| 1.
|
Explain how the following medical reference books are used to evaluate
and process health insurance claims: International Classification of
Diseases (ICD-9), Current Procedural Terminology (CPT), Diagnostic and
Statistical Manual of Mental Disorders (DSM III-R), Relative Value
Services (RVS), and Physician's Desk Reference (PDR). (I)
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| 2.
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Calculate usual, customary, and reasonable fees (UCR). (II)
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| 3.
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Complete the following medical billing forms: Health Care Financing
Administration (HCFCA 1500), Uniformed Billing - 82 (UB82), Patient
Claim, and Superbill. (III)
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| 4.
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Define Coordination of Benefits (COB) and state its purpose. (IV)
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| 5.
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Identify potential COB situations involving a claim. (IV)
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| 6.
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Identify and describe cost containment programs. (V)
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| 7.
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Differentiate between internal and external fraud. (VI)
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| 8.
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Identify possible fraud indicators and explain when to initiate and
conduct a claims investigation. (VI)
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| 9.
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Explain Tax Equity and Financial Responsibility Act (TEFRA) and
Deficit Reduction Act (DEFRA) and their relevance to claims
processing. (VII)
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| 10.
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List Medicare eligibility requirements. (VII)
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| 11.
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Name the two parts of Medicare and explain the benefits they provide.
(VII)
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| 12.
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Define Health Insurance Payment Demands (HIPD) under Medicaid. (VIII)
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| 13.
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Identify guidelines for screening Workers' Compensation claims. (IX)
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| 14.
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Define pre-existing medical condition and list provisions for
coverage. (X)
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