coding and billing all of chapter 17 hw/test

Question 1

Medicare covers those who are

Answer 1

65 and older and some persons under 65 who qualify.

Question 2

Those persons under 65 that qualify for Medicare are

Answer 2

blind or have serious long-term disabilities.

Question 3

Which of the following is true regarding HMO plans?

Answer 3

They only offer in-network benefits.

Question 4

Workers’ compensation covers those who

Answer 4

get hurt on the job.

Question 5

The first step in the health insurance claims process is

Answer 5

obtaining patient information.

Question 6

Coordination of benefits is done to

Answer 6

prevent duplication of payment.

Question 7

Which of the following will you need to prepare the claim form?

Answer 7

The patient charge slip

Question 8

The purpose of a physician’s fee schedule is to

Answer 8

list the usual fees for procedures and services.

Question 9

The universal paper claim form is currently called the

Answer 9

CMS-1500.

Question 10

With an electronic claim, the billing provider is:

Answer 10

the entity transmitting the claim to the payer.

Question 11

The federal health plan designed for those 65 and older is known as:

Answer 11

Medicare.

Question 12

Which of the following plans covers surviving spouses and dependent children of veterans who died in the line of duty or as a result of a service-connected disability?

Answer 12

CHAMPVA

Question 13

HMO stands for:

Answer 13

Health Maintenance Organization

Question 14

Temporary workers’ compensation disability benefits are provided:

Answer 14

until the employee can return to work.

Question 15

Who documents the patient’s symptoms in the medical record?

Answer 15

The physician

Question 16

The insurance carrier reviews each claim for medical necessity, which means:

Answer 16

the insurance carrier feels the diagnosis and treatment are compatible and necessary.

Question 17

The ________blank is paid by the insured to keep an insurance policy in effect.

Answer 17

premium

Question 18

Which of the following is true regarding RBRVS?

Answer 18

RBRVS fees are lower than usual fees.

Question 19

Claims that are accepted by payers for processing are known as ________blank claims.

Answer 19

clean

Question 20

CHAMPVA covers:

Answer 20

families of veterans with certain service-connected disabilities.

Question 20

Who provides funds to the Medicaid program?

Answer 20

The federal and state governments

Question 21

Medicare Part D was created to:

Answer 21

cover prescriptions.

Question 22

The main advantage of choosing a PPO plan over an HMO plan is:

Answer 22

PPO plans offer out-of-network benefits.

Question 23

The major difference between HMOs and PPOs when it comes to the patient’s financial responsibility is:

Answer 23

the patient pays preset copays with HMOs whereas the patient may have to pay a percentage of the cost with a PPO.

Question 24

Your physician is a participating PPO provider which means:

Answer 24

the physician will charge discounted fees.

Question 25

The name of the form the patient should complete during her first office visit is the:

Answer 25

patient registration form.

Question 26

After you obtain the patient's insurance information, you should:

Answer 26

verify eligibility.

Question 27

The purpose of a medical billing program is to:

Answer 27

make the process of creating and following up on claims easier.

Question 28

You should track claims sent to the insurance carrier because:

Answer 28

you need a record of claims sent so you can follow up.

Question 29

The claims time limit deals with:

Answer 29

the time allowed from the date of service to the submission of claims.

Question 30

The resource-based relative value scale (RBRVS) is a payment system used by:

Answer 30

Medicare.

Question 31

Another term for a patient’s insurance carrier is

Answer 31

third-party payer.

Question 32

When claims are keyed directly into a third-party payer’s online system, the process is known as:

Answer 32

DDE.

Question 33

Premium

Answer 33

Charge for keeping the insurance policy in effect

Question 34

Coinsurance

Answer 34

Fixed percentage of covered charges after the deductible is met

Question 35

Benefit

Answer 35

Payment for medical services

Question 36

Deductible

Answer 36

Fixed dollar amount that must be paid or met once a year

Question 37

Copayment

Answer 37

Small fixed fee collected at the time of the visit

Question 38

TRICARE/CHAMPVA

Answer 38

Healthcare benefits to families of military personnel, veterans, and retired military personnel

Question 39

HMO

Answer 39

Only offers in-network benefits; providers usually paid by capitation

Question 40

Medicaid

Answer 40

Health-benefit plan for low-income, blind, disabled, and foster children, children born with birth defects

Question 41

Medicare

Answer 41

Insurance for those 65 or older or those under 65 who are disabled or diagnosed with certain conditions

Question 42

PPO

Answer 42

Offers in- and out-of-network benefits; discounts are given for using network providers

Question 43

Workers' Compensation

Answer 43

Covers employment-related accidents or diseases

Question 44

GAF

Answer 44

An adjustment factor used to reflect the area of the country where the service was performed

Question 45

RVU

Answer 45

Based on the physician's work, the practice cost and the cost of medical malpractice

Question 46

CF

Answer 46

Used to make adjustments according to the cost-of-living index

Question 47

RBRVS

Answer 47

Replaces usual and customary charges; used by third-party payers to determine fees

Question 48

A fixed-dollar amount the subscriber must pay, or “meet,” each year before the insurer begins to cover expenses is the:

Answer 48

deductible.

