health insurence
b4 certain procedures or visits can be made, some insurance policies require which of the following? a) preauthorizaton b) predetermination c) preregistration d) claim reviewal
A
insurance fraud and abuse may be involved i as many of what percentage of submitted medical claims? a. 10% b) 5% c) 20% d) 50%
A
which of the following applies to medical insurance for dependents fir active duty or retired military personnel and thier dependents? a) TRICARE b) SSI c) CMS d) HCFA
A
which of the following best describes insurance policies that provide coverage on a fee for service basis? a) traditional b) group c) managed care d) indemnity
A
which of the following best describes insurance policies that require policy holders to select a primary care provider? a. tradtional b. group c.major medical d. indemnity
A
which of the following is the purpose of screening new pts for insurance coverage? a)verify pt has coverage and obtain vital billing information. b)physician is a providers for the pt's plan c) referral is obtained for services d)disease is covered by provider e) pt understands all provisions of coverage
A
which section of the CPT book includes coding of immunizations and chemotherapy? a) medicine b) surgery c) pathology d) laboratory
A
which of the following term is applied when more than one policy covers an individual? a) coordination of benefits b) co insurance c) co pay d) deductible e) birthday rule
A) coordination of benefits
Dr chad is a participating provider in Medicare. does this mean dr chad will accept assignment and what percent of the allowed amount? a) yes, 80% b) yes100% c) no, 0% d) none of the above
B
health insurance was designed for what reason? a) to help people increase thier salary b) to help individuals and families compensate for high medical costs. c) to ensure pts get the best care. d) to increase revenue for the government
B
what is necessary to authorize release of medical information to an insurance carrier? a) verbal agreement between pt and dr b) a medical release from the pt c) a handshake between the pt and dr d) an authorization is never required to release medical information e) physicians never have to share record information
B
which of the following applies to Medicare coverage that pays for outpatient services? a) Part A b) Part B c) PartC d) Part D
B
which of the following applies to a method of containing hospital costs that is based on an average cost for treatment of a pts conditon? a) capitation b) diagnostically related groups c) fee for service d) allowable charges
B
which of the following volumes is the alphabetic index of ICD-9-CM? a. volume 1 b. volume 2 c. volume 3 d. volume 4
B
which section of the CPT book includes coding of lacerations? a) medicine b) surgery c) pathology d) laboratory
B
which of the following terms means an insurance policy pays a percentage of the balance after the application of the deductible? a) coordination of benefits b) co insurance c) co pay d) deductible e) birthday rule
B) co insurance
`which of the following is known as the fee system that defines allowable charges that will be accepted by insurance carriers? a) VCR b) FCR c) UCR d) TCR
C
the amount of money that the insured must incur for medical services before the policy begins to pay is known as what? a. co- insurance b. co-pay c. deductible d. COB: coordination of benefits
C
which of the following applies to the coding book used for specifying services and procedures performed in the medical office? a) ICD-9 b) RBRVS c) CPT d) EOB
C
which of the following is a type of insurance coverage for persons injured on the job? a) major medical b) managed care c) workers compensation d) self insurance
C
which of the following organizations developed ICD-9-CM? a. american medical association b. centers for medicare and medicaid services c. world health organizaition d. health care financing administration
C
which of the following best describes that state or regional organization that handles medicare claims? a. health maintenance organization b. social security office c. fiscal intermediary d. senior citizens association
C fiscal intermediary
which of the following best describes a network of providers and hospitals who have a contract with insurance companies to provide discounted health care? a. health maintenance organization b. exclusive provider organization c. preferred provider organization d. integrated delivery system
C) PPO
each time a pt comes to the clinic, the MA must verify which of the following insurance information? a) wether insurence covers the procedure b) what the pts insurance plan is c) whether a refferal is required d) all of the above
D
how many sections are in the current procedural terminology reference book? a. four b. five c. six d. seven
D
the amount of charges the provider would have to write off if insurance didnt cover it, is known as what? a. unusual customary fee b. write-off c. deduction d.an adjustment
D
the statement mailed to the pt summarizing how the insurance carrier determined the reimbursement is known as what? a) (COB) coordination of benefits b) (SOB) statement of benefits c) (DOB) deteminant of benefits d) (EOB) explanation of benefits
D
which of the following applies to persons who are eligible for Medicare? a) receive aid to dependent children b) receive supplemental insurance income c) receive income below the poverty level d) receive disability income
D
which of the following is medical insurance for a spouse and unmarried dependent children of a veteran with permanent total disability resulting from a service related injury? a) medicaid b) workers compensation c) TRICARE d) CHAMPVA
D
which of the following traditional type of insurance coverage covers specific dollar amounts for provider's fees, hospital care, and surgery? a. major medical b. individual c. group d. basic e. idemnity
D
why is it important for the MA to understand medical insurance coding? a) needed to transfer all information b) can be explained to pts c) helps the pt file the claims d) serves a basis for the information on the claim form
D
which of the following best describes policies that are supplementary to medicare insurance? a. Interim b. Medicaid c.TRICARE d. Medigap
D) medigap
which of the following best describes the managed care organization model having the freedom of obtaining medical services from an HMO provider or by self referral to non-HMO providers? a. health maintenance organization? b. exclusive provider organization c. integrated delivery system d. point of service plan
D.) point of service plan
which of the following is applied to determine primary coverage for a dependent child when both parents are covered by health insurance? b) co insurance c) co pay d) deductible e) birthday rule
E) birthday rule
which is the most common type of referral used by managed care? a. STAT b. regular c. urgent d. post dated
Regular
which of the following is not a category for referrals? a) post dated b) regular c) urgent d) STAT
a
which of the following ICD-9-CM volumes is recommended as the first reference when coding diagnoses? a. volume 1 b. volume 2 c. volume 3 d. volume 4
b
considering the amount that medicare reimburses for medical care, what amount does the pt and medicare pay? a) pt: 32$,,,, Medicare: 48$ b) pt: 32$;;;;;Medicare: 42$ c) pt: 12$;;;;Medicare: 48$ d) pt: 80$;;;;; Medicare: 0$
c
large companies, non profit organizations,and governments frequently use what kind of insurance to reduce costs and gain more control their finances? a.Blue cross blue sheild b. HMO c. self insurance d. workers compensation
c) self insurance
which of the following is not included in the recommended procedure for researching CPT code numbers using the index? a) search for the service or procedure in the alphabetic index b) find a suggested number or range of numbers c) search for the suggested number range in the tabular list d) choose the correct code number for description e) choose a modifier for all diagnoses and procedures.
e
which of the following applies to medicare coverage that pays for prescription drug coverage? a. part A b. part B c. part C d. part D
part D