medical insurance

Which of the following is a record of claims sent to the insurance carrier?

Claims register.

Which of the following applies to codes used as supplements to the basic CPT sytem and are required when reporting services and procedures to Medicare and Medicaid patients?

HCPCS

Which of the following information must always be completed on the insurance claim?

If the physician accepts assignment of benefits

Before certain procedures or visits can be made, some insurance policies require which of the following?

Preauthorization

Which of the following should be used to check for patient eligibility?

point of service device

How many major sections are in the Current Procedural Terminology book?

Six

Which section of the CPT book includes coding of lacerations?

Surgery

Which of the following applies to medical insurance for dependents of active duty or retired military personnel and their dependents?

TRICARE

Which of the following is the claim form used for filing inpatient admissions claims?

UB-40

Where is the carrier block located on the CMS-1500?

Upper right corner

Which of the following is the purpose of screening new patiens for insurance coverage?

Verify patient has coverage and obtain vital billing information.

An organization that initiated the development of ICD codes is

WHO

On an insurance claim form, when should the box asking whether the patient had been charged for outside laboratory work be checked "yes"?

Whenever the office charged the patient for laboratory work done outside the office.

Which of the following applies to persons who are eligible for Medicare

Receive disability income

Which of the following organizations developed ICD-10-CM

World Health Organization

Which of the following is not affected by coding accuracy?

resubmissions

Which of the following best describes the purpose of a physician's fee profile?

to reflect charges for services and reimbursement rates

Which of the following best describes insurance policies that provide coverage on a fee-for-service basis?

traditional

The statement mailed to the patient summarizing how the insurance carrier determined the reimbursement is know as what?

(EOB) Explanation of Benefits

Insurance fraud and abuse may be involved in as many of what percentage of submitted medical claims?

10%

What is necessary to authorize release of medical information to an insurance carrier?

A medical release form

How is an established patient defined?

A patient who has been seen for the last 3 years.

The amount of charges the provid3er would have to write off if insurance didn't cover it, is know as what?

An adjustment.

Which of the following traditional type of insurance coverage covers specific dollar amounts for provider's fees, hospital care and surgery?

Basic

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

CHAMPVA

Which of the following is completed using data from the patient's electronic health record in most offices today?

CMS 1500

Which of the following applies to the coding book used for specifying services an procedures performed in the medical office?

CPT

Which of the following is recommended to do first when a claim is not paid within 4-6 weeks?

Call the insurance carrier and ask about the delay.

Which of the following is not included in the insurance carrier's role?

Collect a co-payment from the physician.

When completing the patient and insured information section on the CMS-1500 form, you should use what to separate parts of the name?

Commas

Which of the following best describes the state or regional organization that handles Medicare claims?

Fiscal intermediary

The amount of money that the insured must incur for medical services before the policy begins to pay is known as what?

Deductible

Which of the following applies to a method of containing hospital costs that is based on an average cost for treatment of a patient's condition?

Diagnostically related groups.

Which of the following are codes applied to injury or poisoning?

E codes

On completion of the processing of the claim, the insurance company sends what to the insured person?

EOB

Which of the following is the significance of linking diagnosis and procedure codes on claims?

It demonstrate medical necessity

Which of the following statements about UB-40 claim form is correct?

It is used for inpatient services and procedures.

Which section of the CPT book includes coding of immunizations and chemotherapy?

Medicine

Which of the following best describes policies that are supplementary to Medicare insurance?

Medigap

What type of number is usually used to identify the physician who provided each service on an insurance claim form?

NPI number

International Classification of Diseases is released every year in what month?

October

Which of the following applies to Medicare coverage that pays for outpatient services

Part B

Which of the following applies to Medicare coverage that pays for prescription drug coverage?

Part D

Which of the following best describes a network of providers and hospitals who have a contract with insurance companies to provide discounted health care?

Preferred provider organization

Which is the most common type of referral used by managed care?

Regular

Large companies, non-profit organizations, and governments frequently use what kind of insurance to reduce costs and gain more control of their finances?

Self-insurance

Why is it important for the medical assistant to understand medical insurance coding?

Serves as a basis for the information on the claim form.

The ICD-CM 10th revision will utilize alphanumeric codes that will consist up to how many characters?

Seven

Block 32 of the CMS-1500 (02/12) claim form contains what type of information?

The name and address of the service facility

How much is the copayment or coinsurance that a patient with Medicaid must pay?

The patient with Medicaid does not pay nothing.

Health insurance was designed for what reason?

To help individuals and families compensate for high medical costs.

The new CMS-1500 form is distinguishable from the old form in that the 1500 symbol and date are located where?

Top left corner

Which of the following best describes insurance policies that require policy holders to select a primary care provider?

Traditional

Which of the following is a type of insurance coverage for persons injured on the job?

Worker's compensation

Dr. Pagan is participating provider in Medicare. Does this mean Dr. Pagan will accept assignment and what percent of the allowed amount?

Yes, 100%

Each time a patient comes to the clinic; the MA must verify which of the following insurance information?

all of the above: wether the insurance covers the procedure. B) what patient's insurance plan is. C) wether a referral is required.

Which of the following is applied to determine primary coverage for a dependent child when both parents are covered by health insurance?

birthday rule.

Which of the following terms means an insurance policy pays a percentage of the balance after application of the deductible?

co-insurance

which of the following terms is applied when more than one policy covers an individual?

coordination of benefits

Which of the following information is not included in coding?

counseling

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?

point of service plan

Which of the following is not a category for referrals?

post dated

Which of the following occurs when the insurance carrier is deliberately billed a higher rate service than what was performed to obtain a greater reimbursement?

up-coding