Chapter 13-16 Review
Which type of referral is usually processed immediately? A) regular B) urgent C) STAT D) all of the above
STAT
The TRICARE option that is similar to a preferred provider network is TRICARE: A) prime B) extra C) standard D) basic
extra
How many diagnoses can be reported on the CMS-1500? A) two B) three C) four D) six
four
A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called A) group policy B) individual policy C) a government plan D) a self-insured plan
group policy
Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own office? A) staff model B) independent practice association C) group model D) none of the above
independent practice association
Who is financially responsible for a minor seeking treatment for STD without parental consent? A) the parent who brings the child in for treatment B) the legally emancipated minor C) it depends; the medical assistant must determine where the statement should be sent D) the minor E) the legal guardian
it depends; the medical assistant must determine where the statement should be sent
Which of the following should be considered when using collection agency? A) net back B) fee percentage C) fee charged by the collection agency D) both A and B E) all of the above
net back
The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ___________ provider A) participating B) paying C) physician D) none of the above
participating
Which of the following is the most successful collection strategy? A) notes B) patient account statement C) collection letter D) telephone call
telephone call
Which of the following individuals would not normally be eligible for medicare? A) a 66 year old retired woman B) a blind teenager C) a 23 year old recipient of AFDC D) a person on dialysis
a 23 year old recipient of AFDC
Which of the following is not an advantage of managed care? A) healthcare costs are usually contained B) access to specialized care and referrals is limited C) most preventive medical treatment is covered D) out of pocket expenses tend to be less than traditional insurance
access to specialized care and referrals is limited
A system of recording, classifying, and summarizing financial transactions is called: A) bookkeeping B) accounting C) accruing D) depreciation
accounting
Which statement best describes the relationship between bookkeeping and accounting? A) accounting is a summary of the activities of bookkeeping B) bookkeeping takes care of all the reporting activities of accounting C) accounting plans the bookkeeping process D) bookkeeping involves the recording activities of accounting
accounting is a summary of the activities of bookkeeping
Health insurance benefits are determined by A) indemnity schedules B) service benefit plans C) relative value studies D) all of the above
all of the above
Which of the following are special bookkeeping entries? A) credit balances B) third party payments C) refunds D) both A and B E) all of the above
all of the above
Which of the following needs to occur when a provider agrees to settle for a reduced fee? A) negotiations without prejudice B) discount offer in writing C) definite time limit for making payment is stated D) two copies of agreement with witness signatures E) all of the above
all of the above
The maximum amount of money third-party payers will pay for a specific procedure or service is called the A) benefit B) allowable amount C) allowed service D) incurred amount
allowable amount
To examine claims for accuracy and completeness before they are submitted is to _________ the claims A) correct B) audit C) revise D) reject
audit
Which of the following is not a disadvantage of managed care? A) authorized services usually are covered B) Physicians' choices in the treatment of patients can be limited C) more paperwork may be necessary D) reimbursement is historically less than with traditional health insurance
authorized services usually are covered
The amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage is called the A) benefits B) deductible C) premium D) co-pay
benefits
Which of the following needs to occur when a check is returned from the blank for NSF? A) the payment posted to the patient account must be reversed B) a charge line item must be added with the amount of the NSF check C) the original payment must be deleted D) both A and B E) all of the above
both A and B
Payments to the healthcare facility come as reimbursement from the insurance company only. Adjustments are made to a patient's account when it is necessary to add or subtract a patient payment from the balance A) both statements are true B) both statements are false C) the first statement is true D) the second statement is true
both statements are false
Accounts receivable are moneys that are expected but not yet received. All invoices, statements, and operational expenses are included in accounts receivable A) both statements are true B) both statements are false C) the first statement is true D) the second statement is true
the first statement is true
Many healthcare facilities find small claims court a satisfactory, inexpensive means of collecting delinquent accounts. Parties to small claims actions are represented by an attorney at the hearing but may also send another person to court on their behalf to produce records supporting the claim A) both statements are true B) both statements are false C) the first statement is true D) the second statement is true
the first statement is true
Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called A) riders B) service benefit plans C) third-party payers D) capitation
third-party payers
Electronic Data Interchange is A) transferring data back and forth between two or more entities B) sending information to one insurance carrier C) sending information to one clearinghouse for processing D) none of the above
transferring data back and forth between two or more entities
Block 1 of the CMS-1500 contains what information? A) patient's name B) insured's name C) type of insurance coverage D) carrier address
type of insurance coverage
A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a(n) A) credentialing committee review B) peer review committee evaluation C) utilization review D) audit committee review
utilization review
A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called A) an individual policy B) workers' compensation C) unemployment insurance D) disability insurance
workers' compensation
Procedures performed on the patient are found in what block? A) 24a B) 24b C) 24d D) 24e
