Question 1

The ________ fee is considered the maximum charge that the health plan will pay a provider for a particular procedure or service.

Accepted Answer

The answer of The ________ fee is considered the maximum...

Question 2

Which insurance covers a patient who has been hospitalized up to 90 days for each benefit period?

Accepted Answer

A)  Medicare Part A 
B)  CHAMPVA 
C)  Medicare Part B 
D)  Medicaid 
E)  TRICARE Prime 
A)  Medicare Part A 
B)  CHAMPVA 
C)  Medicare Part B 
D)  Medicaid 
E)  TRICARE Prime

Question 3

An appropriate approach to maintaining patient confidentiality on the computer is to ____.

Accepted Answer

A)  make sure a coworker knows your password in case you are sick 
B)  allow former employees to keep their passwords 
C)  change your password every 90 days 
D)  provide each patient with a unique password 
E)  send confidential information only by fax, never by computer 
A)  make sure a coworker knows your password in case you are sick 
B)  allow former employees to keep their passwords 
C)  change your password every 90 days 
D)  provide each patient with a unique password 
E)  send confidential information only by fax, never by computer

Question 4

Mr. Johnson came to the office today complaining of headache and upset stomach. He has the traditional Medicare fee-for-service plan. Your office's usual fee for an established patient visit is $125. Medicare's allowable charge is $100. If Mr. Johnson does not have Medigap insurance, how much will he have to pay for this visit?

Accepted Answer

A)  $20 
B)  $25 
C)  $80 
D)  $100 
E)  $125 
A)  $20 
B)  $25 
C)  $80 
D)  $100 
E)  $125

Question 5

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Accepted Answer

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

Question 6

Three major methods are used to transmit claims electronically: direct transmission to the payer, ________ use, and direct data entry.

Accepted Answer

The answer of Three major methods are used to transmit...

Question 7

The ________ is a fixed percentage payable by the patient after the deductible is met.

Accepted Answer

The answer of The ________ is a fixed percentage payable...

Question 8

In which program can enrollees who are aged 65 and older continue to obtain medical services at military hospitals and clinics as they did before they turned 65?

Accepted Answer

A)  TRICARE Standard 
B)  TRICARE for Life 
C)  TRICARE Prime 
D)  TRICARE Extra 
E)  CHAMPVA 
A)  TRICARE Standard 
B)  TRICARE for Life 
C)  TRICARE Prime 
D)  TRICARE Extra 
E)  CHAMPVA

Question 9

What is the authorization called that directs an insurance carrier to pay the medical provider or the medical practice directly?

Accepted Answer

A)  Copayment 
B)  Provider of medical services 
C)  Assignment of benefits 
D)  Health insurance provider 
E)  Preauthorization 
A)  Copayment 
B)  Provider of medical services 
C)  Assignment of benefits 
D)  Health insurance provider 
E)  Preauthorization

Question 10

The provider should have the patient sign a(n) ________ of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer.

Accepted Answer

The answer of The provider should have the patient sign...

Question 11

Insurers include either an explanation of payment or a(n) ________ advice along with payment to the practice or to the patient, depending on whether an assignment of benefits was signed.

Accepted Answer

The answer of Insurers include either an explanation of payment...

Question 12

Which statement is true regarding health maintenance organizations?

Accepted Answer

A)  They focus on medical procedures and services rather than on wellness and preventive care. 
B)  They require subscribers to complete paperwork and file claims for routine procedures. 
C)  Physicians with HMO contracts are often paid a capitated rate. 
D)  Routine annual physical examinations are discouraged. 
E)  Patients generally do not have to make copayments. 
A)  They focus on medical procedures and services rather than on wellness and preventive care. 
B)  They require subscribers to complete paperwork and file claims for routine procedures. 
C)  Physicians with HMO contracts are often paid a capitated rate. 
D)  Routine annual physical examinations are discouraged. 
E)  Patients generally do not have to make copayments.

Question 13

Under a contracted or fixed prepayment called ____, physicians are paid a fixed amount of money to provide needed care.

Accepted Answer

A)  preauthorization 
B)  copayment 
C)  managed care 
D)  capitation 
E)  dual coverage 
A)  preauthorization 
B)  copayment 
C)  managed care 
D)  capitation 
E)  dual coverage

Question 14

Which of the following statements applies to a physician who agrees to accept Medicaid patients?

