Question 1

Which of the following is what the patient owes after the insurance company has paid?

Accepted Answer

A)  Premium 
B)  Exclusion 
C)  Patient liability 
D)  Comorbidity 
E)  Capitation 
A)  Premium 
B)  Exclusion 
C)  Patient liability 
D)  Comorbidity 
E)  Capitation

Question 2

A managed care plan that establishes a network of providers to perform services for plan members is known as which of the following?

Accepted Answer

A)  PCP 
B)  MCO 
C)  HMO 
D)  PPO 
E)  PCMH 
A)  PCP 
B)  MCO 
C)  HMO 
D)  PPO 
E)  PCMH

Question 3

If your office submits paper claims, you should create and maintain a claims ________ to track the progress of submitted claims.

Accepted Answer

The answer of If your office submits paper claims, you...

Question 4

An organization that provides pain relief to terminally ill patients and supports these patients and their families is a ____.

Accepted Answer

A)  respite 
B)  hospital 
C)  outpatient clinic 
D)  rehabilitation center 
E)  hospice 
A)  respite 
B)  hospital 
C)  outpatient clinic 
D)  rehabilitation center 
E)  hospice

Question 5

The usual fees that are listed on the medical office's fee schedule are fees ____.

Accepted Answer

A)  paid by the third-party provider 
B)  charged over what most third-party payers will pay 
C)  charged to most of their patients most of the time under typical conditions 
D)  charged as a professional courtesy 
E)  charged only to patients who have private insurance 
A)  paid by the third-party provider 
B)  charged over what most third-party payers will pay 
C)  charged to most of their patients most of the time under typical conditions 
D)  charged as a professional courtesy 
E)  charged only to patients who have private insurance

Question 6

Which of the following is a characteristic of Medicaid?

Accepted Answer

A)  It is a health cost assistance program. 
B)  It provides health benefits to people aged 65 and older. 
C)  Patients are enrolled automatically. 
D)  Rules are the same from state to state. 
E)  It is an insurance program for low-income, blind, and disabled patients. 
A)  It is a health cost assistance program. 
B)  It provides health benefits to people aged 65 and older. 
C)  Patients are enrolled automatically. 
D)  Rules are the same from state to state. 
E)  It is an insurance program for low-income, blind, and disabled patients.

Question 7

Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

Accepted Answer

A)  Medical 
B)  Liability 
C)  Disability 
D)  Medicare 
E)  Medicaid 
A)  Medical 
B)  Liability 
C)  Disability 
D)  Medicare 
E)  Medicaid

Question 8

An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

Accepted Answer

A)  payment of benefits 
B)  review of medical necessity 
C)  explanation of benefits 
D)  review for allowable benefits 
E)  payment and remittance advice 
A)  payment of benefits 
B)  review of medical necessity 
C)  explanation of benefits 
D)  review for allowable benefits 
E)  payment and remittance advice

Question 9

When a physician agrees to accept assignment for a Medicare patient, this means the physician ____.

Accepted Answer

A)  bills Medicare for the cost of service not covered by Medicaid 
B)  will accept Medicare but not Medicaid patients 
C)  will accept the amount of money Medicare pays as payment in full. 
D)  will accept only emergency patients covered by Medicaid 
E)  bills the patient for the cost of service not covered by Medicare 
A)  bills Medicare for the cost of service not covered by Medicaid 
B)  will accept Medicare but not Medicaid patients 
C)  will accept the amount of money Medicare pays as payment in full. 
D)  will accept only emergency patients covered by Medicaid 
E)  bills the patient for the cost of service not covered by Medicare

Question 10

Expenses that are not covered by an insurance plan are called ________.

Accepted Answer

The answer of Expenses that are not covered by an...

Question 11

Which statement is true about TRICARE?

Accepted Answer

A)  TRICARE Extra can be used only after enrollment in the program. 
B)  TRICARE is a health insurance plan. 
C)  Physicians must accept all TRICARE patients. 
D)  TRICARE for Life acts as a secondary payer to Medicare. 
E)  TRICARE Standard is a health maintenance organization. 
A)  TRICARE Extra can be used only after enrollment in the program. 
B)  TRICARE is a health insurance plan. 
C)  Physicians must accept all TRICARE patients. 
D)  TRICARE for Life acts as a secondary payer to Medicare. 
E)  TRICARE Standard is a health maintenance organization.

Question 12

Which of the following is included in Medicare benefits for respite care?

Accepted Answer

A)  The patient must be terminally ill with 2 years or less to live. 
B)  Medicare has no respite care benefits. 
C)  The terminally ill patient is moved to a care facility for the respite. 
D)  Medicare provides a respite for the terminally ill patient. 
E)  The terminally ill patient's caregiver is admitted to the respite facility. 
A)  The patient must be terminally ill with 2 years or less to live. 
B)  Medicare has no respite care benefits. 
C)  The terminally ill patient is moved to a care facility for the respite. 
D)  Medicare provides a respite for the terminally ill patient. 
E)  The terminally ill patient's caregiver is admitted to the respite facility.

Question 13

Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional insurance called a(n) ________ plan.

Accepted Answer

The answer of Because Medicare pays 80% of approved charges...

