Question 1

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 2

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

Accepted Answer

coinsurance

Question 3

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 4

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 5

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

Question 6

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

Accepted Answer

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

Question 7

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 8

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 C

Question 9

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

Question 10

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.

Question 11

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.

Question 12

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

Accepted Answer

HIPAA4010

Question 13

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 14

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.

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.

Question 16

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...

Question 17

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%

Question 18

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

Question 19

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 20

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

Exam 17: Insurance and Billing

What is the birthday rule?

Correct Answer
verified

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

Correct Answer
verified
coinsurance

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

Correct Answer
verified

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

Correct Answer
verified

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

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

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

Correct Answer
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C

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

Correct Answer
verified

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

Correct Answer
verified

Which of the following is a characteristic of Medicaid?

Correct Answer
verified

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

Correct Answer
verified
HIPAA4010

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

Correct Answer
verified

Which statement is true regarding health maintenance organizations?

Correct Answer
verified

Which statement is true about TRICARE?

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

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

Correct Answer
verified

Correct Answer
verified

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 ____.

Correct Answer
verified

Exam 17: Insurance and Billing

What is the birthday rule?

Correct AnswerverifiedShow Answer

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

Correct Answerverifiedcoinsurance

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

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

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

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

Correct AnswerverifiedC

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Which of the following is a characteristic of Medicaid?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedHIPAA4010

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

Correct AnswerverifiedShow Answer

Which statement is true regarding health maintenance organizations?

Correct AnswerverifiedShow Answer

Which statement is true about TRICARE?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

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 ____.

Correct AnswerverifiedShow Answer

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coinsurance

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C

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HIPAA4010

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