Office and Admin

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

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

TRICARE for Life covers those who:

Answer 22

are eligible for both Medicare and TRICARE.

Question 23

CHAMPVA covers:

Answer 23

families of veterans with certain service-connected disabilities.

Question 24

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

Answer 24

PPO plans offer out-of-network benefits.

Question 25

Your physician is a participating PPO provider which means:

Answer 25

the physician will charge discounted fees.

Question 26

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

Answer 26

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

Question 27

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

Answer 27

patient registration form.

Question 28

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

Answer 28

verify eligibility.

Question 29

The purpose of a medical billing program is to:

Answer 29

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

Question 30

You should track claims sent to the insurance carrier because:

Answer 30

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

Question 31

The claims time limit deals with:

Answer 31

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

Question 32

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

Answer 32

Medicare.

Question 33

Another term for a patient’s insurance carrier is

Answer 33

third-party payer.

Question 34

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

Answer 34

DDE.

Question 35

Medicare Part A

Answer 35

-IP skilled nursing facility -IP hospital -Hospice

Question 36

Medicare Part B

Answer 36

-Home health supplies -OP office visits -OP therapy services

Question 37

CHAMPVA

Answer 37

-Patients can have a physician of their choice -physicians can decide to accept patients -covers surviving spouses and children -eligibility determines by local veteran affairs office -covers dependent spouses and children of veterans -Participants can have a physician of their children

Question 38

TRICARE

Answer 38

-not a health insurance plan -offers three healthcare benefits -run by the defense department -can also receive Medicare benefits -for families of the uniformed personnel and retirees

Question 39

PPO

Answer 39

-physicians agree to charge discounted fees -network of providers, but members may see any physician they choose -members may choose to see physician outside the network but must pay more for these visits

Question 40

HMO

Answer 40

-does not pay for seeing for seeing physicians that are not participating -only certain services are covered -pts pay premiums and co-pays

Question 41

Premium

Answer 41

Charge for keeping the insurance policy in effect

Question 42

Benefit

Answer 42

Payment for medical services

Question 43

Copayment

Answer 43

Small fixed fee collected at the time of the visit

Question 44

Coinsurance

Answer 44

Fixed percentage of covered charges after the deductible is met

Question 45

Deductible

Answer 45

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

Question 46

Medicaid

Answer 46

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

Question 47

Medicare

Answer 47

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

Question 48

PPO

Answer 48

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

Question 49

Workers' Compensation

Answer 49

Covers employment-related accidents or diseases

Question 50

TRICARE/CHAMPVA

Answer 50

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

Question 51

HMO

Answer 51

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

Question 52

GAF

Answer 52

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

Question 53

RBRVS

Answer 53

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

Question 54

RVU

Answer 54

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

Question 55

CF

Answer 55

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

Question 56

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

Answer 56

deductible

Question 57

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

Answer 57

copayment or coinsurance.

Question 58

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

Answer 58

Negotiated per-service fees

Question 59

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

Answer 59

Medicare

Question 60

The appropriate definition for a Medicaid plan is

Answer 60

Health benefit plan

Question 61

RBRVS consists of which component(s)?

Answer 61

RVU, GAF, and CF

Question 62

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

Answer 62

Submitting the employer's first report of illness or injury

Question 63

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

Answer 63

It proves medical necessity for the procedure

Question 64

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

Answer 64

Clearinghouse

Question 65

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

Answer 65

RA or EOB

Question 66

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

Answer 66

Rehabilitation costs are covered to return an employee to work.

Question 67

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

Answer 67

deductible

Question 68

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

Answer 68

non-military government employees