When using a FOUR-digit Medicare type of bill code in form locator 4, the bill classification (type of care) is represented by the:
first digit.
second digit.
third digit.
fourth digit.
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Q. 2) Credit balances and refunds result from __________ by patients and third-party payers.
Fill in the blank with correct word.
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Q. 3) The government official whose office regulates the insurance industry and who serves as a liaison between patients and carriers, and physicians and carriers, is the state __________ .
Fill in the blank with correct word.
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Q. 4) Once a Medicare patient has been hospitalized for 60 consecutive days, during the next 30 days of hospitalization the patient is responsible for paying__________ .
Fill in the blank with correct word.
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Q. 5) No matter what amount a provider charges for a given service, each third-party payer will establish the amount they will pay based on what is considered:
medically appropriate.
usual and ordinary.
usual, customary, and reasonable.
average.
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Q. 6) A review of systems (ROS) is considered part of the physical examination.
Indicate whether this statement is true or false.
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Q. 7) The act that covers maritime workers injured or killed on or adjacent to navigable waters of the United States is known as the:
Federal Employees' Compensation Act.
District of Columbia Workers' Compensation Act.
Energy Employees Occupational Illness Compensation Program Act.
Longshore and Harbor Workers' Compensation Act.
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Q. 8) A medical office specialist can appeal a claim in writing or over the telephone.
Indicate whether this statement is true or false.
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Q. 9) The patient is responsible for payment when a claim is denied in all of the following cases EXCEPT when:
services were for treatment of an excluded preexisting condition.
services were provided after coverage was canceled.
services were provided that were not preauthorized.
services were provided before coverage was in effect.
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Q. 10) Which three factors are considered in determining resource-based fee structures?
What will be an ideal response?
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