Health Insurance Specialist Career Study Guide PDF
Document Details
Uploaded by Deleted User
Tags
Summary
This document is a career study guide for health insurance specialists. It covers topics such as coding, medical necessity, and the role of the Centers for Medicare and Medicaid Services. The guide also touches on ethics and professional conduct.
Full Transcript
Health Insurance Specialist Career Study Guide Chapter 1 1. If the insurance plan has a hold harmless clause, it means that the patient is *not* responsible for paying what the insurance plan denies. 2. The process of reporting diagnoses and procedures/services as numeric and alphan...
Health Insurance Specialist Career Study Guide Chapter 1 1. If the insurance plan has a hold harmless clause, it means that the patient is *not* responsible for paying what the insurance plan denies. 2. The process of reporting diagnoses and procedures/services as numeric and alphanumeric characters on the insurance claim is called coding. 6\. Medical Necessity involves linking every procedure or service code reported on the claim to a condition code that justifies the necessity of performing that procedure or service. 9\. The Centers for Medicare and Medicaid Services (CMS) agency is located in the DHHS (Department of Health and Human Services). 18\. Ethics describes the principles of right or good conduct and includes rules that govern the conduct of members of a profession.
