Chapter 1: Career Role and Responsibilities
1. Facility Billing
a. Done for Hospitals, acute care hospitals, skilled nursing or long-term care faculties,
rehabilitation centers, or ambulatory surgical centers.
2. Professional Billing
1. Assignment of benefits- signature required by patient on block 13 for the
healthcare provider to receive reimbursement directly from the insurance
2. Paper claim (CMS-1500)form used by health care professionals and suppliers to bill insurance
1. At what date did ethical statement come to play?
- 2500 B.C. Code of Hammurabi
- 5th century B.C. Oath of Hippocrates
- 1980 Principles of Medical ethics
2. What happens when you have illegal coding practice?
- Subject to penalties, fines, imprisonment
Chapter 11: The Blue Plans, Private Insurance and Managed Care Plans
1. *Medicare eligible patients have HMO or Prepaid health plans? P. 379
a. Yes, HMO
2. Point of Service Programs? What Benefits do people get?
a. Pays members a higher level of benefits
Medical Reimbursement Quiz 3 (Chapters 7-9)
1. To correct the patient's prolonged bleeding, the physician scheduled a surgery that involves widening of
the cervix and scraping of the endometrial lining of the uterus or a/an
Dilation and curettage
2. The c
Medical Reimbursement Exam Review 1
Ethical statements are for the benefit of whom?
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit
of the patient.
Who is held liable for the actions