Final Insurance Billing & Coding

Question 1

A fixed percentage of covered charges paid by the insured person after deductible has been meet

Answer 1

Coinsurance

Question 2

A list of charges for services or procedures performed is

Answer 2

Fee scheduled

Question 3

A managed care program in which its members are expected to receive treatment from one of its participants providers

Answer 3

HMO

Question 4

A provider who participates in an insurance carriers plan is considered to be:

Answer 4

PAR

Question 5

An explanation of benefits (EOB) is called a (n)

Answer 5

RA (remittance advice)

Question 6

Assignment of benefits-completed with these providers to ensure payments directly from the insurer to the provider

Answer 6

A PAR

Question 7

Coordination of benefits refers 

Answer 7

The legality of having more than one insurance policy

Question 8

Elderly/disabled patient who qualify for Medicare cannot pay for Medicare charges and qualify for dual coverage

Answer 8

Medi/Medi

Question 9

Electronic Claims sent directly to insurance plan or a __________where the claim information will be scrubbed clean

Answer 9

Clearinghouse

Question 10

Eligibility for this health program may vary as qualification is dependent on the individual monthly income

Answer 10

Medicaid

Question 11

If a claim is submitted electronically, the remittance advice

Answer 11

Will be received electronically

Question 12

In the case of Medi/Madi coverage, which health plan acts as the primary payer

Answer 12

Medicare

Question 13

Medicare part A pays what portion of her hospitalization for the first 60 days

Answer 13

100%

Question 14

Medicare is divided into two main part

Answer 14

A and B

Question 15

Medicare part B has a patient coinsurance responsibility of

Answer 15

20%

Question 16

Most of the demographic information present on a claim form is entered

Answer 16

Before or at time of appointment

Question 17

The CPT manual contains diagnostic codes

Answer 17

False

Question 18

The ICD – 10 contains which two main sections:

Answer 18

Alphabetic index and tabular index

Question 19

The activity of comparing the physician fees with the benefits provided by the patient’s health plan is

Answer 19

Review of allowable benefits

Question 20

The insurance policy holder is also referred to as:

Answer 20

Subscriber

Question 21

The physician’s diagnosis is coded for claim purpose using ICD – 10 – CM

Answer 21

True

Question 22

There are two major types of health plans

Answer 22

MCO and fee of service

Question 23

Program standardize claim information and “scrub” and “clean” claim information before treatment

Answer 23

Clearinghouse

Question 24

This managed care organization requires preauthorization from a PCP who acts as a gatekeeper

Answer 24

HMO

Question 25

Health care reform in the US was enacted in 2010 its focus was make affordable healthcare accessible to more Americans

Answer 25

ACA

Question 26

This section of procedure codes is often considered the most important due to their frequent

Answer 26

E/M

Question 27

Those who are eligible for Social Security benefits are automatically enrolled in which health benefit program

Answer 27

Medicare

Question 28

When preparing paper claims, it is important to use which claim form

Answer 28

CMS-1500

Question 29

Which government health plan is designated for active and retired military person

Answer 29

None of the above (TRICARE)

Question 30

Healthcare program providers coverage for veterans with total permanent service related disabilities

Answer 30

CHAMPVA

Question 31

Which of the following is considered the third-party payer

Answer 31

The health plan

Question 32

Which of the following is NOT an example of government insurance plan

Answer 32

Blue cross blue shield

Question 33

Eligibility is determined by the patient’s nearest veteran affairs (VA) facility

Answer 33

CHAMPVA

Question 34

Is a healthcare program designed for low-income individuals and children

Answer 34

Medicaid