NCCT Preparation Medical Office Management! Test

An inpatient refers to a bed patient in a hospital who requires medical care and treatment that cannot be provided at home or on an outpatient basis. This term is used to describe individuals who are admitted to a hospital and stay overnight or for an extended period of time to receive medical attention and monitoring. Inpatients typically receive more intensive care and have access to a wider range of medical services compared to outpatient or ambulatory patients who receive treatment without being admitted to the hospital.

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

An unexpected event which may cause injury is called an accident. Accidents are unforeseen incidents that can result in harm or injury to individuals. They can occur due to various factors such as negligence, carelessness, or simply by chance. Accidents can happen in different settings, including workplaces, roads, or even at home. It is important to take preventive measures and exercise caution to minimize the occurrence of accidents and ensure the safety of individuals.

Medicare is a health program for individuals aged 65 and older under social security. It provides medical coverage and access to healthcare services, including hospital stays, doctor visits, prescription drugs, and preventive services. Medicare is funded through payroll taxes and premiums paid by beneficiaries. It is a federal program administered by the Centers for Medicare & Medicaid Services (CMS) and helps older adults and certain younger individuals with disabilities to afford healthcare expenses.

When correcting a handwritten error in a patient's chart, it is important to maintain the integrity of the original information while clearly indicating the correction. Drawing a line through the error helps to make it unreadable, ensuring that the original mistake is not visible. Inserting the correct information next to the error allows for accurate documentation. Dating and initialing the correction provides a clear indication of who made the correction and when it was made, which is essential for accountability and tracking changes in the patient's chart.

An outpatient is a patient who receives medical care at a hospital or health facility without being admitted as a bed patient. They typically visit the facility for consultations, tests, treatments, or minor procedures, and then return home the same day. This term is used to distinguish them from inpatients, who require admission and stay overnight or for an extended period of time. The other options (carrier and adjuster) are not relevant to the context of the question.

Workers' Compensation is a form of insurance paid by the employer that provides cash benefits to workers who are injured or disabled while performing their job duties. This insurance coverage is designed to cover medical expenses, rehabilitation costs, and lost wages for employees who experience work-related injuries or illnesses. Workers' Compensation helps ensure that employees are financially protected and able to receive the necessary support and care following a workplace accident or injury.

A person or institution that gives medical care is referred to as a provider. They are responsible for delivering healthcare services and treatments to patients. This can include doctors, nurses, hospitals, clinics, and other healthcare professionals or facilities. Providers play a crucial role in the healthcare system by diagnosing and treating illnesses, managing chronic conditions, and promoting overall well-being. They are an essential part of ensuring that individuals receive the necessary medical care they need.

Medicaid is a type of insurance that provides healthcare coverage for low-income individuals and families. It is a government program that is jointly funded by the federal and state governments, and it is designed to assist those who cannot afford private health insurance. Medicaid covers a wide range of medical services, including doctor visits, hospital stays, prescription medications, and preventive care. Therefore, Medicaid is the correct answer for covering low-income patients.

When a person signs the back of a check, it is known as an endorsement. This signature serves as confirmation that the person is authorizing the check to be deposited or transferred to another party. Endorsement is a common banking practice that ensures the validity and legality of the transaction. It also helps in tracking the flow of funds and maintaining financial records.

A request for payment under an insurance contractor bond is called a claim. This is the correct answer because a claim is a formal request made by the insured party to the insurance company, seeking compensation for a covered loss or damage. In the context of an insurance contractor bond, if the contractor fails to fulfill their obligations or breaches the terms of the bond, the party who suffered a loss can file a claim to recover the damages.

A deductible is the amount that an insured person must pay out of pocket before their insurance policy will start covering the costs. It is a predetermined amount set by the insurance company and helps to share the risk between the insured person and the insurer. The purpose of a deductible is to discourage small and frequent claims and to ensure that insurance is primarily used for significant losses or expenses.

A ledger is a record of debits, credits, and balances, typically used in accounting to track financial transactions. In the context of a patient, a ledger can be used to track medical expenses, payments, and outstanding balances. It serves as a comprehensive record of the patient's financial interactions with the healthcare provider, allowing for accurate billing and financial management.

Fee-for-service is a method of charging in which a physician presents a bill for each service rendered. This means that the patient is billed separately for each medical service they receive, rather than being charged a fixed monthly fee or having their benefits duplicated. This system allows for transparency and flexibility in billing, as each service is individually accounted for and charged accordingly.

Partial disability refers to an injury that hinders a worker from carrying out some, but not all, of their regular job functions. This means that the worker may still be able to perform certain tasks, but not to the same extent as before the injury. Unlike total disability, where the worker is completely unable to perform any job functions, partial disability allows for some level of work to be done. Permanent disability refers to a lasting impairment, while resultant disability is not a commonly used term in this context.

The correct answer is CMS-1500. The CMS-1500 form is used by non-institutional providers and suppliers to bill Medicare for Part B covered services. This form is used to submit claims for services such as physician visits, outpatient procedures, and durable medical equipment. It includes important information such as patient demographics, diagnosis codes, and procedure codes, which are necessary for Medicare to process the claim and provide reimbursement to the provider.

