CH 17 AND 18

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. Coordination of benefits

C. Deductible

Which of the following are codes applied to an injury or poisoning? A. Modifiers B. V codes C. E codes D. Injury codes

C. E codes

On completion of the processing of the claim, the insurance company sends what to the insured person? A. POS B. Claim remittance C. EOB D. 1490 form

C. EOB

Which of the following best describes the 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

Considering the amount that Medicare reimburses for medical care, what amount does the patient and Medicare pay? A. Patient $32; Medicare $48 B. Patient $32; Medicare $42 C. Patient $12; Medicare $48 D. Patient $80; Medicare $0

C. Patient $12; Medicare $48

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. Preferred provider organization

Which of the following is NOT affected by coding accuracy? A. Ruling out a diagnosis B. Physician reimbursement C. Resubmissions D. Medical records

C. Resubmissions

Large companies, non-profit organizations, and governments frequently use what kind of insurance to reduce costs and fain more control of their finances? A. Blue Cross/Blue Shield B. HMO C. Self-insurance D. Workers' Compensation

C. Self-insurance

The ICD-CM 10th revision will utilize alphanumeric codes that will consist of up to how many characters? A. Five B. Six C. Seven D. Eight

C. Seven

How many diagnosis codes will the preceding scenario require? A. One B. Two C. Three D. Four E. Five

C. Three

How many procedure codes would apply to the preceding scenario? A. One B. Two C. Three D. Four E. Five

C. Three

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. UCR

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. Workers' Compensation

Which of the following organizations developed ICD-9-CM? A. American Medical Associated B. Centers for Medicare and Medicaid Services C. World Health Organization D. Health Care Financing Administration

C. World Health Organization

The statement mailed to the patient summarizing how the insurance carrier determined the reimbursement is known as what? A. (COB) coordination of benefits B. (SOB) statement of benefits C. (DOB) determinant of benefits D. (EOB) explanation of benefits

D. (EOB) explanation of benefits

The amount of charges the provider would have to write off if insurance did not cover it, is known as what? A. Usual customary fee B. Write-off C. Deduction D. Adjustment

D. Adjustment

Each time a patient comes to the clinic, the medical assistant must verify which of the following insurance information? A. Whether insurance covers the procedure B. Which insurance plan does the patient have C. Whether a referral is required D. All of the above

D. All of the above

Which of the following traditional types of insurance coverage covers specific dollar amounts for a provider's fees, hospital care, and surgery? A. Major medical B. Individual C. Group D. Basic E. Indemnity

D. Basic

Which of the following is medical insurance for the 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. CHAMPVA

Which of the following is NOT included in the insurance carrier's role? A. Check to see that there are no pre-existing condition restrictions B. Ensure that the provider has a contract with the carrier C. Ensure that the coverage was in force at the time of treatment D. Collect a co-payment from the physician E. Ensure that amounts meet usual and customary standards

D. Collect a co-payment from the physician

Separating the components of a procedure and reporting them as billable codes with charges in order to increase reimbursement rates is known as what? A. Upcoding B. Unbundling C. Bundling D. Downcoding

B. Unbundling

Which of the following ICD-9-CM volumes is recommended as the first reference when coding diagnoses? A. Volume I B. Volume II C. Volume III D. Volume IV

B. Volume II

Which of the following volumes is the alphabetic index of ICD-9-CM? A. Volume I B. Volume II C. Volume III D. Volume IV

B. Volume II

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. Yes, 100% C. No, 0% D. None of the above

B. Yes, 100%

Which of the following is completed using data from the patient's electronic health record in most offices today? A. CMS 1490 B. UB92 C. CMS 1500 D. HCFA form

C. CMS 1500

Which of the following applies to the coding book used for specifying services and procedures performed in the medical office? A. ICD-9-CM B. RBRVS C. CPT D. EOB

C. CPT

Which of the following is recommended to do first when a claim is not paid without 4-6 weeks? A. Allow the carrier 30 days more to pay the claim B. Check the carrier's regulations for payment C. Call the insurance carrier and ask about the delay D. Resubmit the claim

C. Call the insurance carrier and ask about the delay

Which of the following information is NOT included in coding? A. Visit complexity B. Diagnosis for visit C. Specific procuders D. Counseling

D. Counseling

Which of the following are diagnosis codes used primarily with cancer registries> A. V codes B. E codes C. DRG codes D. M codes

D. M codes

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 applies to Medicare coverage that pays for prescription drugs? A. Part A B. Part B C. Part C D. Part D