Accepted Answer

A)  The physician can bill the patient for services that Medicaid does not cover. 
B)  The physician may see Medicaid patients as a last resort when he does not have enough patients with insurance. 
C)  If the physician's fee is higher than the Medicaid payment, the patient is billed for the difference. 
D)  The physician does not have to agree to accept the established Medicaid payment for covered services. 
E)  The physician can bill Medicare for any services not covered by Medicaid. 
A)  The physician can bill the patient for services that Medicaid does not cover. 
B)  The physician may see Medicaid patients as a last resort when he does not have enough patients with insurance. 
C)  If the physician's fee is higher than the Medicaid payment, the patient is billed for the difference. 
D)  The physician does not have to agree to accept the established Medicaid payment for covered services. 
E)  The physician can bill Medicare for any services not covered by Medicaid.

Question 15

Which of the following is included under Workers' Compensation insurance in most states?

Accepted Answer

A)  Rehabilitation costs are covered to return an employee to work. 
B)  A monthly amount is paid to the patient for a temporary disability. 
C)  There are no death benefits. 
D)  Only selected medical expenses are covered, and no inpatient expenses are covered. 
E)  It covers workers who are injured while they are on vacation. 
A)  Rehabilitation costs are covered to return an employee to work. 
B)  A monthly amount is paid to the patient for a temporary disability. 
C)  There are no death benefits. 
D)  Only selected medical expenses are covered, and no inpatient expenses are covered. 
E)  It covers workers who are injured while they are on vacation.

Question 16

Using a clearinghouse to transmit electronic media claims ____.

Accepted Answer

A)  makes more paperwork than paper claims 
B)  requires a greater amount of time to process claims 
C)  includes data elements that are transmitted in a computer file. 
D)  enables a 30-day turnaround time from submission to payment 
E)  requires a translator and technology to conduct electronic data interchange 
A)  makes more paperwork than paper claims 
B)  requires a greater amount of time to process claims 
C)  includes data elements that are transmitted in a computer file. 
D)  enables a 30-day turnaround time from submission to payment 
E)  requires a translator and technology to conduct electronic data interchange

Question 17

Some payers offer an Internet-based service called ________ data entry, or DDE, that allows medical offices to enter data without EDI formatting.

Accepted Answer

The answer of Some payers offer an Internet-based service called...

Question 18

When the medical assistant confirms with the insurance company that the patient has coverage for a procedure before scheduling, the process is called ____________.

Accepted Answer

The answer of When the medical assistant confirms with the...

Question 19

The list of drugs approved by an insurance company is called a(n) ________.

Accepted Answer

The answer of The list of drugs approved by an...

Question 20

The electronic claim transaction preferred by Medicare is the X12 837 Health Care Claim, commonly referred to as the "________ claim."

Accepted Answer

The answer of The electronic claim transaction preferred by Medicare...

Exam 17: Insurance Billing

The ________ fee is considered the maximum charge that the health plan will pay a provider for a particular procedure or service.

Which insurance covers a patient who has been hospitalized up to 90 days for each benefit period?

An appropriate approach to maintaining patient confidentiality on the computer is to ____.

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Three major methods are used to transmit claims electronically: direct transmission to the payer, ________ use, and direct data entry.

The ________ is a fixed percentage payable by the patient after the deductible is met.

In which program can enrollees who are aged 65 and older continue to obtain medical services at military hospitals and clinics as they did before they turned 65?

What is the authorization called that directs an insurance carrier to pay the medical provider or the medical practice directly?

The provider should have the patient sign a(n) ________ of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer.

Insurers include either an explanation of payment or a(n) ________ advice along with payment to the practice or to the patient, depending on whether an assignment of benefits was signed.

Which statement is true regarding health maintenance organizations?

Under a contracted or fixed prepayment called ____, physicians are paid a fixed amount of money to provide needed care.

Which of the following statements applies to a physician who agrees to accept Medicaid patients?

Which of the following is included under Workers' Compensation insurance in most states?

Using a clearinghouse to transmit electronic media claims ____.

Some payers offer an Internet-based service called ________ data entry, or DDE, that allows medical offices to enter data without EDI formatting.

When the medical assistant confirms with the insurance company that the patient has coverage for a procedure before scheduling, the process is called ____________.

The list of drugs approved by an insurance company is called a(n) ________.

The electronic claim transaction preferred by Medicare is the X12 837 Health Care Claim, commonly referred to as the "________ claim."

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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