Question 14

The oldest and most expensive type of healthcare plans repay policyholders for costs of healthcare due to illness and accidents and are called ________ plans.

Accepted Answer

fee-for-se

Question 15

CHIP allows states to provide health coverage to uninsured ________ in families that do not qualify for Medicaid but cannot afford private health insurance.

Accepted Answer

The answer of CHIP allows states to provide health coverage...

Question 16

If providers submit a claim for a simple procedure when in fact a more complicated procedure was documented in the medical record, ____ may occur.

Accepted Answer

A)  no payment 
B)  underpayment 
C)  overpayment 
D)  denial of claim 
E)  recovery audit 
A)  no payment 
B)  underpayment 
C)  overpayment 
D)  denial of claim 
E)  recovery audit

Question 17

The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be ____.

Accepted Answer

A)  coverage at 100 percent for both the sore throat and the broken leg 
B)  the fee for service would be applied toward the patient's deductible 
C)  denied because the treatment was not medically necessary based on the diagnosis 
D)  a reprimand to the physician for not treating the sore throat 
E)  the patient may have to pay a coinsurance after the deductible is met 
A)  coverage at 100 percent for both the sore throat and the broken leg 
B)  the fee for service would be applied toward the patient's deductible 
C)  denied because the treatment was not medically necessary based on the diagnosis 
D)  a reprimand to the physician for not treating the sore throat 
E)  the patient may have to pay a coinsurance after the deductible is met

Question 18

When the insured person pays an annual cost for healthcare insurance, it is called a ________.

Accepted Answer

A)  coinsurance 
B)  premium 
C)  copayment 
D)  capitation 
E)  benefit 
A)  coinsurance 
B)  premium 
C)  copayment 
D)  capitation 
E)  benefit

Question 19

To be covered under Medicare Part B, patients must ____.

Accepted Answer

A)  remain in the hospital for more than 90 days 
B)  receive medical care at home 
C)  purchase private insurance 
D)  enroll, because coverage is not automatic 
E)  be terminally ill 
A)  remain in the hospital for more than 90 days 
B)  receive medical care at home 
C)  purchase private insurance 
D)  enroll, because coverage is not automatic 
E)  be terminally ill

Question 20

Insurance carriers perform a review for medical ________ on each claim to determine whether the treatment is needed for the diagnosis listed.

Accepted Answer

The answer of Insurance carriers perform a review for medical...

Exam 17: Insurance Billing

Which of the following is what the patient owes after the insurance company has paid?

A managed care plan that establishes a network of providers to perform services for plan members is known as which of the following?

If your office submits paper claims, you should create and maintain a claims ________ to track the progress of submitted claims.

An organization that provides pain relief to terminally ill patients and supports these patients and their families is a ____.

The usual fees that are listed on the medical office's fee schedule are fees ____.

Which of the following is a characteristic of Medicaid?

Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

When a physician agrees to accept assignment for a Medicare patient, this means the physician ____.

Expenses that are not covered by an insurance plan are called ________.

Which statement is true about TRICARE?

Which of the following is included in Medicare benefits for respite care?

Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional insurance called a(n) ________ plan.

The oldest and most expensive type of healthcare plans repay policyholders for costs of healthcare due to illness and accidents and are called ________ plans.

CHIP allows states to provide health coverage to uninsured ________ in families that do not qualify for Medicaid but cannot afford private health insurance.

If providers submit a claim for a simple procedure when in fact a more complicated procedure was documented in the medical record, ____ may occur.

The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment code indicating a cast for a broken leg would be ____.

When the insured person pays an annual cost for healthcare insurance, it is called a ________.

To be covered under Medicare Part B, patients must ____.

Insurance carriers perform a review for medical ________ on each claim to determine whether the treatment is needed for the diagnosis listed.

Introduction to Medical Assisting

Healthcare and the Healthcare Team

Professionalism and Success

Interpersonal Communication

Legal and Ethical Issues

Infection Control Fundamentals

Safety and Patient Reception

Office Equipment and Supplies

Examination and Treatment Areas

Written and Electronic Communication

Medical Records and Documentation

Electronic Health Records

Managing Medical Records

Telephone Techniques

Patient Education

Schedule Management

Diagnostic Coding

Procedure Coding

Patient Collections and Financial Management

Organization of the Body

The Integumentary System

The Skeletal System

The Muscular System

The Cardiovascular System

The Blood

The Lymphatic and Immune Systems

The Respiratory System

The Nervous System

The Urinary System

The Reproductive Systems

The Digestive System

The Endocrine System

Special Senses

Infection Control Practices

Patient Interview and History

Vital Signs and Measurements

Assisting With a General Physical Exam

Assisting in Reproductive and Urinary Specialties

Assisting in Pediatrics

Assisting in Geriatrics

Assisting in Other Medical Specialties

Assisting in Eye and Ear Care

Assisting in Minor Surgery

Orientation to the Lab

Microbiology and Disease

Processing and Testing Urine and Stool Samples

Collecting, Processing, and Testing Blood Specimens

Electrocardiography and Pulmonary Function Testing

Diagnostic Imaging

Principles of Pharmacology

Math and Dosage Calculations

Medication Administration

Physical Therapy and Rehabilitation

Nutrition and Health

Practice Management

Emergency Preparedness

Preparing for the World of Work

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