Question 1

An organization that provides pain relief to terminally ill patients and supports these patients and their families is a ____.

Accepted Answer

A)   respite
B)   hospital
C)   outpatient clinic
D)   rehabilitation center
E)   hospiceF) D) and E)
G) A) and E)

Question 2

To be covered under Medicare Part B, patients must ____.

Accepted Answer

A)   remain in the hospital for more than 90 days
B)   receive medical care at home
C)   purchase private insurance
D)   enroll, because coverage is not automatic
E)   be terminally illF) A) and B)
G) A) and E)

Question 3

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.F) B) and D)
G) A) and D)

Question 4

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

Accepted Answer

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

Question 5

Insurance carriers perform a review for medical ________ on each claim to determine whether the treatment is needed for the diagnosis listed.

Accepted Answer

The answer of Insurance carriers perform a review for medical...

Question 6

An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

Accepted Answer

A)   payment of benefits
B)   review of medical necessity
C)   explanation of benefits
D)   review for allowable benefits
E)   payment and remittance adviceF) A) and B)
G) A) and C)

Question 7

If your office submits paper claims, you should create and maintain a claims ________ to track the progress of submitted claims.

Accepted Answer

The answer of If your office submits paper claims, you...

Question 8

Which of the following is what the patient owes after the insurance company has paid?

Accepted Answer

A)   Premium
B)   Exclusion
C)   Patient liability
D)   Comorbidity
E)   CapitationF) A) and B)
G) All of the above

Question 9

Which of the following is included in Medicare benefits for respite care?

Accepted Answer

A)   The patient must be terminally ill with 2 years or less to live.
B)   Medicare has no respite care benefits.
C)   The terminally ill patient is moved to a care facility for the respite.
D)   Medicare provides a respite for the terminally ill patient.
E)   The terminally ill patient's caregiver is admitted to the respite facility.F) B) and C)
G) A) and E)

Question 10

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 metF) B) and C)
G) C) and E)

Question 11

Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

Accepted Answer

A)   Medical
B)   Liability
C)   Disability
D)   Medicare
E)   MedicaidF) A) and B)
G) A) and C)

Question 12

The oldest and most expensive type of healthcare plans repay policyholders for costs of healthcare due to illness and accidents and are called ________ plans.

Accepted Answer

fee-for-se...

Question 13

When the insured person pays an annual cost for healthcare insurance, it is called a ________.

Accepted Answer

A)   coinsurance
B)   premium
C)   copayment
D)   capitation
E)   benefitF) All of the above
G) A) and E)

Question 14

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 15

The usual fees that are listed on the medical office's fee schedule are fees ____.

Accepted Answer

A)   paid by the third-party provider
B)   charged over what most third-party payers will pay
C)   charged to most of their patients most of the time under typical conditions
D)   charged as a professional courtesy
E)   charged only to patients who have private insuranceF) A) and E)
G) C) and D)

Question 16

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.F) C) and E)
G) A) and B)

Question 17

When a physician agrees to accept assignment for a Medicare patient, this means the physician ____.

Accepted Answer

A)   bills Medicare for the cost of service not covered by Medicaid
B)   will accept Medicare but not Medicaid patients
C)   will accept the amount of money Medicare pays as payment in full.
D)   will accept only emergency patients covered by Medicaid
E)   bills the patient for the cost of service not covered by MedicareF) A) and B)
G) B) and D)

Question 18

If providers submit a claim for a simple procedure when in fact a more complicated procedure was documented in the medical record, ____ may occur.

Accepted Answer

A)   no payment
B)   underpayment
C)   overpayment
D)   denial of claim
E)   recovery auditF) A) and C)
G) A) and E)

Question 19

A managed care plan that establishes a network of providers to perform services for plan members is known as which of the following?

Accepted Answer

A)   PCP
B)   MCO
C)   HMO
D)   PPO
E)   PCMHF) B) and D)
G) C) and E)

Question 20

Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional insurance called a(n) ________ plan.

Accepted Answer

The answer of Because Medicare pays 80% of approved charges...

Exam 17: Insurance Billing

Insurance carriers perform a review for medical ________ on each claim to determine whether the treatment is needed for the diagnosis listed.

Correct AnswerverifiedShow Answer

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

A managed care plan that establishes a network of providers to perform services for plan members is known as which of the following?

Correct AnswerverifiedShow Answer

Which of the following is a characteristic of Medicaid?

Correct AnswerverifiedShow Answer

An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

Correct AnswerverifiedShow Answer

Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

Correct AnswerverifiedShow Answer

Which of the following is included in Medicare benefits for respite care?

Correct AnswerverifiedShow Answer

Which statement is true about TRICARE?

Correct AnswerverifiedShow Answer

To be covered under Medicare Part B, patients must ____.

Correct AnswerverifiedShow Answer

The oldest and most expensive type of healthcare plans repay policyholders for costs of healthcare due to illness and accidents and are called ________ plans.

Correct Answerverifiedfee-for-se...View AnswerShow Answer

When a physician agrees to accept assignment for a Medicare patient, this means the physician ____.

Correct AnswerverifiedShow Answer

Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional insurance called a(n) ________ plan.

Correct AnswerverifiedShow Answer

Which of the following is what the patient owes after the insurance company has paid?

Correct AnswerverifiedShow Answer

If providers submit a claim for a simple procedure when in fact a more complicated procedure was documented in the medical record, ____ may occur.

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

When the insured person pays an annual cost for healthcare insurance, it is called a ________.

Correct AnswerverifiedShow Answer

An organization that provides pain relief to terminally ill patients and supports these patients and their families is a ____.

Correct AnswerverifiedShow Answer

If your office submits paper claims, you should create and maintain a claims ________ to track the progress of submitted claims.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

The usual fees that are listed on the medical office's fee schedule are fees ____.

Correct AnswerverifiedShow Answer

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