Medical Insurance Ch 16 & 17 Exam

Which of the following is NOT included in the recommended procedure for researching CPT code numbers using the index?

Choose a modifier for all diagnoses and procedures.

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

Claims register

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

Preauthorization

Insurance fraud and abuse may be involved in more than what percentage of submitted medical claims?

10%

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

A medical release from the patient is needed.

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

The amount of charges the provider would have to write off if insurance did not cover it, is known as what?

Adjustment

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 is medical insurance for the 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 is NOT included in the insurance carrier's role?

Collect a co-payment from the physician.

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

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

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

EOB

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

Fiscal intermediary

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?

HCPCS

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

Which of the following is a convention used when there is not enough information to find a more specific code?

NEC

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

Part B

Considering the amount that Medicare reimburses for medical care, what amount does the patient and Medicare pay?

Patient $12; Medicare $48

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

Point-of-service device

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?

Point-of-service plan

Which of the following is NOT a category for referrals?

Post-dated

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 of the following is NOT affected by coding accuracy?

Resubmissions

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

Serves as basis for the information on the claim form

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

Seven

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

Patrick fell from a tree, hurt his arm, and his face was cut. His mother took him to the physician's office where a greenstick fracture of the wrist was put in a splint. A laceration was repaired on his cheek. He was given a tetanus injection. How many diagnosis codes will the preceding scenario require?

Three

Patrick fell from a tree, hurt his arm, and his face was cut. His mother took him to the physician's office where a greenstick fracture of the wrist was put in a splint. A laceration was repaired on his cheek. He was given a tetanus injection. How many procedure codes would apply to the preceding scenario?

Three

Health insurance was designed for what reason?

To help individuals and families compensate for high medical costs

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 is the purpose of screening new patients for insurance coverage?

To verify the patient has coverage and to obtain vital billing information.

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

Top left margin

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

Traditional

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

Traditional

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

UB-04

Which of the following is known as the fee system that defines allowable charges that will be accepted by insurance carriers?

UCR

Separating the components of a procedure and reporting them as billable codes with charges in order to increase reimbursement rates is known as what?

Unbundling

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?

Upcoding

Which of the following is the volume of the ICD-9-CM known as the tabular list?

Volume I

Which of the following ICD-9-CM volumes is recommended as the first reference when coding diagnoses?

Volume II

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

Workers' Compensation

Which of the following organizations developed ICD-9-CM?

World Health Organization

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

Yes, 100%

Which of the following volumes is the alphabetic index of ICD-9-CM?

Volume II