Question 1

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

Accepted Answer

coinsurance

Question 2

The authorization for an insurance carrier to pay the physician or the medical practice directly is the ____.

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 C

Question 3

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

Accepted Answer

HIPAA4010

Question 4

In a typical medical practice, insurance claims are filed ____.

Accepted Answer

A)  the day before the filing limit is reached 
B)  the day before the date of service 
C)  a few business days after the date of service 
D)  9 months after the service is rendered 
E)  1 year from the date of service 
A)  the day before the filing limit is reached 
B)  the day before the date of service 
C)  a few business days after the date of service 
D)  9 months after the service is rendered 
E)  1 year from the date of service

Question 5

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 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

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 8

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 9

The amount Medicare pays the physician or healthcare provider after the annual deductible is met is ____.

Accepted Answer

A)  20% 
B)  50% 
C)  75% 
D)  80% 
E)  100% 
A)  20% 
B)  50% 
C)  75% 
D)  80% 
E)  100%

Question 10

What is the birthday rule?

Accepted Answer

A)  Coverage for the year begins on the policyholder's birthday. 
B)  Dependent children lose coverage on their 18th birthday. 
C)  The policyholder's primary insurance coverage ends on his 80th birthday. 
D)  The insurance policy of the policyholder whose birthday comes first in the calendar year is the primary payer for all dependents. 
E)  Insurance coverage for all dependents ends on the policyholder's 65th birthday. 
A)  Coverage for the year begins on the policyholder's birthday. 
B)  Dependent children lose coverage on their 18th birthday. 
C)  The policyholder's primary insurance coverage ends on his 80th birthday. 
D)  The insurance policy of the policyholder whose birthday comes first in the calendar year is the primary payer for all dependents. 
E)  Insurance coverage for all dependents ends on the policyholder's 65th birthday.

Question 11

Billing programs used to exchange health information about the practice's patients with health plans use an electronic data ________ to send information quickly and securely.

Accepted Answer

The answer of Billing programs used to exchange health information...

Question 12

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

Accepted Answer

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

Question 13

What is the term for the 10-digit number that identifies the physician's medical specialty?

Accepted Answer

A)  Taxonomy code 
B)  National identifier 
C)  Capitation 
D)  Physician code 
E)  DEA number 
A)  Taxonomy code 
B)  National identifier 
C)  Capitation 
D)  Physician code 
E)  DEA number

Question 14

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 15

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 16

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 17

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 18

Mrs. Lawrence is an elderly diabetic patient who is on Medicare. She recently injured her lower left leg, and since then has had trouble with open sores or ulcers on that leg. She came to the office last week to have the physician examine and treat the ulcers. At that time, you checked, and she qualified for Medicaid as well as Medicare. She has come to the office today for follow-up care and treatment. Which of the following should you do first?

Accepted Answer

A)  Ensure that the physician signs the Medicaid claim 
B)  Contact Medicare for preauthorization 
C)  Contact Medicaid to verify her eligibility 
D)  Send the claim to Medicaid 
E)  Notify Mrs. Lawrence that she will not have to pay anything 
A)  Ensure that the physician signs the Medicaid claim 
B)  Contact Medicare for preauthorization 
C)  Contact Medicaid to verify her eligibility 
D)  Send the claim to Medicaid 
E)  Notify Mrs. Lawrence that she will not have to pay anything

Question 19

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 20

Some payers, particularly PPOs, establish fixed fee schedules with their participating physicians, which are also called ________ fee schedules.

Accepted Answer

The answer of Some payers, particularly PPOs, establish fixed fee...

Exam 17: Insurance and Billing

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

The authorization for an insurance carrier to pay the physician or the medical practice directly is the ____.

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

In a typical medical practice, insurance claims are filed ____.

Which of the following is a characteristic of Medicaid?

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

Which statement is true regarding health maintenance organizations?

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

The amount Medicare pays the physician or healthcare provider after the annual deductible is met is ____.

What is the birthday rule?

Billing programs used to exchange health information about the practice's patients with health plans use an electronic data ________ to send information quickly and securely.

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

What is the term for the 10-digit number that identifies the physician's medical specialty?

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

Which statement is true about TRICARE?

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 ____.

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

Some payers, particularly PPOs, establish fixed fee schedules with their participating physicians, which are also called ________ fee schedules.

Introduction to Medical Assisting

Healthcare and the Healthcare Team

Professionalism and Success

Interpersonal Communication

Legal and Ethical Issues

Basic Safety and Infection Control

Patient Reception

Office Equipment and Supplies

Examination and Treatment Areas

Written and Electronic Documents

Medical Records and Documentation

Electronic Health Records

Telephone Techniques

Patient Education

Managing Medical Records

Schedule Management

Diagnostic Coding

Procedure Coding

Patient Billing and Collection

Financial Management Key

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 System

The Digestive System

The Endocrine System

Special Senses

Patient Interview and History

Vital Signs and Measurements

Assisting With a General Physical Examination

Assisting in Reproductive and Urinary Specialties

Assisting in Pediatrics

Assisting in Geriatrics

Assisting in Other Medical Specialties

Assisting With Eye and Ear Care

Assisting With Minor Surgery

Orientation to the Lab

Electrocardiography and Pulmonary Function Testing

Microbiology and Disease

Processing and Testing Urine and Stool Specimens

Collecting, Processing, and Testing Blood Specimens

Diagnostic Imaging

Principles of Pharmacology

Dosage Calculation

Medication Administration

Physical Therapy and Rehabilitation

Nutrition and Health

Practice Management

Emergency Preparedness

Preparing for the World of Work

Filters