front 1 Of the federal programs providing healthcare, the largest is? Which provides health insurance for citizens aged 65 and older? | back 1 MEDICARE |
front 2 Who most frequently files insurance claims and handles insurers’ payments for a medical practice? | back 2 MEDICAL ASSISTANT |
front 3 What is the authorization called that directs an insurance carrier to pay the medical provider or medical practice directly? | back 3 ASSIGNMENT OF BENEFITS |
front 4 The person whose name the insurance is carried under is called the | back 4 SUBSCRIBER |
front 5 When the insured person pays an annual cost for healthcare insurance, it is called? | back 5 PREMIUM |
front 6 Patients who belong to managed care health plan, such as an HMO, are responsible for a small per-visit fee collected at the time of the visit. This fee is commonly called? | back 6 COPAYMENT |
front 7 In a typical medical practice, insurance claims are filled? | back 7 A FEW DAYS AFTER THE DATE OF SERVICE |
front 8 The most likely outcome of an insurance claim submitted with a diagnosis code of a sore throat and a treatment indicating a cast for a broken leg would be? | back 8 DENIED BECAUSE THE TREATMENT WAS NOT MEDICALLY NECESSARY BASED ON THE DIAGNOSIS |
front 9 An insurance claims department compares the fee the doctor charges with the benefits provided by the patient’s health plan. This is called? | back 9 REVIEW FOR ALLOWABLE BENEFITS |
front 10 Which of the following is what the patient owes after the insurance company has paid? | back 10 PATIENT LIABILITY |
front 11 Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured’s property? | back 11 LIABILITY |
front 12 To be covered under Medicare Part B, patients must | back 12 ENROLL BECAUSE COVERAGE IS NOT AUTOMATIC |
front 13 Which insurance covers a patient who has been hospitalized up to 90 days for each benefit period? | back 13 MEDICARE PART A |
front 14 Which of the following is a characteristic of Medicaid? | back 14 IT IS A HEALTH COST ASSISTANCE PROGRAM |
front 15 Patients under the age of 65 who are blind or widowed or who have serious long-term disabilities such as ? may be entitled to Medicare? | back 15 KIDNEY FAILURE |
front 16 Which of the following is included in Medicare benefits for respite care? | back 16 THE TERMINALLY ILL PATIENT WILL BE MOVED TO A RESPITE CARE FACILITY |
front 17 An organization that provides pain relief to terminally ill patients and supports that patients and their families is a? | back 17 HOSPICE |
front 18 Which of the following statements applies to a physician who agrees to accept Medicaid patients? | back 18 THE PHYSICIAN CAN BILL THE PATIENT FOR WHAT MEDICAID DOES NOT COVER |
front 19 What percent of the allowable fee does Medicare pay the healthcare provider after the annual deductible is met? | back 19 80% |
front 20 Which of the following is NOT part of Medicare’s resource-based relative value scale | back 20 MEDIGAP TO REDUCE THE GAP IN COVERAGE |
front 21 Which of the following guidelines is applicable when filling a Medicaid claim and interacting with Medicaid patients? | back 21 TREAT THE PATIENT AS IF HE OR SHE HAS PRIVATE INSURANCE |
front 22 Which statement is true about TRICARE? | back 22 TRICARE FOR LIFE ACTS AS A SECONDARY PAYER TO MEDICAID |
front 23 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? | back 23 TRICARE FOR LIFE |
front 24 Which of the following is included in Worker’s Compensation insurance in most states? | back 24 REHABILITATION SERVICES ARE COVERED TO RETURN AN EMPLOYEE TO WORK |
front 25 One advantage of submitting claims electronically is? | back 25 ELECTRONIC SUBMISSIONS IS COST-EFFECTIVE |
front 26 Which statement is TRUE regarding health maintenance organizations | back 26 PHYSICIANS WITH HMO CONTRACTS ARE OFTEN PAID A CAPITATED RATE |
front 27 A husband and wife are both employed and have work-sponsored insurance plans that cover each other and their three children. Which insurance plan is the primary payer? | back 27 THE INSURANCE PLAN OF THE PERSON WHO'S BIRTHDAY COMES FIRST IN THE CALENDER YEAR |
front 28 Using a clearinghouse to transmit electronic media claims? | back 28 INCLUDES ALL DATA ELEMENTS THAT ARE TRANSMITTED IN A COMPUTER FILE |
front 29 Which of the following is correct regarding electronic claim submission? | back 29 CLAIMS ARE PREPARED FOR TRANSMISSION AFTER ALL REQUIRED DATA ELEMENTS HAVE BEEN ENTERED |
front 30 An appropriate approach to maintaining patient confidentiality on the computer is to? | back 30 CHANGE YOUR PASSWORD EVERY 90 DAYS |
front 31 Under a contracted of fixed prepayment called ? physicians are paid a fixed amount of money to provided needed care? | back 31 CAPITATION |
front 32 Which of the following groups are not covered by TRICARE or CHAMPVA | back 32 FAMILIES OF ALL MILITARY PERSONNEL |
front 33 The payment system used by Medicare is based on? | back 33 RESOURCES |
front 34 How should data in medical billing programs be entered | back 34 ENTER ALL INFORMATION IN CAPITAL LETTERS |
front 35 The process of deciding the amount of money that will be paid by a third-party payer for a procedure is? | back 35 PREDETERMINATION |
front 36 The request for approval for payment from a third-party payer prior to a procedure is the? | back 36 PREAUTHORIZATION |
front 37 When a physician agrees to accept assignment for a Medicare patient, this means the physician? | back 37 WILL ACCEPT THE AMOUNT OF MONEY MEDICARE PAYS AS PAYMENT IN FULL |
front 38 Eligibility for Medicaid is? | back 38 BASED ON THE PATIENTS REPORTED INCOME AND ASSETS FROM THE PREVIOUS MONTH |
front 39 Which of the following is NOT part of the process for verifying worker’s compensation coverage? | back 39 GETTING THE NAME AND POLICY NUMBER OF THE PATIENTS PERSONAL HEALTH INSURANCE |
front 40 What is the birthday rule? | back 40 THE INSURANCE POLICY OF THE POLICYHOLDER WHOSE BIRTHDAY COMES FIRST IN THE CALENDER YEAR IS THE PRIMARY PAYER FOR ALL DEPENDENTS |
front 41 The usual fees that are listed on the medical office's fee schedule are fees? | back 41 CHARGED TO MOST OF THEIR PATIENTS MOST OF THE TIME UNDER TYPICAL CONDITIONS |
front 42 What is the term for the 10-digit number that identifies the physician's medical specialty? | back 42 NATIONAL IDENTIFIER |
front 43 Which of the following must be verbally discussed with a Medicare beneficiary to enable the beneficiary to consider options and make informed choices? | back 43 A BN |
front 44 If providers submit a claim for a simple procedure when in fact a more complicated procedure was documented in the medical record ? may occur? | back 44 UNDERPAYMENT |
front 45 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. 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? | back 45 CONTACT MEDICAID TO VERIFY HER ELIGIBILITY |
front 46 Mr. Johnson came to the office today complaining of headaches and upset stomach. He has the traditional Medicaid fee-for-service plan. Your offices 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? | back 46 $25 |
front 47 Greg Owen is in the office today for treatment of a small but deep cut he received while cutting laminate for the new floor in his kitchen. He has employer-provided insurance and is also listed as a dependent on his wife's insurance. His DOB IS 7/19/1973 and his wife's DOB 5/23/1978. Who is the primary payer in this case? | back 47 GREG'S INSURANCE BECAUSE HE WAS BORN 5 YEARS EARLIER THAN HIS WIFE |