Tri-Care is the correct answer because it is a civilian health and medical program of uniform services. It provides health care services to active duty service members, retirees, and their dependents. Tri-Care offers a variety of health plans, including options for both military treatment facilities and civilian providers. It is designed to ensure that uniformed service members and their families have access to quality healthcare services.

The term "explanation of benefits" refers to a recap sheet that is provided along with a Medicare or Medicaid check. This sheet provides a detailed breakdown and explanation of the payment made on a claim. It helps the recipient understand how the payment was calculated and what services or expenses it covers. This information is crucial for both the healthcare provider and the patient to ensure transparency and accuracy in the billing and payment process.

A doctor who agrees to accept an insurance companies 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 to provide medical services to patients who have insurance coverage with that company. By agreeing to the pre-established fee, the doctor agrees to accept the insurance company's payment as full compensation for the services provided, without billing the patient for any additional amount.

A person who belongs to a group insurance plan is referred to as a subscriber. This term is commonly used to denote an individual who enrolls in and pays for an insurance policy, typically through a group or employer-sponsored plan. The subscriber is responsible for the premiums and is entitled to the benefits provided by the insurance coverage.

A health maintenance organization (HMO) is an organization that provides health insurance at a fixed monthly premium with little or no deductible and operates through a primary care provider. HMOs typically require members to choose a primary care physician who coordinates their healthcare and provides referrals to specialists if needed. This type of organization focuses on preventive care and aims to keep healthcare costs low by emphasizing primary care and managing the overall health of its members.

The International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) is a coding system used to classify and code diagnoses. It provides a standardized way to categorize and record various medical conditions, diseases, and injuries. By using ICD-9-CM codes, healthcare professionals can accurately document and communicate diagnoses, which is crucial for insurance billing, research, and statistical analysis. This coding system does not specifically code medications, services rendered, or procedures, but focuses primarily on diagnoses.

A form used to itemize deposits made to savings or checking accounts is called a deposit slip. This slip is typically provided by the bank and allows the account holder to list the details of the deposit, such as the amount and type of funds being deposited. It serves as a record for both the account holder and the bank, ensuring that the deposit is accurately processed and credited to the correct account.

A payment made periodically to keep an insurance policy in force is called a premium. This is the amount that the policyholder pays to the insurance company in exchange for coverage. It is typically paid on a monthly or annual basis and is necessary to maintain the policy and ensure that it remains active.

Coinsurance refers to the percentage of covered services that a patient is responsible for paying when they have health insurance. This means that the patient will pay a specified percentage of the cost of the service, while the insurance company will cover the remaining portion. It is an important aspect of health insurance plans as it helps to share the cost of healthcare between the patient and the insurance provider.

An adjuster is a person who represents either party of an insurance claim. They are responsible for investigating the claim, determining the extent of the loss, and negotiating a settlement. They work on behalf of the insurance company to ensure that the claim is handled fairly and accurately. The adjuster reviews the policy, assesses the damages, and works with the insured and any other involved parties to reach a resolution. They play a crucial role in the insurance claims process, helping to facilitate communication and ensure that all parties are treated fairly.

A grace period is a specific period of time after a payment is due to the insurance company in which the policy holder can still make payments without the policy being terminated. During this grace period, the policy remains in effect, providing coverage to the policy holder. This allows the policy holder some flexibility in making payments and ensures that they do not immediately lose their insurance coverage if they miss a payment deadline.

An insurance agent is a representative of an insurance company who is responsible for soliciting and initiating contracts for insurance coverage and services. They act as the policyholder for the insurer, meaning they are the intermediary between the policyholder and the insurance company. They help individuals or businesses choose the right insurance policies and provide assistance throughout the claims process.

Payment for hospital charges incurred by an insured person because of injury or illness is referred to as "hospital benefits." This term encompasses the financial assistance provided by insurance companies to cover the expenses associated with hospitalization, including medical procedures, tests, medications, and room charges. Hospital benefits ensure that insured individuals are not burdened with the high costs of medical treatment, allowing them to receive necessary care without facing significant financial strain.

The correct answer is W-4. The W-4 form is used by employees to indicate their withholding allowances, which determines how much federal income tax is withheld from their paychecks. The number on the employees withholding Exemption Certificate refers to the form that employees need to fill out to indicate their withholding allowances, so that the correct amount of taxes can be withheld from their wages.

The correct answer is "usual, customary and reasonable." This term refers to insurance plans that will cover the full charge of a physician's services if it falls within the normal range of charges for that service. It ensures that the insurance company will not pay more than what is typically charged for the service, providing a standard benchmark for reimbursement.

The Tri-Care fiscal year is from October 1 to September 30. This means that the financial reporting and budgeting for Tri-Care, a healthcare program for military personnel and their families, is based on this time period. The fiscal year starts in October and ends in September of the following year, allowing for consistent financial planning and reporting.

