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