Question 1

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

Question 2

Who most frequently files insurance claims and handles insurers' payments for a medical practice?

Accepted Answer

A)   Patient
B)   Nurse
C)   Medical assistant
D)   Physician
E)   Physician assistant C

Question 3

Payments made by a health plan for medical services provided to the patient are known as ________.

Accepted Answer

The answer of Payments made by a health plan for...

Question 4

Which of the following is not part of Medicare's resource-based relative value scale?

Accepted Answer

A)   The nationally uniform relative value
B)   A nationally uniform conversion factor
C)   Medigap, to reduce the gap in coverage
D)   A geographic adjustment factor
E)   Adjustments according to the cost-of-living index

Question 5

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

Question 6

The main goal of the _________ model is to change the organization and delivery of primary health care in America.

Accepted Answer

PCMH patie...

Question 7

The request for approval for payment from a third-party payer prior to a procedure is the ____.

Accepted Answer

A)   coinsurance
B)   elective procedure
C)   preauthorization
D)   predetermination
E)   explanation of payment

Question 8

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.

Question 9

The health plan that pays for medical services is known as a __________ payer.

Accepted Answer

third-part...

Question 10

A fixed prepayment is made under contract to a medical provider for each plan member in the ________ payment method.

Accepted Answer

capitation

Question 11

Under a Medicare managed care plan, the primary care physician (PCP) provides treatment and manages the patient's medical care through ________ to specialists when additional care is required.

Accepted Answer

The answer of Under a Medicare managed care plan, the...

Question 12

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 13

Which Medicare plan covers prescription medications?

Accepted Answer

A)   Part A
B)   Part B
C)   SSI
D)   Part C
E)   Part D

Question 14

Which of the following guidelines is applicable when filing a Medicaid claim and interacting with Medicaid patients?

Accepted Answer

A)   Allow a 2-year time limit on all claim submissions
B)   Submit claims without proving patient eligibility for benefits
C)   Treat the patient as if he or she has private insurance
D)   Submit claims without proving Medicaid membership
E)   Send claims to the national claims center

Question 15

Which of the following groups are not covered by TRICARE or CHAMPVA?

Accepted Answer

A)   active military personnel
B)   veterans who served in active combat
C)   non-military government employees
D)   families of all military personnel
E)   disabled veterans

Question 16

Billing the patient for the difference between a higher usual fee and a lower allowed charge is called ________ billing.

Accepted Answer

The answer of Billing the patient for the difference between...

Question 17

How should data in medical billing programs be entered?

Accepted Answer

A)   Use prefixes such as Mr., Mrs., or Ms.
B)   Enter information using capital letters
C)   Include invalid data only if necessary
D)   Use "see above" for repeated data
E)   Use hyphens, commas, and apostrophes as appropriate B

Question 18

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.

Accepted Answer

A)   asthma
B)   kidney failure
C)   pneumonia
D)   stomach ulcers
E)   gallstones

Question 19

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 is 5/23/1978. Who is the primary payer in this case?

Accepted Answer

A)   Greg's insurance, because he was born 5 years earlier than his wife
B)   Greg's wife's insurance, because her birthday occurs earlier in the calendar year
C)   Medicare, because Greg is over 65
D)   Medicaid, because Greg does not think he can afford to have sutures
E)   Workers' Compensation, since Greg is employed full-time

Question 20

Which of the following must be verbally discussed with a Medicare beneficiary to enable the beneficiary to consider options and make informed choices?

Accepted Answer

A)   CHIP
B)   DRG
C)   RBRVS
D)   ABN
E)   GAF

Exam 17: Insurance Billing

Correct Answer
verified

Who most frequently files insurance claims and handles insurers' payments for a medical practice?

Correct Answer
verified
C

Payments made by a health plan for medical services provided to the patient are known as ________.

Correct Answer
verified

Which of the following is not part of Medicare's resource-based relative value scale?

Correct Answer
verified

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

Correct Answer
verified

The main goal of the _________ model is to change the organization and delivery of primary health care in America.

Correct Answer
verified
PCMH patie...
View Answer

The request for approval for payment from a third-party payer prior to a procedure is the ____.

Correct Answer
verified

What is the birthday rule?

Correct Answer
verified

The health plan that pays for medical services is known as a __________ payer.

Correct Answer
verified
third-part...
View Answer

A fixed prepayment is made under contract to a medical provider for each plan member in the ________ payment method.

Correct Answer
verified
capitation

Under a Medicare managed care plan, the primary care physician (PCP) provides treatment and manages the patient's medical care through ________ to specialists when additional care is required.

Correct Answer
verified

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.

Correct Answer
verified

Which Medicare plan covers prescription medications?

Correct Answer
verified

Which of the following guidelines is applicable when filing a Medicaid claim and interacting with Medicaid patients?

Correct Answer
verified

Which of the following groups are not covered by TRICARE or CHAMPVA?

Correct Answer
verified

Billing the patient for the difference between a higher usual fee and a lower allowed charge is called ________ billing.

Correct Answer
verified

How should data in medical billing programs be entered?

Correct Answer
verified
B

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.

Correct Answer
verified

Correct Answer
verified

Which of the following must be verbally discussed with a Medicare beneficiary to enable the beneficiary to consider options and make informed choices?

Correct Answer
verified

Exam 17: Insurance Billing

Correct AnswerverifiedShow Answer

Who most frequently files insurance claims and handles insurers' payments for a medical practice?

Correct AnswerverifiedC

Payments made by a health plan for medical services provided to the patient are known as ________.

Correct AnswerverifiedShow Answer

Which of the following is not part of Medicare's resource-based relative value scale?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

The main goal of the _________ model is to change the organization and delivery of primary health care in America.

Correct AnswerverifiedPCMH patie...View AnswerShow Answer

The request for approval for payment from a third-party payer prior to a procedure is the ____.

Correct AnswerverifiedShow Answer

What is the birthday rule?

Correct AnswerverifiedShow Answer

The health plan that pays for medical services is known as a __________ payer.

Correct Answerverifiedthird-part...View AnswerShow Answer

A fixed prepayment is made under contract to a medical provider for each plan member in the ________ payment method.

Correct Answerverifiedcapitation

Under a Medicare managed care plan, the primary care physician (PCP) provides treatment and manages the patient's medical care through ________ to specialists when additional care is required.

Correct AnswerverifiedShow Answer

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.

Correct AnswerverifiedShow Answer

Which Medicare plan covers prescription medications?

Correct AnswerverifiedShow Answer

Which of the following guidelines is applicable when filing a Medicaid claim and interacting with Medicaid patients?

Correct AnswerverifiedShow Answer

Which of the following groups are not covered by TRICARE or CHAMPVA?

Correct AnswerverifiedShow Answer

Billing the patient for the difference between a higher usual fee and a lower allowed charge is called ________ billing.

Correct AnswerverifiedShow Answer

How should data in medical billing programs be entered?

Correct AnswerverifiedB

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.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Which of the following must be verbally discussed with a Medicare beneficiary to enable the beneficiary to consider options and make informed choices?

Correct AnswerverifiedShow Answer

Correct Answer
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C

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PCMH patie...
View Answer

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third-part...
View Answer

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capitation

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B

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