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Discuss the eligibility requirements in detail

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Reference no: EM132120577

Question: Answer the following questions.

1. A small number of large insurance companies dominate the national market for commercial insurance. Name the eight major payers and select three payers of your choice to briefly discuss. Your response should be at least 75 words in length.

2. One of the largest government programs for health care coverage is Medicare (MCR) and it consists of multiple parts. Define each part of the MCR program and discuss the eligibility requirements. Your response should be at least 200 words in length.

3. A major government-sponsored insurance plan is Medicaid (MCD) and it is funded at the state level with matching funds from the federal government if the criteria are met. The criteria are based upon the inclusion of specific covered services. First, provide a definition of MCD. Next, proceed to discuss what is meant by the term covered services verses excluded services? What are the excluded services for Medicaid? Your response should be at least 200 words in length.

4. Which of the following errors in the coding process may cause claims to be rejected?

a. Gender or age mismatches

b. Not satisfying the conditions of coverage for a particular service

c. Coding unilaterally for a service that is represented by a bilateral code

d. All of these are correct

5. All are false regarding the HIPPA 837P, EXCEPT:

a. the diagnosis codes order are not regulated.

b. the diagnosis codes restrict what clearinghouse is used.

c. the diagnosis codes restrict what the PMP office uses.

d. the diagnosis codes delay payment of a non-complaint claim.

6. What type of coding uses diagnoses that are not as specific as possible?

a. truncated coding

b. assumption coding

c. upcoding

d. downcoding

7. Which is not a characteristic of correctly linked codes?

a. The procedure codes match the diagnosis codes.

b. The procedure codes have three modifiers.

c. The procedure are not elective, experimental, or nonessential.

d. The procedure are provided at an appropriate level.

8. Professional courtesy refers to:

a. discounts to poor patients

b. discounts to patients who pay on time

c. discounted charges made for other providers and their families

d. none of these are correct

Reference no: EM132120577

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