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Quiz sobre Chapter 7: Insurance and Coding, criado por carrieleekennedy em 24-08-2014.

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Chapter 7: Insurance and Coding

Questão 1 de 33

1

A physicians usual fee is

Selecione uma das seguintes:

  • 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

Explicação

Questão 2 de 33

1

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

Selecione uma das seguintes:

  • insurance allowance

  • customary fee

  • prevailing rate

  • reasonable fee

  • fee profile

Explicação

Questão 3 de 33

1

The proportion of a patients charge billed to Medicare Part B that will be paid is

Selecione uma das seguintes:

  • varied

  • total amount of bill

  • 80%

  • 80% of the allowed charge minus a deductible

  • 70% of reasonable charge

Explicação

Questão 4 de 33

1

Copies of Medicare forms may be obtained from

Selecione uma das seguintes:

  • office supply firm

  • fiscal agent

  • patient

  • Social Security Administration

  • Internal Revenue Service

Explicação

Questão 5 de 33

1

Which of the following is NOT a duty of a medical assistant acting as the medical insurance specialist in medical office?

Selecione uma das seguintes:

  • 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

Explicação

Questão 6 de 33

1

In a Worker's Compensation case, the medical assistant should

Selecione uma das seguintes:

  • 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

Explicação

Questão 7 de 33

1

The CPT-4 method of procedural coding became the procedural coding terminology of choice when

Selecione uma das seguintes:

  • 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

Explicação

Questão 8 de 33

1

Blue Shield makes direct payment to

Selecione uma das seguintes:

  • physician members

  • all physicians

  • all policy holders

  • whomever the patient specifies

  • the hospital

Explicação

Questão 9 de 33

1

Hospital insurance is included under Medicare

Selecione uma das seguintes:

  • 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

Explicação

Questão 10 de 33

1

Part B of Medicare is

Selecione uma das seguintes:

  • voluntary

  • compulsory

  • automatically included with Part A

  • free to the policyholder

  • required for hospital benefits

Explicação

Questão 11 de 33

1

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

Selecione uma das seguintes:

  • two copies

  • three copies

  • at least four copies signed by the doctor

  • two copies signed by the doctor

  • four copies signed by the patient

Explicação

Questão 12 de 33

1

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):

Selecione uma das seguintes:

  • claim form (CF)

  • medical necessity (MN)

  • denial of service (DOS)

  • advance beneficiary notice (ABN)

Explicação

Questão 13 de 33

1

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

Selecione uma das seguintes:

  • assignment of insurannce benefits

  • deductible

  • insuring clause

  • coinsurance

  • income limit

Explicação

Questão 14 de 33

1

The national correct coding initiative is a system of CPT code edits that detects:

Selecione uma das seguintes:

  • mutually exclusive code pairs

  • unbundling

  • appropriate modifiers

  • all of the above

  • none of the above

Explicação

Questão 15 de 33

1

Blue Cross offers which method of reimbursement?

Selecione uma das seguintes:

  • fee for service

  • capitation

  • closed panel

  • salary

  • indemnity method

Explicação

Questão 16 de 33

1

Retrospective reimbursement whereby charges are made by the medical professional for each rofessional service rendered is also known as

Selecione uma das seguintes:

  • fee for service

  • capitation

  • closed panel

  • salary

  • indemnity method

Explicação

Questão 17 de 33

1

Reimbursement (payment) for medical services from the insurance carrier (company) is known as

Selecione uma das seguintes:

  • coordination of benefits

  • indemnity

  • assignment of benefits

  • adjustment

  • salary

Explicação

Questão 18 de 33

1

Private patients are not accepted for treatment in the type of plan referred to as

Selecione uma das seguintes:

  • prepaid group practice

  • Blue Cross

  • Blue Shield

  • indemnity plans

  • fee for service

Explicação

Questão 19 de 33

1

The Kaiser Foundation Health Plan is an example of

Selecione uma das seguintes:

  • managed care

  • fee for service

  • capitation

  • Worker's Compensation

  • indirect type of service plan

Explicação

Questão 20 de 33

1

Part A of Medicare does NOT pay for

Selecione uma das seguintes:

  • hospitalizaation

  • home health care

  • physical therapy

  • skilled nursing facilities

  • hospice care

Explicação

Questão 21 de 33

1

How many days of hospitalization will be paid by medicare after the initial deductible has been met?

Selecione uma das seguintes:

  • 30

  • 60

  • 90

  • 120

Explicação

Questão 22 de 33

1

The number of benefit periods under Part A of Medicare is

Selecione uma das seguintes:

  • limited to 120 days

  • limited to one per 6 month period

  • limited to one per year

  • limited to three per year

  • unlimited

Explicação

Questão 23 de 33

1

The number of benefit periods under Part A of Medicare is

Selecione uma das seguintes:

  • limited to 120 days

  • limited to one per 6 month period

  • limited to one per year

  • limited to three per year

  • unlimited

Explicação

Questão 24 de 33

1

Part B of Medicare does NOT pay for

Selecione uma das seguintes:

  • home health care

  • colonoscopy

  • flu shots

  • hearing examinations for prescribing hearing aids

  • durable medical equipment

Explicação

Questão 25 de 33

1

Under many Blue Shield Plans, patients entitled to :paid-in-full benefits," meaning there will be no additional charges, must go to

Selecione uma das seguintes:

  • participating physicians

  • nonpaticipating physicians

  • specialists

  • physicins listed by the Social Security Administration

  • doctos associated with clinics

Explicação

Questão 26 de 33

1

The CPT-4 code book is divided into how many coding sections?

Selecione uma das seguintes:

  • three

  • four

  • five

  • six

  • seven

Explicação

Questão 27 de 33

1

In the CPT 2004 manual, descriptors for the level of evaluation and management services include which of the following?

Selecione uma das seguintes:

  • history

  • examination

  • medical decision making

  • nature of the presenting problem

  • all of the above

Explicação

Questão 28 de 33

1

In the CPT 2004 manual, what modifiers are avalable in E/M (evaluation and management)

Selecione uma das seguintes:

  • 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

  • all of the above

Explicação

Questão 29 de 33

1

What are the primary classes of main terms in the CPT 2000 index?

Selecione uma das seguintes:

  • procedure or service

  • organ or other anatomic site

  • condition (i.e., abscess, entropion)

  • synonyms, eponyms, and abbreviations

  • all of the above

Explicação

Questão 30 de 33

1

A summary of additions, deletions, and revisions of CPT codes can be found in

Selecione uma das seguintes:

  • Appendix A

  • Appendix B

  • Appendix C

  • index

  • Introduction

Explicação

Questão 31 de 33

1

The CPT-4 coding system uses a main number to describe particuar services. This main number uses a base of

Selecione uma das seguintes:

  • three digits

  • four digits

  • five digits

  • six digits

  • seven digits

Explicação

Questão 32 de 33

1

How many levels are used in the Health Care Financing Administration, Common Procedure Coding System (HCPCS)

Selecione uma das seguintes:

  • one

  • two

  • three

  • four

  • five

Explicação

Questão 33 de 33

1

The diagnostic-related groups (DRGSss) are divided by body systems into 470 groups. What purposes does the DRG system serve?

Selecione uma das seguintes:

  • 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

  • none of the above

Explicação