question

Insurance is considered a federally regul;ated industry

answer

B. False

question

The insured may not necessarily be the patient seen for the medical services

answer

A. True

question

An insurance claims repersentative may also be known as the ajuster

answer

A True

question

A coordination of benefits statement in as insurance policy refers to the waiting period

answer

B False

question

Medicare is a program jointly sponsered by the federal and state governments for those eligible for public assistance

answer

B False

question

Information such as the deductable, co payment, preapproval provisions, and insurance company address and telephone number can be usally found on the insurance card

answer

A True

question

If a patient has an individual insurance policy, a release of information does not have to be signed before the physicians office submits a claim to the insurance company

answer

A True

question

A two or three part form that incorporates a combination bill, insurance form, and routing document used in both computer and pegboard systems is called an encounter form

answer

A True

question

When a HMO is paid a fixed amount for each patient without vconsidering the actual number or nature of services provided to each person, this is know as A Fee for Services B. Capitation C. usual charges

answer

B. Capitation

question

An Organaization that gives members freedom of choice among phyicians and hospitals and providers a higher benefits if the provider listed on the plan are used is called A. Health maintenance org (HMO) B. Managed care Org. (MCO) C. Preferred provider Org (PPO)

answer

C. Preferred provider Org (PPO)

question

A program that offers a combinations of HMO style cost management and PPO style freedom choice is a A. Point of Service (POS) plan B. Managed care Org (MCO) C. Physician provider group (PPG)

answer

A. Point of Service (POS) plan

question

What is the correct procedure to collect a copayment on a managed care plan A. There is no copayment with a managed care plan B. Bil lthe plan for the copayment C. Bill the patient for the copayment D. Collect the copayment copayment when the patient arrives for the office visit

answer

D. Collect the copayment copayment when the patient arrives for the office visit

question

The physician/patient contract begins A After the physicians has examined the patient for the first time B. When the patient steps into the examation room to be treated C. When the physician acepts the patient and agrees to treat the patient

answer

C. When the physician acepts the patient and agrees to treat the patient

question

When a patient carries medical insurance, the contract for treatment exists between A The patient and ithe insurance company B The physicians and the patient C The physicians and the insurance company

answer

C The physicians and the insurance company

question

An emancipated minor is A. Person under the age of 18 who lives independently B A person over the age of 21 C A person under 16 who lives with his parenrts

answer

A. Person under the age of 18 who lives independently

question

The contract in a worker compensation case exists between A The patient and the insurance company B The physician and the patient C The physician and the insurance company

answer

C The physician and the insurance company

question

In health insurance, the insured is also known as A The subscriber B The member C The Policyholder D All of the abhove

answer

D All of the abhove

question

The reason for coordination of benefits statement in a health insurance polisy is A To prevent duplication or overlapping of payments for the same medical expense B. To ensure adequate payment to the insured who holds more then one policy C. To ensure payment for the physician

answer

A To prevent duplication or overlapping of payments for the same medical expense

question

If a child has health insurance coverage from two parents, according to the birthday law A The fathers insurance is always the porimary B. The health plan of the pewrson whose birthday earlier in the calendar C. The health plan of the person whose birthday (month, and day) falls earlier in the calendar year will pay first

answer

C. The health plan of the person whose birthday (month, and day) falls earlier in the calendar year will pay first

question

Conditions that existed and where treated before the health insurance policy was issued are called A Accidents B Illnesses C Preexisting conditions D unforessen occurrences

answer

C Preexisting conditions

question

A Patient intake sheet is also called a A Patient form B Patient report C Patient registration form D Medical record

answer

C Patient registration form

question

Assignment of benefits is A Only used by nonpartticipating physicians B Never used by partticipating physicians C Fee sharing between physicians D. The transfer of ones right to collect an amount payable under an insurance contract

answer

D. The transfer of ones right to collect an amount payable under an insurance contract

question

An encounter form may also be known as a A Ledger card or patient account B Day sheet or daily sheet C. Communicator or super bill D fact sheet or face sheet

answer

C. Communicator or super bill

question

A daily record sheet used to record daily business transactions is called A. Ledger B. Encounter form C. Day sheet D. transaction slip

answer

C. Day sheet

question

It is acceptable practice to use words "signature on file" in Block 12 of the CMS 1500 form under which of the following conditions A. Only when the patient, parent or guardian neglects to sign the patient informatioon sheet and you know they meant to but forgot B. When the patient forgets to sign but later verbally authorized the doctor or nurse practioner to sign on his behalf C When the patient refuses to sign but the doctor has already provided the service D. None of the above

