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Chapter 7: Insurance and Coding

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Quiz on Chapter 7: Insurance and Coding, created by carrieleekennedy on 24/08/2014.
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Quiz by carrieleekennedy, updated more than 1 year ago
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Created by carrieleekennedy over 10 years ago
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Resource summary

Question 1

Question
A physicians usual fee is
Answer
  • the charge he or she makes to private patients
  • the range of charges made by the majority of physicians in a given area
  • the average charge made by the majority of physicians in a given area
  • the charge specified by an insurance council
  • the charge set by a government agency

Question 2

Question
the 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
Answer
  • insurance allowance
  • customary fee
  • prevailing rate
  • reasonable fee
  • fee profile

Question 3

Question
The proportion of a patients charge billed to Medicare Part B that will be paid is
Answer
  • varied
  • total amount of bill
  • 80%
  • 80% of the allowed charge minus a deductible
  • 70% of reasonable charge

Question 4

Question
Copies of Medicare forms may be obtained from
Answer
  • office supply firm
  • fiscal agent
  • patient
  • Social Security Administration
  • Internal Revenue Service

Question 5

Question
Which of the following is NOT a duty of a medical assistant acting as the medical insurance specialist in medical office?
Answer
  • Inform patients of the amount their insurance payment will pay on thir clinic bill
  • gather information and signatures for insurance claims
  • submit the insurance claim form
  • review insurance payments
  • help clients

Question 6

Question
In a Worker's Compensation case, the medical assistant should
Answer
  • bill the patient for the deductible
  • file a bill with the insurance carrier every 2 weeks
  • send no bill to the patient
  • bill the patient for the unpaid portion
  • bill carrier in one lump sum

Question 7

Question
The CPT-4 method of procedural coding became the procedural coding terminology of choice when
Answer
  • the AMA promoted it
  • the Medicare program used it as the first level of HCPCS
  • the states adopted it
  • Blue Shield Adopted it
  • the Food and Drug Administration adopted it

Question 8

Question
Blue Shield makes direct payment to
Answer
  • physician members
  • all physicians
  • all policy holders
  • whomever the patient specifies
  • the hospital

Question 9

Question
Hospital insurance is included under Medicare
Answer
  • in Part A
  • in Part B
  • only for those who are older than 70 years of age
  • only for those who pay an additional premium
  • for those who do not receive monthly Social security benefits

Question 10

Question
Part B of Medicare is
Answer
  • voluntary
  • compulsory
  • automatically included with Part A
  • free to the policyholder
  • required for hospital benefits

Question 11

Question
Within 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
Answer
  • two copies
  • three copies
  • at least four copies signed by the doctor
  • two copies signed by the doctor
  • four copies signed by the patient

Question 12

Question
A 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):
Answer
  • claim form (CF)
  • medical necessity (MN)
  • denial of service (DOS)
  • advance beneficiary notice (ABN)

Question 13

Question
An 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
Answer
  • assignment of insurannce benefits
  • deductible
  • insuring clause
  • coinsurance
  • income limit

Question 14

Question
The national correct coding initiative is a system of CPT code edits that detects:
Answer
  • mutually exclusive code pairs
  • unbundling
  • appropriate modifiers
  • all of the above
  • none of the above

Question 15

Question
Blue Cross offers which method of reimbursement?
Answer
  • fee for service
  • capitation
  • closed panel
  • salary
  • indemnity method

Question 16

Question
Retrospective reimbursement whereby charges are made by the medical professional for each rofessional service rendered is also known as
Answer
  • fee for service
  • capitation
  • closed panel
  • salary
  • indemnity method

Question 17

Question
Reimbursement (payment) for medical services from the insurance carrier (company) is known as
Answer
  • coordination of benefits
  • indemnity
  • assignment of benefits
  • adjustment
  • salary

Question 18

Question
Private patients are not accepted for treatment in the type of plan referred to as
Answer
  • prepaid group practice
  • Blue Cross
  • Blue Shield
  • indemnity plans
  • fee for service

Question 19

Question
The Kaiser Foundation Health Plan is an example of
Answer
  • managed care
  • fee for service
  • capitation
  • Worker's Compensation
  • indirect type of service plan

Question 20

Question
Part A of Medicare does NOT pay for
Answer
  • hospitalizaation
  • home health care
  • physical therapy
  • skilled nursing facilities
  • hospice care

Question 21

Question
How many days of hospitalization will be paid by medicare after the initial deductible has been met?
Answer
  • 30
  • 60
  • 90
  • 120

Question 22

Question
The number of benefit periods under Part A of Medicare is
Answer
  • limited to 120 days
  • limited to one per 6 month period
  • limited to one per year
  • limited to three per year
  • unlimited

Question 23

Question
The number of benefit periods under Part A of Medicare is
Answer
  • limited to 120 days
  • limited to one per 6 month period
  • limited to one per year
  • limited to three per year
  • unlimited

Question 24

Question
Part B of Medicare does NOT pay for
Answer
  • home health care
  • colonoscopy
  • flu shots
  • hearing examinations for prescribing hearing aids
  • durable medical equipment

Question 25

Question
Under many Blue Shield Plans, patients entitled to :paid-in-full benefits," meaning there will be no additional charges, must go to
Answer
  • participating physicians
  • nonpaticipating physicians
  • specialists
  • physicins listed by the Social Security Administration
  • doctos associated with clinics

Question 26

Question
The CPT-4 code book is divided into how many coding sections?
Answer
  • three
  • four
  • five
  • six
  • seven

Question 27

Question
In the CPT 2004 manual, descriptors for the level of evaluation and management services include which of the following?
Answer
  • history
  • examination
  • medical decision making
  • nature of the presenting problem
  • all of the above

Question 28

Question
In the CPT 2004 manual, what modifiers are avalable in E/M (evaluation and management)
Answer
  • prolonged E/M services
  • unrelated E/M services by the same
  • significant separately identifiable E/M services by the same physician on the same day of a procedure or other service
  • all of the above

Question 29

Question
What are the primary classes of main terms in the CPT 2000 index?
Answer
  • procedure or service
  • organ or other anatomic site
  • condition (i.e., abscess, entropion)
  • synonyms, eponyms, and abbreviations
  • all of the above

Question 30

Question
A summary of additions, deletions, and revisions of CPT codes can be found in
Answer
  • Appendix A
  • Appendix B
  • Appendix C
  • index
  • Introduction

Question 31

Question
The CPT-4 coding system uses a main number to describe particuar services. This main number uses a base of
Answer
  • three digits
  • four digits
  • five digits
  • six digits
  • seven digits

Question 32

Question
How many levels are used in the Health Care Financing Administration, Common Procedure Coding System (HCPCS)
Answer
  • one
  • two
  • three
  • four
  • five

Question 33

Question
The diagnostic-related groups (DRGSss) are divided by body systems into 470 groups. What purposes does the DRG system serve?
Answer
  • a revised Health Care Financing Administration code
  • a substitute for CPT coding
  • a substitute for ICD-9 clsssification
  • strict guidelines for hospital admissions and stays
  • none of the above
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