NCCT - Medical Office Management

An inpatient is a term used to describe a person who is admitted to a hospital and stays overnight or for an extended period of time for medical treatment or observation. This term is commonly used to refer to a bed patient in a hospital setting. It distinguishes them from outpatient, who receives medical treatment without being admitted to the hospital. The other options, third party payer and provider, are unrelated to the question and do not describe a bed patient in a hospital.

An unexpected event that may cause injury is called an accident. Accidents can happen suddenly and without warning, resulting in harm or injury to individuals involved. This term is commonly used to describe incidents such as car crashes, falls, or workplace mishaps that can lead to physical harm or damage.

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An outpatient is a patient who receives medical care at a hospital or health facility without being admitted as a bed patient. This means that they do not stay overnight and are not required to be admitted to the hospital. Outpatients typically receive treatment, tests, or consultations and then go home the same day.

Medicare is a health program for people aged 65 and older under Social Security. It provides medical coverage and benefits to help with healthcare costs. Tri-Care is a health program for military personnel, CHAMPVA is a health program for veterans, and Workers' Compensation is a program that provides benefits for employees who are injured or become ill due to their job. Therefore, Medicare is the correct answer for the given question.

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. It is a system that helps protect employees by ensuring that they receive financial compensation for medical expenses, lost wages, and rehabilitation services related to their work-related injuries or disabilities. This insurance coverage is mandatory for most employers and helps to ensure that workers are taken care of in the event of a workplace accident or injury.

A deductible is an amount that the insured must pay out of pocket before the insurance policy benefits begin. It is a form of cost-sharing between the insurance company and the insured. The purpose of a deductible is to discourage small and frequent claims, as the insured is responsible for covering a portion of the expenses. Once the deductible is paid, the insurance company will then cover the remaining costs up to the policy limits. Deductibles can vary depending on the type of insurance policy and coverage.

A preexisting condition refers to an injury, disease, or physical condition that already existed before the health insurance policy was issued. This means that the individual had the condition prior to obtaining the insurance coverage.

A person or institution that gives medical care is referred to as a provider. This term encompasses healthcare professionals such as doctors, nurses, hospitals, clinics, and other healthcare facilities that offer medical services to patients. Providers play a crucial role in delivering healthcare and are responsible for diagnosing, treating, and managing patients' medical conditions. They may be reimbursed directly by patients or through third-party payers such as insurance companies.

A form to itemize deposits made to savings or checking accounts is called a deposit slip. This slip is used by individuals to record the details of the deposit, such as the account number, the amount being deposited, and the date. It serves as a proof of the transaction and helps the bank in accurately crediting the funds to the account.

An explanation of benefits is a recap sheet that accompanies a Medicare or Medicaid check, showing a breakdown and explanation of payment on a claim. It provides detailed information about the services provided, the amount billed, the amount paid by the insurance company, and any remaining balance that may be the responsibility of the patient. This document helps the patient understand how their insurance coverage is being applied to their healthcare expenses.

Fee-for-service is a method of charging where a physician presents a bill for each service rendered. This means that the patient is charged separately for each individual service or procedure that they receive from the physician. This method allows for transparency in pricing and allows the physician to be compensated for each specific service they provide. It is a common payment model in healthcare where the patient pays for each service they receive, rather than a bundled or prepaid payment system.

Medicaid is a government-funded health insurance program that provides coverage for low-income individuals and families. It is specifically designed to assist those who have limited financial resources and cannot afford private health insurance. Therefore, Medicaid is the type of insurance that can cover low-income patients.

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.

The International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) is used to code diagnoses. This coding system is used to classify and categorize diseases, injuries, and other health conditions for the purpose of medical billing, research, and statistical analysis. It provides a standardized way to record and communicate diagnoses, allowing healthcare providers to accurately document and report patient conditions. Using ICD-9-CM codes ensures consistency and uniformity in healthcare data, which is essential for effective healthcare management and analysis.

Partial disability refers to an injury that hinders a worker from performing one or more regular functions of their job. This means that the worker is still able to perform some of their job duties, but not all of them. It indicates a limitation in their ability to work, but it is not a complete inability to work like in the case of total disability. Permanent disability refers to a long-term or permanent impairment that prevents a worker from performing their job duties. Resultant disability is not a commonly used term in this context.

When a patient has health insurance, the percentage of covered services that is the responsibility of the patient to pay is known as coinsurance. Coinsurance is a cost-sharing arrangement between the insurance company and the patient, where the patient is required to pay a certain percentage of the total cost of a covered service, while the insurance company pays the remaining percentage. This helps to distribute the financial burden of healthcare expenses between the patient and the insurance provider.

A doctor who agrees to accept an insurance company's pre-established fee as the maximum amount to be collected is called a participating physician. This means that the doctor has entered into a contract with the insurance company and agrees to provide services to their insured members at the agreed-upon fee schedule. By being a participating physician, the doctor is able to access a larger patient base and receive payment directly from the insurance company, rather than relying on the patient to pay out-of-pocket and seek reimbursement.

