SimChart 20 Post-Case Quiz

Precertification may be done via: A. phone, fax, and/or email. B. email. C. phone. D. fax.

What process indicates that a patient's insurance company has verified a service is covered by the patient's policy, reviewed the medical necessity for the service, and agreed that it is medically appropriate? A. Reimbursement B. Claim overview C. Advanced Directive D. Precertification

Documentation for precertification can include which of the following? A. Diagnosis B. Proposed procedure C. Insurance ID number D. Diagnosis, proposed procedure, and insurance ID number

Providing the diagnosis when requesting precertification for a procedure will help the insurance carrier to determine what? A. Patient viability B. Medical necessity C. Diagnosis code D. Procedure code

Services that usually require preauthorization or precertification include: A. laboratory tests. B. routine "wellness" examinations. C. emergency room services. D. inpatient hospitalization.

True or false? There is nothing that needs to be indicated on an insurance claim regarding preauthorization.

Which of the following is an example of fraud? A. Leaving a field blank on the claim B. Accidentally coding a diagnosis incorrectly C. Appealing a denied service D. Altering patient documentation to increase levels of reimbursement

The signature on file that authorizes the insurance company to pay the doctor directly is: A. coordination of benefits. B. NPI. C. SOF. D. assignment of benefits.

Which of the following statements is true of nonparticipating Medicare providers? A. The doctor pays Medicare B. The patient will directly pay the doctor C. Medicare will reimburse the doctor D. The patient will directly pay Medicare

What must a patient pay before the insurance starts paying? A. Premium B. Office fees C. Claim D. Deductible

An xray report would be documented in which section of the patient record? A. Correspondence B. Radiology C. Progress notes D. Health history