Chapters 1 and 2 Homework Assignment

1. A _________________reviews claims for medical necessity and is employed by a third-party payer.

2.The coding system used to report diagnoses and conditions on claims is known as the ___________ manual.

3. The ________mandates worker's compensation insurance cover employees and their dependents against injury and death occurring during the course of employment.

4. Medical malpractice insurance is a type of _________insurance.

5. Remittance advice provides information about how a provider __________ was paid.

6. The __________is submitted to the patient by the payer to clarify the results of claims processing.

7. The Current Procedural Coding manual is published by the_________.

8. The process of justifying the provision of services and procedures is known as ___________.

9. A________________ prohibits the provider from billing patients for balances denied by third-party payers.

10. ________are the principles of right or good conduct, and rules that govern the conduct of members of profession.

11. A patient complains of severe stomach pain. After undergoing an x-ray it was determined that a surgical tool remained in her abdomen from previous surgery. The insurance presented by the patient originally was Blue cross Blue Shield. The new diagnosis indicates foreign object left in abdomen post-surgical procedure. Is Blue Cross Blue Shield the correct insurance? Why or Why not? What is the correct insurance?

12. What is health insurance? List and describe the types of health insurance( Ex. group health insurance).

contract between a policyholder and third-party payer or government program to reimburse policyholder for all or a portion of the cost of medical treatment

No answer text provided.

13. What is a problem-oriented record? What are the components of a problem-oriented record? What purpose does the problem-oriented record serve?