1186689
Descripción
Test por carrieleekennedy, actualizado hace más de 1 año
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Creado por carrieleekennedy
hace más de 10 años
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Pregunta 1
Pregunta
A physicians usual fee is
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the charge he or she makes to private patients
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the range of charges made by the majority of physicians in a given area
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the average charge made by the majority of physicians in a given area
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the charge specified by an insurance council
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the charge set by a government agency
Pregunta 2
Pregunta
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
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insurance allowance
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customary fee
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prevailing rate
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reasonable fee
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fee profile
Pregunta 3
Pregunta
The proportion of a patients charge billed to Medicare Part B that will be paid is
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varied
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total amount of bill
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80%
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80% of the allowed charge minus a deductible
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70% of reasonable charge
Pregunta 4
Pregunta
Copies of Medicare forms may be obtained from
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office supply firm
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fiscal agent
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patient
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Social Security Administration
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Internal Revenue Service
Pregunta 5
Pregunta
Which of the following is NOT a duty of a medical assistant acting as the medical insurance specialist in medical office?
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Inform patients of the amount their insurance payment will pay on thir clinic bill
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gather information and signatures for insurance claims
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submit the insurance claim form
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review insurance payments
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help clients
Pregunta 6
Pregunta
In a Worker's Compensation case, the medical assistant should
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bill the patient for the deductible
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file a bill with the insurance carrier every 2 weeks
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send no bill to the patient
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bill the patient for the unpaid portion
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bill carrier in one lump sum
Pregunta 7
Pregunta
The CPT-4 method of procedural coding became the procedural coding terminology of choice when
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the AMA promoted it
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the Medicare program used it as the first level of HCPCS
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the states adopted it
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Blue Shield Adopted it
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the Food and Drug Administration adopted it
Pregunta 8
Pregunta
Blue Shield makes direct payment to
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physician members
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all physicians
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all policy holders
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whomever the patient specifies
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the hospital
Pregunta 9
Pregunta
Hospital insurance is included under Medicare
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in Part A
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in Part B
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only for those who are older than 70 years of age
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only for those who pay an additional premium
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for those who do not receive monthly Social security benefits
Pregunta 10
Pregunta
Part B of Medicare is
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voluntary
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compulsory
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automatically included with Part A
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free to the policyholder
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required for hospital benefits
Pregunta 11
Pregunta
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
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two copies
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three copies
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at least four copies signed by the doctor
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two copies signed by the doctor
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four copies signed by the patient
Pregunta 12
Pregunta
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):
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claim form (CF)
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medical necessity (MN)
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denial of service (DOS)
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advance beneficiary notice (ABN)
Pregunta 13
Pregunta
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
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assignment of insurannce benefits
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deductible
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insuring clause
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coinsurance
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income limit
Pregunta 14
Pregunta
The national correct coding initiative is a system of CPT code edits that detects:
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mutually exclusive code pairs
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unbundling
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appropriate modifiers
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all of the above
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none of the above
Pregunta 15
Pregunta
Blue Cross offers which method of reimbursement?
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fee for service
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capitation
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closed panel
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salary
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indemnity method
Pregunta 16
Pregunta
Retrospective reimbursement whereby charges are made by the medical professional for each rofessional service rendered is also known as
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fee for service
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capitation
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closed panel
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salary
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indemnity method
Pregunta 17
Pregunta
Reimbursement (payment) for medical services from the insurance carrier (company) is known as
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coordination of benefits
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indemnity
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assignment of benefits
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adjustment
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salary
Pregunta 18
Pregunta
Private patients are not accepted for treatment in the type of plan referred to as
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prepaid group practice
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Blue Cross
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Blue Shield
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indemnity plans
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fee for service
Pregunta 19
Pregunta
The Kaiser Foundation Health Plan is an example of
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managed care
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fee for service
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capitation
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Worker's Compensation
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indirect type of service plan
Pregunta 20
Pregunta
Part A of Medicare does NOT pay for
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hospitalizaation
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home health care
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physical therapy
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skilled nursing facilities
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hospice care
Pregunta 21
Pregunta
How many days of hospitalization will be paid by medicare after the initial deductible has been met?
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30
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60
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90
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120
Pregunta 22
Pregunta
The number of benefit periods under Part A of Medicare is
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limited to 120 days
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limited to one per 6 month period
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limited to one per year
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limited to three per year
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unlimited
Pregunta 23
Pregunta
The number of benefit periods under Part A of Medicare is
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limited to 120 days
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limited to one per 6 month period
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limited to one per year
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limited to three per year
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unlimited
Pregunta 24
Pregunta
Part B of Medicare does NOT pay for
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home health care
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colonoscopy
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flu shots
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hearing examinations for prescribing hearing aids
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durable medical equipment
Pregunta 25
Pregunta
Under many Blue Shield Plans, patients entitled to :paid-in-full benefits," meaning there will be no additional charges, must go to
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participating physicians
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nonpaticipating physicians
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specialists
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physicins listed by the Social Security Administration
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doctos associated with clinics
Pregunta 26
Pregunta
The CPT-4 code book is divided into how many coding sections?
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three
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four
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five
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six
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seven
Pregunta 27
Pregunta
In the CPT 2004 manual, descriptors for the level of evaluation and management services include which of the following?
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history
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examination
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medical decision making
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nature of the presenting problem
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all of the above
Pregunta 28
Pregunta
In the CPT 2004 manual, what modifiers are avalable in E/M (evaluation and management)
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prolonged E/M services
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unrelated E/M services by the same
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significant separately identifiable E/M services by the same physician on the same day of a procedure or other service
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all of the above
Pregunta 29
Pregunta
What are the primary classes of main terms in the CPT 2000 index?
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procedure or service
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organ or other anatomic site
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condition (i.e., abscess, entropion)
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synonyms, eponyms, and abbreviations
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all of the above
Pregunta 30
Pregunta
A summary of additions, deletions, and revisions of CPT codes can be found in
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Appendix A
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Appendix B
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Appendix C
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index
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Introduction
Pregunta 31
Pregunta
The CPT-4 coding system uses a main number to describe particuar services. This main number uses a base of
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three digits
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four digits
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five digits
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six digits
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seven digits
Pregunta 32
Pregunta
How many levels are used in the Health Care Financing Administration, Common Procedure Coding System (HCPCS)
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one
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two
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three
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four
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five
Pregunta 33
Pregunta
The diagnostic-related groups (DRGSss) are divided by body systems into 470 groups. What purposes does the DRG system serve?
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a revised Health Care Financing Administration code
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a substitute for CPT coding
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a substitute for ICD-9 clsssification
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strict guidelines for hospital admissions and stays
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none of the above
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