D. Part D

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 a non-HMO provider? 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 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. Receive disability income

Why is it important for the medical assistant to understand medical insurance coding? A. Needed to transfer all information B. Assists explanations to patients C. Helps the patient file claims D. Serves as basis for the information on the claim form

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

How many major sections are in the Current Procedural Terminology reference book? A. Four B. Five C. Six D. Seven

D. Seven

The new CMS-1500 form is distinguished from the old form in that the 1500 symbol and date are located where? A. Top right margin B. Bottom right margin C. Bottom left margin D. Top left margin

D. Top left margin

Which of the following is applied to determine primary coverage for a dependent child when both parents are covered by health insurance? A. Coordination of benefits B. Co-insurance C. Co-pay D. Deductible E. Birthday Rule

E. Birthday Rule

Which of the following is NOT included in the recommended procedure for researching CPT code numbers when 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. Choose a modifier for all diagnoses and procedures

Which of the following terms 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

Which of the following applies to codes used as supplements to the basic CPT system and are required when reporting services and procedures to Medicare and Medicaid patients? A. HCPCS B. M codes C. E&M codes D. DRGs

A. HCPCS

Which section of the CPT book includes coding of immunizations and chemotherapy? A. Medicine B. Surgery C. Pathology D. Laboratory

A. Medicine

Which of the following is a convention used when there is not enough information to find a more specific code? A. NEC B. NOS C. V codes D. E codes

A. NEC

Which of the following should be used to check for patient eligibility? A. Point-of-service device B. Claims register C. Universal claim form D. Explanation of benefits

A. Point-of-service device

Which of the following in NOT a category for refferals? A. Post-dated B. Regular C. Urgent D. STAT

A. Post-dated

Before certain procedures or visits can be made, some insurance policies require which of the following? A. Preauthorization B. Predetermination C. Preregistration D. Claim review

A. Preauthorization

Which of the following applies to medical insurance for dependents of active duty or retired military personnel and their dependents? A. TRICARE B. SSI C. CMS D. HCFA

A. TRICARE

Which of the following best describes insurance policies that provide coverage on a fee-for-service business? A. Traditional B. Group C. Managed care D. Indemnity

A. Traditional

Which of the following best describes insurance policies that require policyholders to select a primary care provider? A. Traditional B. Group C. Major medical D. .Indemnity

A. Traditional

Which of the following occurs when the insurance carrier is deliberately billed a higher rate service than what was performed to order for the provider to obtain greater reimbursements? A. Upcoding B. Bundling C. Downcoding D. Unbundling

A. Upcoding

Which of the following is the volume of the ICD-9-CM known as the tabular list? A. Volume I B. Volume II C. Volume III D. Volume 1-111

A. Volume I

What is necessary in order to authorize release of medical information to an insurance carrier? A. A verbal agreement between the patient and the doctor is necessary B. A medical release from the patient is needed. C. A handshake between the patient and doctor is all that is necessary D. Authorization is never required to release medical information E. Physicians never have to share medical information

B. A medical release from the patient is needed.

Which of the following is a record of claims sent to the insurance carrier? A. Point-of-service device B. Claims register C. Universal claim form D. Explanation of benefits

B. Claims register

Which of the following terms means an insurance policy pays a percentage of the balance after 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 applies to a method of containing hospital costs that is based on an average cost for treatment of a patient's condition? A. Capitation B. Diagnostically related groups C. Fee-for-service D. Allowable charges

B. Diagnostically related groups

Which of the following applies to Medicare coverage that pays for outpatient services? A. Part A B. Part B C. Part C D. Part D

B. Part B

Which is the most common type of referral used by managed care? A. STAT B. Regular C. Urgent D. Post-dated

B. Regular

Which section of the CPT book includes coding of lacerations? A. Medicine B. Surgery C. Pathology D. Laboratory

B. Surgery

Health insurance was designed for what reason? A. To help providers increase their salary B. To help individuals and families compensate for high medical costs C. To ensure patients get the best care D. To increase revenue for the government

B. To help individuals and families compensate for high medical costs

Which of the following best describes the purpose of a physician's fee profile? A. To analyze office fees B. To reflect charges for services and reimbursement rates C. To prevent downcoding D. To subrogate monies

B. To reflect charges for services and reimbursement rates

Which of the following is the claim form used for filing inpatient admissions claims? A. CMS 1500 B. UB-04 C. CMS 1400 D. HCPA 1500

B. UB-04