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Flashcards in Part 2 Deck (10)
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Vocational rehabilitation claims cover expenses for vocational retraining for both temporary and permanent disability cases. Vocational rehabilitation retrains an ill or injured employee so he or she can return to the workforce. The employee _______ of resuming the position held prior to the illness or injury.

A. May be incapable
B. May be capable

May be incapable


An account receivable that cannot be collected by the provider or a collection agency is called a bad debt. To deduct a bad debt, the amount must have been _________.

A. Previously included in the provider's income
B. Deposited in the bank via electronic funds transfer
C. Turned over to a collection agency for processing
D. Received from the third party payer or patient

Turned over to a collection agency for processing


Electronic claims are submitted directly to the payer after being checked for accuracy by billing software or a healthcare clearinghouse, which results in a ________ claim that contains all required data elements needed to process and pay the claim.

A. Unassigned
B. Electronic
C. Submitted
D. Clean



If normal fee is $500 bu the physician agreed with a payer to accept $450, the remaining $50 is a

A. Capitation
B. Withhold
C. Accounts receivable
D. Contractual adjustment

Contractual adjustment


Which program added prescription medication coverage to the original Medicare plan, some Medicare cost plans, some Medicare private-fee-for-service plans, and Medicare medical savings Account Plans?

A. Medicare Part B
B. Medicare Part C
C. Medicare Part D
D. Medicare Part A

Medicare Part D


An appeal is documented as a(n) __________ why a claim should be reconsidered for payment.

A. Addendum to the patient record to justify
B. Patient release of information form describing
C. Resubmitted CMS 1500 insurance claim indicating
D. Letter signed by the provider explaining

Letter signed by the provider explaining


Which of the following is not routinely collected data by admissions?

A. Physician orders
B. Demographic information
C. Payment/guarantor data
D. Charges



Which of the following is NOT covered by Medicare Part A?

A. Home health care
B. Outpatient ambulatory care
C. Hospice care
D. Inpatient hospital care

Outpatient ambulatory care


Which is issued by a military treatment facility that cannot provide needed care to TRICARE Standard beneficiaries and means the beneficiary can seek care from a civilian provider and reimbursement will be approved?

A. Insurance certificate
B. TRICARE standard letter
C. Common access card
D. Nonavailability statement

Nonavailability statement


What governmental agency administers the Medicaid and Medicare programs?