Question 49

Depending upon the type of plan, the patient's portion of the medical charges after the insurance has paid is known as the:

Answer 49

copayment or coinsurance.

Question 50

Most specialists are paid by MCOs using which of the following methods?

Answer 50

Negotiated per-service fees

Question 51

The national health insurance plan for Americans age 65 and older is

Answer 51

Medicare

Question 52

The appropriate definition for a Medicaid plan is

Answer 52

Health benefit plan

Question 53

RBRVS consists of which component(s)?

Answer 53

RVU, GAF, and CF

Question 54

Which of the following is not performed by the medical practice when preparing a healthcare claim for payment and reviewing the insurance payment?

Answer 54

Submitting the employer's first report of illness or injury

Question 55

Why is it important that each procedure on the CMS-1500 be matched with a diagnosis code?

Answer 55

It proves medical necessity for the procedure

Question 56

Which of the following is the most common method for medical practices to submit electronic medical claims to third-party payers?

Answer 56

Clearinghouse

Question 57

Which of the following documents provides information regarding the payer's payment (or denial) of charges received?

Answer 57

RA or EOB

Question 58

The request for approval for payment from a third-party payer prior to a procedure is the ________blank.

Answer 58

preauthorization

Question 59

Which of the following is included under Workers' Compensation insurance in most states?

Answer 59

Rehabilitation costs are covered to return an employee to work.

Question 60

Which of the following groups are not covered by TRICARE or CHAMPVA?

Answer 60

non-military government employees

Question 61

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ________blank.

Answer 61

deductible

Question 62

Which of the following is what the patient owes after the insurance company has paid?

Answer 62

patient liability

Question 62

An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ________blank.

Answer 62

review for allowable benefits

Question 63

Which of the following is included under Workers' Compensation insurance in most states?

Answer 63

Rehabilitation costs are covered to return an employee to work.

Question 64

A managed care plan that establishes a network of providers to perform services for plan members is known as which of the following?

Answer 64

PPO

Question 65

How should data in medical billing programs be entered?

Answer 65

enter information using capital letters

Question 66

Which of the following is not part of Medicare's resource-based relative value scale?

Answer 66

Medigap, to reduce the gap in coverage

Question 67

One advantage of submitting claims electronically is ________

Answer 67

electronic submissions are cost-efficient

Question 68

What is the authorization called that directs an insurance carrier to pay the medical provider or the medical practice directly?

Answer 68

assignment of benefits

Question 69

Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities, such as ________blank, may be entitled to Medicare.

Answer 69

kidney failure

Question 70

In a typical medical practice, insurance claims are filed ________

Answer 70

a few business days after the date of service

Question 71

A fixed-dollar amount the subscriber must pay, or “meet,” each year before the insurer begins to cover expenses is the:

Answer 71

deductible.

Question 72

Depending upon the type of plan, the patient's portion of the medical charges after the insurance has paid is known as the:

Answer 72

copayment or coinsurance.

Question 73

Most specialists are paid by MCOs using which of the following methods?

Answer 73

Negotiated per-service fees

Question 74

The national health insurance plan for Americans age 65 and older is

Answer 74

Medicare

Question 75

The appropriate definition for a Medicaid plan is

Answer 75

Health benefit plan

Question 76

RBRVS consists of which component(s)?

Answer 76

RVU, GAF, and CF

Question 77

hich of the following is not performed by the medical practice when preparing a healthcare claim for payment and reviewing the insurance payment?

Answer 77

Submitting the employer's first report of illness or injury

Question 78

Why is it important that each procedure on the CMS-1500 be matched with a diagnosis code?

Answer 78

It proves medical necessity for the procedure

Question 79

Which of the following is the most common method for medical practices to submit electronic medical claims to third-party payers?

Answer 79

Clearinghouse

Question 80

Which of the following documents provides information regarding the payer's payment (or denial) of charges received?

Answer 80

RA or EOB