Test
Chapter 7: Insurance and Coding
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Preguntas del test (33)
1A physicians usual fee is
- Athe charge he or she makes to private patients
- Bthe range of charges made by the majority of physicians in a given area
- Cthe average charge made by the majority of physicians in a given area
- Dthe charge specified by an insurance council
- Ethe charge set by a government agency
2the fiscal agenets for Medicare and other government-sponsored insurance programs keep a continuous list of the usual and customary charges by individual doctors for specific procedures. This is used to determine the
- Ainsurance allowance
- Bcustomary fee
- Cprevailing rate
- Dreasonable fee
- Efee profile
3The proportion of a patients charge billed to Medicare Part B that will be paid is
- Avaried
- Btotal amount of bill
- C80%
- D80% of the allowed charge minus a deductible
- E70% of reasonable charge
4Copies of Medicare forms may be obtained from
- Aoffice supply firm
- Bfiscal agent
- Cpatient
- DSocial Security Administration
- EInternal Revenue Service
5Which of the following is NOT a duty of a medical assistant acting as the medical insurance specialist in medical office?
- AInform patients of the amount their insurance payment will pay on thir clinic bill
- Bgather information and signatures for insurance claims
- Csubmit the insurance claim form
- Dreview insurance payments
- Ehelp clients
6In a Worker's Compensation case, the medical assistant should
- Abill the patient for the deductible
- Bfile a bill with the insurance carrier every 2 weeks
- Csend no bill to the patient
- Dbill the patient for the unpaid portion
- Ebill carrier in one lump sum
7The CPT-4 method of procedural coding became the procedural coding terminology of choice when
- Athe AMA promoted it
- Bthe Medicare program used it as the first level of HCPCS
- Cthe states adopted it
- DBlue Shield Adopted it
- Ethe Food and Drug Administration adopted it
8Blue Shield makes direct payment to
- Aphysician members
- Ball physicians
- Call policy holders
- Dwhomever the patient specifies
- Ethe hospital
9Hospital insurance is included under Medicare
- Ain Part A
- Bin Part B
- Conly for those who are older than 70 years of age
- Donly for those who pay an additional premium
- Efor those who do not receive monthly Social security benefits
10Part B of Medicare is
- Avoluntary
- Bcompulsory
- Cautomatically included with Part A
- Dfree to the policyholder
- Erequired for hospital benefits
11Within the time limit set by the state after a physician has seen a Workers Compensation patient for the first time, a report, Doctors First Reort of Occupational Injury or illness, is typed. It should have
- Atwo copies
- Bthree copies
- Cat least four copies signed by the doctor
- Dtwo copies signed by the doctor
- Efour copies signed by the patient
12A written document signed by a Medicare beneficiary, prior to services being provided, that states the service provided may not be reimbursed by Medicare is called a(n):
- Aclaim form (CF)
- Bmedical necessity (MN)
- Cdenial of service (DOS)
- Dadvance beneficiary notice (ABN)
13An insurance term used to describe the payment by an insurance company of a certain percentage of the actual expense (perhaps 75 to 80%), with the patient paying the remaining amount, is
- Aassignment of insurannce benefits
- Bdeductible
- Cinsuring clause
- Dcoinsurance
- Eincome limit
14The national correct coding initiative is a system of CPT code edits that detects:
- Amutually exclusive code pairs
- Bunbundling
- Cappropriate modifiers
- Dall of the above
- Enone of the above
15Blue Cross offers which method of reimbursement?
- Afee for service
- Bcapitation
- Cclosed panel
- Dsalary
- Eindemnity method
16Retrospective reimbursement whereby charges are made by the medical professional for each rofessional service rendered is also known as
- Afee for service
- Bcapitation
- Cclosed panel
- Dsalary
- Eindemnity method
17Reimbursement (payment) for medical services from the insurance carrier (company) is known as
- Acoordination of benefits
- Bindemnity
- Cassignment of benefits
- Dadjustment
- Esalary
18Private patients are not accepted for treatment in the type of plan referred to as
- Aprepaid group practice
- BBlue Cross
- CBlue Shield
- Dindemnity plans
- Efee for service
19The Kaiser Foundation Health Plan is an example of
- Amanaged care
- Bfee for service
- Ccapitation
- DWorker's Compensation
- Eindirect type of service plan
20Part A of Medicare does NOT pay for
- Ahospitalizaation
- Bhome health care
- Cphysical therapy
- Dskilled nursing facilities
- Ehospice care
21How many days of hospitalization will be paid by medicare after the initial deductible has been met?
- A30
- B60
- C90
- D120
22The number of benefit periods under Part A of Medicare is
- Alimited to 120 days
- Blimited to one per 6 month period
- Climited to one per year
- Dlimited to three per year
- Eunlimited
23The number of benefit periods under Part A of Medicare is
- Alimited to 120 days
- Blimited to one per 6 month period
- Climited to one per year
- Dlimited to three per year
- Eunlimited
24Part B of Medicare does NOT pay for
- Ahome health care
- Bcolonoscopy
- Cflu shots
- Dhearing examinations for prescribing hearing aids
- Edurable medical equipment
25Under many Blue Shield Plans, patients entitled to :paid-in-full benefits," meaning there will be no additional charges, must go to
- Aparticipating physicians
- Bnonpaticipating physicians
- Cspecialists
- Dphysicins listed by the Social Security Administration
- Edoctos associated with clinics
26The CPT-4 code book is divided into how many coding sections?
- Athree
- Bfour
- Cfive
- Dsix
- Eseven
27In the CPT 2004 manual, descriptors for the level of evaluation and management services include which of the following?
- Ahistory
- Bexamination
- Cmedical decision making
- Dnature of the presenting problem
- Eall of the above
28In the CPT 2004 manual, what modifiers are avalable in E/M (evaluation and management)
- Aprolonged E/M services
- Bunrelated E/M services by the same
- Csignificant separately identifiable E/M services by the same physician on the same day of a procedure or other service
- Dall of the above
29What are the primary classes of main terms in the CPT 2000 index?
- Aprocedure or service
- Borgan or other anatomic site
- Ccondition (i.e., abscess, entropion)
- Dsynonyms, eponyms, and abbreviations
- Eall of the above
30A summary of additions, deletions, and revisions of CPT codes can be found in
- AAppendix A
- BAppendix B
- CAppendix C
- Dindex
- EIntroduction
31The CPT-4 coding system uses a main number to describe particuar services. This main number uses a base of
- Athree digits
- Bfour digits
- Cfive digits
- Dsix digits
- Eseven digits
32How many levels are used in the Health Care Financing Administration, Common Procedure Coding System (HCPCS)
- Aone
- Btwo
- Cthree
- Dfour
- Efive
33The diagnostic-related groups (DRGSss) are divided by body systems into 470 groups. What purposes does the DRG system serve?
- Aa revised Health Care Financing Administration code
- Ba substitute for CPT coding
- Ca substitute for ICD-9 clsssification
- Dstrict guidelines for hospital admissions and stays
- Enone of the above
Información
- Descripción
- Test sobre Chapter 7: Insurance and Coding, creado por carrieleekennedy el 24/08/2014.
- Autor
- carrieleekennedy
- Idioma
- English
- Visitas
- 68
- Historial
- Creado el 24 ago 2014 · actualizado el 27 sep 2016
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