24d
The physician's signature is located in block A) 12 B) 13 C) 31 D) 33
31
Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent A) 32003 B) 32002 C) 32001 D) 32000
32000
Total splenectomy A) 38115 B) 38102 C) 38101 D) 38100
38100
The insured's name is found in block A) 1 B) 2 C) 3 D) 4
4
Suture of a recent wound on the eyelid A) 67938 B) 67930 C) 67950 D) 67961
67930
Biopsy of external ear A) 69090 B) 69100 C) 69140 D) 69150
69100
Eustachian tube inflation, transnasal, with catheterization A) 69399 B) 69401 C) 69400 D) 69405
69400
Chest x-ray examination. single view, frontal A) 71000 B) 71100 C) 71010 D) 71011
71010
Pelvimetry, with or without placental localization A) 74710 B) 74740 C) 74742 D) 74775
74710
Liver function study with hepatobiliary agents, with serial images A) 78201 B) 78205 C) 78220 D) 78223
78220
Basic metabolic panel A) 80048 B) 80050 C) 80051 D) 80053
80048
Urinalysis A) 81000 B) 81005 C) 82000 D) 81001
81000
Cyanide A) 82595 B) 82600 C) 82615 D) 82530
82600
Serum folic acid A) 82735 B) 82760 C) 82746 D) 82803
82746
Triglycerides A) 84476 B) 84477 C) 84478 D) 84479
84478
Febrile agglutinins, including Rocky Mountain spotted fever A) 86000 B) 86001 C) 86010 D) 86011
86000
Which of the following account aging categories requires a final demand letter before the account is turned over to a collection agency? A) 30-60 days B) 60-90 days C) 90-120 days D) over 120 days
90-120 days
Psychoanalysis A) 90845 B) 90846 C) 90847 D) 90849
90845
Cardiopulmonary resuscitation A) 93000 B) 93015 C) 92960 D) 92950
92950
New patient office visit, problem-focused history and examination, straightforward decision making A) 99201 B) 99202 C) 99203 D) 99204
99201
New patient office visit, expanded problem-focused history and examination, straightforward decision making A) 99201 B) 99202 C) 99203 D) 99024
99202
New patient office visit, comprehensive history, examination, and moderate-complexity decision making A) 99201 B) 99202 C) 99203 D) 99204
99204
New patient office visit, comprehensive history and examination, high-complexity decision making A) 99202 B) 99203 C) 99204 D) 99205
99205
Established patient office visit, problem-focused history and examination, straightforward decision making A) 99211 B) 99212 C) 99213 D) 99214
99212
Initial hospital observation care, new patient A) 99217 B) 99218 C) 99219 D) 99220
99218
Hospital discharge day management, 45 minutes A) 99238 B) 99239 C) 99234 D) 99235
99239
New patient, initial inpatient consultation A) 99251 B) 99252 C) 99253 D) 99254
99251
Initial pediatric inpatient critical care A) 99296 B) 99295 C) 99294 D) 99293
99293
Initial nursing facility care, detailed or comprehensive history or examination, straightforward or low-complexity decision making A) 99304 B) 99305 C) 99306 D) 99307
99304
Subsequent nursing facility care, comprehensive interval history and examination, high-complexity medical decisions A) 99310 B) 99309 C) 99308 D) 99307
99310
Established patient, home patient, problem-focused interval history and examination, straightforward medical decision making A) 99347 B) 99348 C) 99349 D) 99350
99347
Veterans of the U.S. Armed Forces may be covered by A) CHAMPVA B) TRICARE C) Workers' compensation D) Blue Cross/Blue Shield
CHAMPVA
Which part of medicare covers prescription drug services? A) A B) B C) C D) D
D
Acne surgery, removal of multiple milia, comedones, cysts, pustules A) 10080 B) 10061 C) 10040 D) 11001
10040
The physician's office place of service code is A) 9 B) 10 C) 11 D) 12
11
The assignment of benefits is located in block A) 12 B) 13 C) 27 D) 33
13
Breast reduction A) 19316 B) 19318 C) 19328 D) 19330
19318
The patient's name is found in block A) 1 B) 2 C) 3 D) 4
2
The federal and state-sponsored health insurance program for the medically indigent is called A) Medicare B) Medicaid C) Medigap D) MediCal
Medicaid
Health insurance designed for military dependents and retired military personnel is called A) CHAMPVA B) TRICARE C) Medicare D) Medicaid
TRICARE
The "cash basis" system of accounting used by most physicians means that A) credit is used as little as possible B) charges are recorded as income at the time they are received C) a simple bookkeeping system is used D) expenses are recorded at the time they are incurred
charges are recorded as income at the time they are received
When tracing "skips," which of the following is strictly forbidden by law? A) check the debtor's place of employment B) check the internet to secure the names of neighbors or landlord C) communicate with a third party more than once D) call the telephone number listed in the patient account
communicate with a third party more than once
If not handled properly, which of the following can decrease what is owed to the provider erroneously A) payments and adjustments B) credit balances and refunds C) both A and B D) all of the above
credit balances and refunds
Which of the following agreements for payment plans is not subject to TILA and does not require a signed Truth in Lending statement? A) specific agreement for less than four installments and finance charge B) specific agreement with more than four installments and finance charge C) no specific agreement with more than four installments and no fiance charge D) credit card or loan specifically for healthcare treatment E) all of the above
credit card or loan specifically for healthcare treatment
The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the A) exclusion B) premium C) deductible D) remittance
deductible
Claims that have errors or omissions that must be corrected and resubmitted to receive reimbursement are called ________ claims A) clean B) dirty C) dingy D) incomplete
dirty
Which of the following expenses would be paid for by medicare part B? A) inpatient hospital charges B) hospice services C) physician;s office visits D) Home healthcare charges
physician;s office visits
The insured's address in block 7 refers to the __________ address. A) patient's B) spouse's C) policyholder's D) insurance carrier's
policyholder's
The amount of money paid to keep an insurance policy in force is the A) premium B) deductible C) co-pay D) co-insurance
premium
The STARK law imposes restrictions on which of the following? A) medicare advance beneficiary notices B) professional courtesy C) fee for service D) billing minors
professional courtesy
Organizations that fund their own insurance programs offer their employees A) group coverage B) individual coverage C) government plans D) self-funded plans
self-funded plans
