe or lengthy illnesses or disabilities that result in high treatment costs. This type of insurance is designed to protect individuals from financial burden in case of major medical expenses. It typically has high deductibles and lower monthly premiums compared to other health insurance plans. Catastrophic health insurance is suitable for individuals who are generally healthy but want coverage for unexpected and expensive medical events. It does not cover routine medical expenses or preventive care.

A co-payment is a type of insurance where the insured pays a specific amount per unit of service and the insurer covers the remaining cost. This means that the insured shares the cost of the service with the insurer, paying a fixed amount each time they receive a particular service. It is a common feature in many health insurance plans and helps to reduce the financial burden on the insurer while still providing coverage for the insured.

FICA stands for the Federal Insurance Contributions Act, which is a U.S. law that requires employees to contribute a portion of their earnings to fund Social Security and Medicare. Social Security provides benefits to retired workers and their dependents, as well as disabled workers and the families of deceased workers. Medicare provides health insurance for individuals who are 65 years or older, as well as certain younger individuals with disabilities. Therefore, the correct answer is social security, as FICA provides benefits for this program.

Using an "E" code in insurance coding is a way to classify environmental events, such as poisoning. This coding system helps to categorize and track specific causes of injuries or illnesses. It allows insurance companies to determine the cause of a particular condition or disease and assess the appropriate coverage and treatment options.

An adjuster is a person who represents either party of an insurance claim. They are responsible for investigating and assessing the damages or losses claimed by the insured party. Adjusters evaluate the validity of the claim, negotiate settlements, and ensure that the insurance policy terms and conditions are met. They play a crucial role in facilitating the claims process and ensuring fair and accurate settlements for both the insured and the insurance company.

Coinsurance refers to the percentage of covered services that a patient is responsible for paying when they have health insurance. It is the amount that the patient must contribute out of pocket, while the insurance company covers the remaining percentage. This helps to share the cost of healthcare between the patient and the insurance provider.

Coordination of benefits refers to the process of ensuring that a policyholder does not receive duplicate payments for the same losses from multiple insurance policies. This is important to prevent overcompensation and fraud. By coordinating benefits, insurance companies work together to determine the primary and secondary coverage for the insured, avoiding duplicate payments and ensuring that the insured receives the appropriate amount of compensation for their losses.

Major medical insurance is designed to provide coverage for significant medical expenses resulting from a catastrophic illness. This type of insurance typically has higher coverage limits and lower deductibles compared to primary insurance. It is meant to protect individuals from the financial burden of expensive medical treatments and procedures. Whole life policy and comprehensive insurance are not specifically tailored to cover medical expenses, while primary insurance refers to the basic coverage provided by an insurance plan.

When an insured person incurs hospital charges due to injury or illness, the payment made to cover these expenses is referred to as "hospital benefits". This term specifically relates to the financial assistance provided for medical treatment received in a hospital setting. It does not include catastrophic health benefits or extra help benefits, which may have different coverage and eligibility criteria.

An extended care facility is a skilled nursing facility that provides specialized care for patients after they have been discharged from a hospital. This type of facility is designed to offer ongoing medical attention and rehabilitation services to help patients recover and regain their independence. It is different from a nursing home because it focuses on providing short-term care for patients who need additional support and therapy before they can return home or to a less intensive care setting. Therefore, the correct answer is an extended care facility.

The correct answer is W-4. The Employees Withholding Exemption Certificate is commonly known as Form W-4. This form is used by employees to indicate their tax withholding preferences to their employer. It includes information such as the employee's filing status, number of allowances, and any additional withholding amounts. The employer uses this form to calculate the amount of federal income tax to withhold from the employee's paycheck.

The Tri-Care fiscal year is from October 1 to September 30. This means that the financial year for Tri-Care starts on October 1st and ends on September 30th of the following year. This fiscal year period is commonly used by organizations and governments to track and report their financial activities and budgets.

The correct answer is "current procedural terminology". This is the reference procedural code book that uses a numbering system developed by the AMA. It is commonly used in medical billing and coding to accurately describe medical procedures and services provided to patients.

In an insurance policy, the sum of money provided for covered services is referred to as "benefits". This refers to the amount that the insurance company will pay for medical expenses or other covered services as outlined in the policy. The benefits may include coverage for hospitalization, doctor visits, prescription drugs, and other healthcare services. The insured individual can avail these benefits when they require medical treatment or services covered by their insurance policy.

The correct answer is "checkbook". As part of office bookkeeping procedures, reconciling the physician's bank statement with the checkbook is necessary to ensure that all transactions recorded in the checkbook match the transactions recorded by the bank. This process helps identify any discrepancies or errors in the records and ensures the accuracy of the financial statements.

E/M codes are located in the CPT manual. CPT (Current Procedural Terminology) codes are used to describe medical procedures and services provided by healthcare professionals. The CPT manual is published by the American Medical Association (AMA) and is widely used in the United States for coding and billing purposes. It provides a comprehensive list of codes and descriptions for various medical services, including evaluation and management (E/M) codes that are used to document and bill for patient visits. Therefore, the correct answer is CPT.

Comprehensive coverage in insurance refers to a policy that provides a wider range of coverage for diseases or accidents compared to a limited clause. It offers greater protection and higher indemnity payments, ensuring that the policyholder is adequately covered in various situations. This type of coverage is often preferred by individuals who want more extensive insurance protection.

Indemnities are benefits that are provided in the form of cash payments. They are usually given as compensation or reimbursement for a loss or damage. Deductibles refer to the amount of money that an individual is required to pay before their insurance coverage kicks in. Medical co-pays are the fixed amount that an individual has to pay for each medical service or prescription. Cash advances are short-term loans that are typically given by credit card companies. Therefore, the correct answer is indemnities.

Pre-certification is a method used for determining whether a particular service or procedure is covered under a patient's policy. This process involves obtaining approval from the insurance company before the service or procedure is performed. It helps ensure that the patient's insurance will cover the cost of the healthcare service and prevents any unexpected financial burden on the patient. Informed consent is a different concept that relates to the patient's understanding and agreement to undergo a specific medical treatment or procedure.

A grace period is a period of time after a payment is due to the insurance company in which the policy holder may still make payments and the policy will remain in effect. During this period, the policy holder is given some extra time to make the payment without any penalty or risk of the policy being cancelled. It provides a buffer period for the policy holder to catch up on missed payments and avoid any gaps in coverage.

Modifiers can be added to CPT codes to indicate that a procedure or service has been altered in some way. CPT codes are used for reporting medical procedures and services, and modifiers provide additional information about the procedure or service, such as whether it was modified due to certain circumstances or if it was performed by a different provider. ICD-9-CM and ICD-10-CM codes, on the other hand, are used for reporting diagnoses and do not typically have modifiers associated with them. Therefore, the correct answer is CPT.

A notice of insurance claim or proof of loss must be filed within a designated grace period or it can be denied. This means that there is a specific period of time after an incident occurs where the insured must submit the necessary documents to the insurance company in order to make a claim. If this is not done within the grace period, the claim may be denied.