A request for payment under an insurance contractor bond is called a claim. This is because when an insured party experiences a loss or damage covered by the insurance policy, they submit a claim to the insurance company to request compensation for the damages. The insurance company then investigates the claim and if it is found to be valid, they will provide the necessary payment to the insured party.

A grace period is an interval after a payment is due to the insurance company in which the policyholder may make payments, and still, the policy remains in effect. During this period, the policyholder is given additional time to make the payment without any penalty or loss of coverage. It is a provision that allows for flexibility in payment deadlines, ensuring that the policyholder does not immediately lose coverage if they miss a payment.

A type of insurance where the insured pays a specific amount per unit of service and the insurer pays the rest of the cost is called a co-payment. A co-payment is a fixed amount that the insured person must pay out of pocket for each medical service or prescription drug. It is a cost-sharing arrangement between the insured and the insurer, where the insured pays a portion of the cost and the insurer covers the remaining expenses. This helps to reduce the financial burden on the insured while still ensuring that they contribute to the cost of their healthcare.

A payment made periodically to keep an insurance policy in force is called a premium. This is the amount of money that an individual or business pays to an insurance company in exchange for coverage. The premium is typically paid on a monthly, quarterly, or annual basis, depending on the terms of the insurance policy. By paying the premium, the policyholder ensures that their insurance coverage remains active and that they will be protected in the event of a covered loss or claim.

An assignment of benefits is an agreement in which a patient transfers their right to receive payment for the services they have received to another party. This means that the payment from a third party, such as an insurance company, will be made directly to the party to whom the benefits have been assigned. This allows for a more efficient payment process and ensures that the healthcare provider receives the payment for the services rendered.

A rider added to a policy to provide additional benefits for certain conditions is called a dread disease rider. This type of rider offers extra coverage specifically for serious illnesses or diseases such as cancer, heart attack, or stroke. It provides financial protection to the policyholder in the event they are diagnosed with one of the specified conditions, helping to cover medical expenses and other related costs.

The correct answer is TRI-CARE. Tri-Care is a civilian health and medical program of the Uniformed Services, which provides healthcare coverage to military personnel, their families, and retired military members. It is a comprehensive healthcare program that offers different plans and options to meet the specific needs of the beneficiaries. Tri-Care aims to ensure that eligible individuals have access to quality healthcare services and benefits.

A record of debits, credits, and balances is referred to as a patient's ledger. A ledger is a financial record that tracks all financial transactions, including debits (expenses) and credits (income), and keeps a running balance. In the context of a patient, a ledger would track the financial transactions related to their healthcare expenses, such as medical bills, insurance payments, and any outstanding balances.

A signature on the reverse side of a check is called an endorsement. This is when the payee signs the back of the check to authorize the transfer of funds to another party. Endorsements can be blank, restrictive, or special, depending on the instructions provided by the payee. It is a common practice when depositing or cashing a check.

The correct answer is benefits because in an insurance policy, benefits refer to the sum of money provided by the insurance company to cover the cost of services that are included in the policy. This can include medical expenses, hospital stays, prescription medications, and other covered services. The benefits are the financial compensation that the policyholder receives from the insurance company when they use the services covered by their policy.

A person who belongs to a group insurance plan is referred to as a subscriber. This term is commonly used in the insurance industry to denote an individual who is enrolled in a group insurance policy and is responsible for paying the premiums. The subscriber may also be the policyholder or the main contact person for the insurance plan.

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. In an HMO, individuals must choose a primary care provider who coordinates their healthcare and provides referrals to specialists if needed. The primary care provider acts as a gatekeeper, controlling access to healthcare services. This model emphasizes preventive care and focuses on managing and coordinating healthcare services for its members.

Hospital benefits refer to the payment made by an insurance company to cover the charges incurred by an insured person due to injury or illness. This includes expenses such as hospitalization, surgeries, medications, and other medical services. It is a form of financial assistance provided to the insured individual to help them cover the costs associated with their healthcare needs.

An adjuster is a person who represents either party of an insurance claim. They are responsible for investigating and evaluating the claim, determining the coverage, and negotiating a settlement. They act as a mediator between the insurance company and the policyholder or claimant, ensuring that the claim is handled fairly and in accordance with the terms of the insurance policy.

Major medical insurance is designed to provide coverage for extensive medical expenses that result from a catastrophic illness or injury. This type of insurance typically has higher deductibles and out-of-pocket costs, but offers more comprehensive coverage for hospital stays, surgeries, and other costly treatments. It is meant to protect individuals from the financial burden of significant medical expenses that could potentially bankrupt them.

The correct answer is USUAL, CUSTOMARY AND REASONABLE. This term refers to insurance plans that will pay a physician's full charge if it does not exceed their normal charge or the amount normally charged for the service. This means that the insurance plan will cover the cost of the service as long as it falls within the usual and customary charges for that specific service.

The CMS-1500 form is used by non-institutional providers and suppliers to bill Medicare for Part B covered services. This form is specifically designed for healthcare professionals and suppliers to submit claims for reimbursement for services rendered to Medicare beneficiaries. It includes all the necessary information such as patient demographics, diagnosis codes, procedure codes, and other relevant details required for Medicare billing purposes.

