A physicians usual fee is
the charge he or she makes to private patients
the range of charges made by the majority of physicians in a given area
the average charge made by the majority of physicians in a given area
the charge specified by an insurance council
the charge set by a government agency
the fiscal agenets for Medicare and other government-sponsored insurance programs keep a continuous list of the usual and customary charges by individual doctors for specific procedures. This is used to determine the
insurance allowance
customary fee
prevailing rate
reasonable fee
fee profile
The proportion of a patients charge billed to Medicare Part B that will be paid is
varied
total amount of bill
80%
80% of the allowed charge minus a deductible
70% of reasonable charge
Copies of Medicare forms may be obtained from
office supply firm
fiscal agent
patient
Social Security Administration
Internal Revenue Service
Which of the following is NOT a duty of a medical assistant acting as the medical insurance specialist in medical office?
Inform patients of the amount their insurance payment will pay on thir clinic bill
gather information and signatures for insurance claims
submit the insurance claim form
review insurance payments
help clients
In a Worker's Compensation case, the medical assistant should
bill the patient for the deductible
file a bill with the insurance carrier every 2 weeks
send no bill to the patient
bill the patient for the unpaid portion
bill carrier in one lump sum
The CPT-4 method of procedural coding became the procedural coding terminology of choice when
the AMA promoted it
the Medicare program used it as the first level of HCPCS
the states adopted it
Blue Shield Adopted it
the Food and Drug Administration adopted it
Blue Shield makes direct payment to
physician members
all physicians
all policy holders
whomever the patient specifies
the hospital
Hospital insurance is included under Medicare
in Part A
in Part B
only for those who are older than 70 years of age
only for those who pay an additional premium
for those who do not receive monthly Social security benefits
Part B of Medicare is
voluntary
compulsory
automatically included with Part A
free to the policyholder
required for hospital benefits
Within the time limit set by the state after a physician has seen a Workers Compensation patient for the first time, a report, Doctors First Reort of Occupational Injury or illness, is typed. It should have
two copies
three copies
at least four copies signed by the doctor
two copies signed by the doctor
four copies signed by the patient
A written document signed by a Medicare beneficiary, prior to services being provided, that states the service provided may not be reimbursed by Medicare is called a(n):
claim form (CF)
medical necessity (MN)
denial of service (DOS)
advance beneficiary notice (ABN)
An insurance term used to describe the payment by an insurance company of a certain percentage of the actual expense (perhaps 75 to 80%), with the patient paying the remaining amount, is
assignment of insurannce benefits
deductible
insuring clause
coinsurance
income limit
The national correct coding initiative is a system of CPT code edits that detects:
mutually exclusive code pairs
unbundling
appropriate modifiers
all of the above
none of the above
Blue Cross offers which method of reimbursement?
fee for service
capitation
closed panel
salary
indemnity method
Retrospective reimbursement whereby charges are made by the medical professional for each rofessional service rendered is also known as
Reimbursement (payment) for medical services from the insurance carrier (company) is known as
coordination of benefits
indemnity
assignment of benefits
adjustment
Private patients are not accepted for treatment in the type of plan referred to as
prepaid group practice
Blue Cross
Blue Shield
indemnity plans
The Kaiser Foundation Health Plan is an example of
managed care
Worker's Compensation
indirect type of service plan
Part A of Medicare does NOT pay for
hospitalizaation
home health care
physical therapy
skilled nursing facilities
hospice care
How many days of hospitalization will be paid by medicare after the initial deductible has been met?
30
60
90
120
The number of benefit periods under Part A of Medicare is
limited to 120 days
limited to one per 6 month period
limited to one per year
limited to three per year
unlimited
Part B of Medicare does NOT pay for
colonoscopy
flu shots
hearing examinations for prescribing hearing aids
durable medical equipment
Under many Blue Shield Plans, patients entitled to :paid-in-full benefits," meaning there will be no additional charges, must go to
participating physicians
nonpaticipating physicians
specialists
physicins listed by the Social Security Administration
doctos associated with clinics
The CPT-4 code book is divided into how many coding sections?
three
four
five
six
seven
In the CPT 2004 manual, descriptors for the level of evaluation and management services include which of the following?
history
examination
medical decision making
nature of the presenting problem
In the CPT 2004 manual, what modifiers are avalable in E/M (evaluation and management)
prolonged E/M services
unrelated E/M services by the same
significant separately identifiable E/M services by the same physician on the same day of a procedure or other service
What are the primary classes of main terms in the CPT 2000 index?
procedure or service
organ or other anatomic site
condition (i.e., abscess, entropion)
synonyms, eponyms, and abbreviations
A summary of additions, deletions, and revisions of CPT codes can be found in
Appendix A
Appendix B
Appendix C
index
Introduction
The CPT-4 coding system uses a main number to describe particuar services. This main number uses a base of
three digits
four digits
five digits
six digits
seven digits
How many levels are used in the Health Care Financing Administration, Common Procedure Coding System (HCPCS)
one
two
The diagnostic-related groups (DRGSss) are divided by body systems into 470 groups. What purposes does the DRG system serve?
a revised Health Care Financing Administration code
a substitute for CPT coding
a substitute for ICD-9 clsssification
strict guidelines for hospital admissions and stays