answer

D. None of the above

question

It is acceptacle practice to use the words "signature on file" in Block 13 of the CMS 1500 form under which of the following conditions A. When you are billing for a nonparticipating provider but doctors agrees to accept the same payment as a participating provider B. When you know the patient will be paid directly C. When you haver the patient, parent or legal guardian signature on a form assigned benefits to the provider

answer

C. When you haver the patient, parent or legal guardian signature on a form assigned benefits to the provider

question

Because there is no assignment of benefits in a workers compensation case, the following occur A. The carrier will pay the provider directly and the balance should be billed to the patient B. The patient will be paid directly and wil then reimburse the provider for any and all of charges C. The patient will pay the provider out of pocket and will be remibursed from the carrier when the case settles D. None of the above. The patient is not responsable for payment of services for any work related injury or illness

answer

D. None of the above. The patient is not responsable for payment of services for any work related injury or illness

question

Block 31 on the CMS 1500 form is reserved for the provider's signature. Which of the following is acceptable to most insurance companies A. An electronic signature B. The provider['s handwritten signature C. A rubber stamped signature D. All of the above

answer

D. All of the above

question

If prior authorization for a procedure is denied by an insurance company, the providers office should A. Write a letter of appeal to the insurance company as well as a letter to the patient informing him/her of the denial B. Advise the patient of the decision and have the patient file the appeal if he/she wishes, as the appeal is ultimately the patients responsabilty C. Let the patient know the procedure will have to be paid out of pocket should he or she decide to have it done D. All of the above are acceptable

answer

D. All of the above are acceptable

question

A crave-out consists of A. Only basic services covered under capitation agreement B. Services not included within the capitation rate but may be contracted seperatly C. Services not covered under the capitation agreement

answer

B. Services not included within the capitation rate but may be contracted seperatly

question

The gatekeeper may issue a referral in the following manner A. Formal written authorization that can be mailed or faxed B. Formal written authorization that can be handed to the patient C. Verbally authorize an appointment with another physician D. All of the above

answer

D. All of the above

question

The monthly, quarterly or annual fee necessary to keep a policy in force is called A. A premium B. An Indemnity C. A renewal D. A deductable

answer

A. A premium

question

Medical necessity must be determined before a case can be A. Precertified B. Predetermined C. Preauthorized D all of the above

answer

C. Preauthorized

question

Quality improvement is a process within a Quality Improvement Org., formerly known as professional review org. designed to A. Evaluate the quilty and efficiency of services rendered by a practing physician or physicians within the speciatly group B. Settle disputes on fees C. Examine evidence for admissionand discahage of a hospital patient D. all of above

answer

D. all of above

question

TRICARE is a government sponsored program providing non-military hospital and medical services for A Spouces and dependents of active service personal B Active duty service members C. Retired service personnel and their dependents D. A and C only

answer

D. A and C only

question

A divorced motrher brings a child for treatment and presents the divorce decree showing you the child's father is responsable for all medical bills. Since she brought a legal document, you should A Send the father the bill B Have the mother pay the bill at time of service C Call your divorced friend qho just went through the same situation

answer

B Have the mother pay the bill at time of service

question

A new patient has shown up late for her appointment. Since very little information was taken at the time of the appointment A. Let the patient call the office later with the information as the signature isnt really important once treatment is received B. Let the patient see the doctor in an effort to get the office back on shedule C. Very patiently, assit the patient in completing the form. knowing how important it will be later to have all the information

answer

C. Very patiently, assit the patient in completing the form. knowing how important it will be later to have all the information

question

DNR

answer

D. Do not resuscitate

question

DOA

answer

E. Dead on arrival

question

DRG

answer

A Diagnosis-related group

question

DX

answer

D. Diagnosis

question

ECG

answer

C. Electrocardiogram

question

ED

answer

L Emergency Department

question

FDA

answer

J. Food and Drug Administration

question

EEG

answer

I. Electroencephalogram

question

ESRD

answer

G. End stage renal disease

question

ETOH

answer

H. Ethyl alchol

question

DIG

answer

K. Digoxin, digitalis

question

ENT

answer

F. Ear, nose, & throat

question

DVT

answer

M. Deep vein thrombosis

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