Using an "E" code in insurance coding designates the classification of environmental events, such as poisoning. This means that when coding for insurance purposes, an "E" code is used to identify and classify incidents related to environmental events, specifically those involving poisoning. It helps in accurately categorizing and documenting these events for insurance claims and other purposes.

Comprehensive coverage in insurance refers to a policy that provides extensive protection against a wide range of risks, including diseases and accidents. It offers greater coverage compared to a limited clause, meaning it covers more potential expenses and damages. This type of coverage often includes higher indemnity payments, meaning the insurance company will pay a larger portion of the costs incurred. Therefore, the term "comprehensive" accurately describes the concept of greater coverage and indemnity payment in comparison to a limited clause.

A notice of insurance claim or proof of loss must be filed within a designated time limit or it can be denied. This means that there is a specific period of time within which the claim or proof of loss must be submitted in order for it to be considered valid. If the submission is made after the time limit has passed, the insurance company has the right to deny the claim.

FICA provides benefits for Social Security. FICA stands for Federal Insurance Contributions Act, which is a law that requires employers and employees to contribute a portion of their earnings to fund Social Security and Medicare. Social Security provides benefits to retired workers, disabled individuals, and the dependents of deceased workers. Therefore, FICA contributions help fund the Social Security program and provide benefits to individuals in need.

The correct answer is W-4. The W-4 form is used by employees to provide their employer with information about their tax withholding preferences. It determines how much federal income tax should be withheld from their paychecks. The W-2 form, on the other hand, is a summary of an employee's earnings and tax withholdings for the year, which is provided by the employer to the employee and the IRS. The 1040 form is the individual tax return form that taxpayers use to file their annual income tax returns. The W-3 form is a transmittal form that employers use to report employee wage and tax information to the Social Security Administration.

Coordination of benefits is the correct answer because it refers to the process of preventing the insured from receiving duplicate payments for losses under multiple insurance policies. This is done to ensure that the insured does not receive more than the actual amount of the loss. By coordinating benefits, insurance companies work together to determine the primary and secondary coverage for a claim, avoiding overpayment and reducing the potential for fraud or abuse.

Health insurance that provides protection against the high cost of treating severe or lengthy illnesses or disabilities is called catastrophic. This type of insurance is designed to cover major medical expenses that exceed a certain threshold, such as a high deductible. It is meant to provide financial protection in case of a catastrophic event that could result in significant medical expenses.

The correct answer is CPT. E/M codes, which stand for Evaluation and Management codes, are located in the CPT (Current Procedural Terminology) manual. This manual is published by the American Medical Association and is widely used for reporting medical procedures and services. The CPT manual provides a standardized system for coding and billing for medical services, including E/M codes which are used to describe the level of complexity and time spent during patient encounters.

An extended care facility is a skilled nursing facility that provides specialized care to patients after they are discharged from a hospital. This type of facility offers medical services and assistance with daily activities to help patients recover and regain their independence. It is different from a nursing home, which typically provides long-term care for individuals who are unable to live independently. A post care facility is not a commonly used term in the healthcare industry.

The correct answer is "CUURENT PROCEDURE TERMINOLOGY." This is because the question asks for the name of the reference procedural code book that uses a numbering system developed by the AMA. Current Procedure Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services. It is published by the American Medical Association (AMA) and is widely used in medical billing and coding.

Pre-certification is a method used for determining whether a particular service or procedure is covered under a patient's policy. It involves obtaining approval from the insurance company before the service or procedure is performed, ensuring that the patient's policy will cover the costs. This process helps prevent unexpected expenses for the patient and allows the healthcare provider to confirm coverage and receive payment for services rendered.

As part of the office bookkeeping procedures, the physician's bank statements should be reconciled with the checkbook. This means that the transactions recorded in the checkbook should be compared and matched with the transactions listed in the bank statements. By doing so, any discrepancies or errors can be identified and corrected, ensuring that the financial records are accurate and up to date. Reconciling the bank statements with the checkbook is an important step in maintaining the integrity of the office's financial records.

The Tri-Care fiscal year is from October 1 to September 30. This means that the fiscal year begins on October 1st and ends on September 30th of the following year. This time frame is commonly used for financial reporting and budgeting purposes in various organizations and government agencies.

Cash payments that are made as benefits are known as indemnities. An indemnity is a form of compensation or reimbursement provided in cash. It is usually given to cover losses or damages incurred by an individual or organization. In the context of benefits, indemnities refer to the monetary payments made to individuals as part of their compensation package or insurance coverage. This can include cash payments for medical expenses, disability benefits, or other forms of financial assistance. Indemnities provide individuals with direct financial support and flexibility to use the funds as needed.

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 the addition of modifiers helps provide additional information about the specific circumstances of the procedure or service. Modifiers can indicate things like multiple procedures performed, services provided by different physicians, or the use of specific equipment during the procedure. Therefore, the correct answer is CPT.