Question 1

The total sum that the health plan will pay out over the patient's life is the lifetime ________ benefit.

Accepted Answer

The answer of The total sum that the health plan...

Question 2

Legal clauses in insurance policies that prevent duplication of payment are called ________ of benefits clauses.

Accepted Answer

The answer of Legal clauses in insurance policies that prevent...

Question 3

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 D)
G) B) and D)

Question 4

A(n) ________ procedure is a medical procedure that is not required to sustain life and that is planned in advance to be done at the convenience of the physician or surgeon and the patient.

Accepted Answer

The answer of A(n) ________ procedure is a medical procedure...

Question 5

The list of drugs approved by an insurance company is called a(n) ________.

Accepted Answer

The answer of The list of drugs approved by an...

Question 6

Patients who belong to a 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 a(n)  ____.

Accepted Answer

A)   copayment
B)   premium
C)   coinsurance
D)   capitation
E)   deductibleF) A) and E)
G) C) and D)

Question 7

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 D)
G) A) and B)

Question 8

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)   gallstonesF) B) and E)
G) A) and B)

Question 9

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Accepted Answer

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

Question 10

When entering data in medical billing programs, you should ____.

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 appropriateF) A) and B)
G) A) and C)

Question 11

Which of the following is correct regarding electronic claim submissions?

Accepted Answer

A)   Claims cannot be transmitted directly by electronic data interchange (EDI) .
B)   Claims cannot be entered into the health plan's computer system.
C)   Clearinghouses will modify data as necessary to ensure a standard format.
D)   Claims are prepared for transmission after all required data elements have been entered.
E)   Claim submissions cannot be integrated with EHR systems.F) A) and C)
G) C) and D)

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

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 E)
G) A) and B)

Question 14

The payment system used by Medicare is based on ____.

Accepted Answer

A)   prevailing rates in the region
B)   resources
C)   the price of medical equipment used
D)   fee-for-service agreements
E)   the physicians' minimum chargesF) C) and D)
G) A) and D)

Question 15

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?

Accepted Answer

A)   The husband's insurance plan, because he makes more money
B)   The insurance plan of the person whose birthday comes first in the calendar year
C)   The wife's insurance plan, because it has the most comprehensive coverage
D)   Whichever the husband and wife want to declare as primary
E)   The insurance plan of the person whose policy went into effect firstF) A) and B)
G) A) and C)

Question 16

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 indexF) A) and C)
G) A) and D)

Question 17

Which of the following is not part of the process for verifying workers' compensation coverage?

Accepted Answer

A)   Getting the name and policy number of the patient's personal health insurance policy
B)   Obtaining the employer's verification that the accident was work-related
C)   Asking the verifier at the patient's company for the original date of the injury
D)   Getting the name of the verifier at the patient's company
E)   Asking if the company has opened a worker's compensation case with the insurance companyF) A) and D)
G) None of the above

Question 18

The provider should have the patient sign a(n) ________ of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer.

Accepted Answer

The answer of The provider should have the patient sign...

Question 19

Eligibility for Medicaid is ____.

Accepted Answer

A)   automatic for patients aged 65 and older
B)   based on the patient's reported income and assets from the previous month
C)   based on the patient's reported income and assets from the previous year
D)   based on the patient's reported income and assets for the previous three months
E)   based on the patient's reported income and assets for the previous six monthsF) C) and D)
G) A) and E)

Question 20

The benefit period for Medicare begins the day a patient goes into the hospital and ends when that patient has not been hospitalized for ____ days.

Accepted Answer

A)   10
B)   30
C)   60
D)   90
E)   120F) A) and C)
G) All of the above

Exam 17: Insurance and Billing

A(n) ________ procedure is a medical procedure that is not required to sustain life and that is planned in advance to be done at the convenience of the physician or surgeon and the patient.

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

Patients who belong to a 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 a(n) ____.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

The total sum that the health plan will pay out over the patient's life is the lifetime ________ benefit.

Correct AnswerverifiedShow Answer

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?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

When entering data in medical billing programs, you should ____.

Correct AnswerverifiedShow Answer

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Correct AnswerverifiedShow Answer

The provider should have the patient sign a(n) ________ of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer.

Correct AnswerverifiedShow Answer

Which of the following is not part of the process for verifying workers' compensation coverage?

Correct AnswerverifiedShow Answer

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

The benefit period for Medicare begins the day a patient goes into the hospital and ends when that patient has not been hospitalized for ____ days.

Correct AnswerverifiedShow Answer

Which of the following is correct regarding electronic claim submissions?

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

The list of drugs approved by an insurance company is called a(n) ________.

Correct AnswerverifiedShow Answer

Legal clauses in insurance policies that prevent duplication of payment are called ________ of benefits clauses.

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

Eligibility for Medicaid is ____.

Correct AnswerverifiedShow Answer

The payment system used by Medicare is based on ____.

Correct AnswerverifiedShow Answer

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