The correct answer is current procedural terminology. This is because current procedural terminology is a reference procedural code book that uses a numbering system developed by the AMA. It is commonly used in the medical field to code and bill for procedures and services.

FICA, which stands for Federal Insurance Contributions Act, provides benefits for social security. This includes retirement benefits for individuals who have reached old age, as well as disability benefits and survivor benefits for eligible individuals. FICA taxes are deducted from employees' wages to fund these social security programs. Medicare, on the other hand, is a separate program that provides healthcare benefits for individuals aged 65 and older. Aid to dependent children is not directly related to FICA benefits.

An extended care facility is a skilled nursing facility that provides specialized care to patients after they have been discharged from a hospital. This type of facility is designed to meet the ongoing medical needs of patients who require additional care and rehabilitation before they can return home. It offers a range of services such as physical therapy, occupational therapy, and round-the-clock nursing care to ensure the well-being and recovery of patients. Therefore, the correct answer for this question is "extended care facility".

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. It typically has a high deductible and low monthly premiums, making it more affordable for individuals who are generally healthy but want protection against unexpected and expensive medical events. Catastrophic health insurance is particularly beneficial for those who do not qualify for government subsidies or employer-sponsored plans. It provides financial security and peace of mind in the event of a serious medical condition or injury.

In insurance coding, using an "E" code designates the classification of environmental events, such as poisoning. This means that when an "E" code is used, it indicates that the condition or disease is caused by an external factor, specifically an environmental event like poisoning. This classification helps in identifying and documenting the cause of the condition or disease for insurance and medical purposes.

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 must be filed in order for it to be considered valid. If the claim is not filed within this time limit, the insurance company has the right to deny the claim.

The correct answer is CPT. CPT stands for Current Procedural Terminology, which is a coding system used to report medical procedures and services. E/M codes, which stand for Evaluation and Management codes, are a subset of CPT codes that are used to report physician services. Therefore, it makes sense that E/M codes would be located in the CPT manual. ICD-9-CM and ICD-10-CM are coding systems used to report diagnoses, while HCPC is a coding system used for reporting supplies, equipment, and services not covered by CPT codes.

Major medical insurance is designed to provide coverage for significant 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 extensive coverage for hospital stays, surgeries, and other costly medical treatments. It is meant to protect individuals from the financial burden of unexpected and expensive healthcare needs.

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 another party, such as a healthcare provider or insurance company, to directly receive payment from the third party payer, such as an insurance company or government program, on their behalf. This allows for a more streamlined payment process and ensures that the healthcare provider is reimbursed for the services rendered to the patient.

The physician's bank statement should be reconciled with the checkbook as part of the office bookkeeping procedures. Reconciling the bank statement with the checkbook helps 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 information.

A dread disease rider is a type of additional coverage that can be added to an insurance policy to provide benefits specifically for certain conditions. This rider is designed to offer financial protection in the event of a serious illness or disease, such as cancer or heart disease. It provides coverage beyond what is typically included in a standard insurance policy, offering additional benefits and support for policyholders facing these specific conditions.

Coordination of benefits refers to the process of preventing an insured individual from receiving duplicate payments for losses under multiple insurance policies. It ensures that the total benefits received do not exceed the actual expenses incurred by the insured. This is particularly important when an individual is covered by multiple insurance plans, such as through their employer and their spouse's employer. By coordinating benefits, insurers can determine the primary and secondary coverage, avoiding overpayment and ensuring fair distribution of benefits.

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 specific circumstances of the procedure or service. Modifiers can indicate things like multiple procedures performed, bilateral procedures, or services provided by different healthcare providers. Therefore, the correct answer is CPT.

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 is responsible for a fixed portion of the cost of each service or treatment, while the insurer covers the rest. Co-payments are common in health insurance plans and help to share the financial burden between the insured and the insurer.

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 is provided to ensure that it meets the necessary criteria for coverage. This process helps to prevent any surprises or denials of coverage for the patient and allows them to plan and budget accordingly.

In an insurance policy, the sum of money provided for covered services is referred to as "benefits". This refers to the amount that the policyholder is entitled to receive from the insurance company for the services or expenses covered under the policy. It can include reimbursement for medical expenses, compensation for lost wages, or other types of financial assistance as outlined in the policy terms.

Comprehensive coverage in insurance refers to a policy that provides extensive protection against a wide range of diseases or accidents. It offers greater coverage and indemnity payment compared to a limited clause, meaning that it includes more benefits and covers a broader scope of risks. Comprehensive insurance is designed to provide policyholders with a higher level of protection and financial support in the event of unexpected incidents or medical expenses.

Indemnities are benefits that are provided in the form of cash payments. They are a type of financial compensation or reimbursement for losses or damages incurred. Unlike medical co-pays, which are specific payments made by individuals for medical services, or deductibles, which are the amount individuals must pay before insurance coverage kicks in, indemnities are cash payments made to compensate for losses or damages. Cash advances, on the other hand, refer to borrowing money from a credit card or loan, which is not related to benefits.