Medical Office Management C

Question 1

A bed patient in a hospital is called a (n) ________-
A. inpatient
B. outpatient
C. third party payer
D. provider

Answer 1

A. Inpatient

Question 2

A person who represents either party of an insurance claim is the ______
A. doctor
B. adjuster
C. provider
D. subscriber

Answer 2

B. Adjuster.

Question 3

A request for payment under an insurance contractor bond is called a (n) _______
A. insurance application
B. claim
C. dual choice request
D. total disability

Answer 3

B. Claim

Question 4

Payment made periodically to keep an insurance policy in force is called ________
A. time limit
B. premium
C. coinsurance
D. fee-for-service

Answer 4

B. Premium

Question 5

A person or institution that gives medical care is a (n) _________
A. third parter payer
B. provider
C. adjuster
D. insurance agent

Answer 5

B. Provider

Question 6

Which of the following insurance plans provides a fixed payment per month to the physician regardless of the services rendered?
A. capitation
B. preferred provider
C. adjuster
D. insurance agent

Answer 6

A. Capitation

Question 7

An amount the insured must pay before policy benefits begin is called ______
A. indemnity
B. extended benefits
C. deductible
D. catastrophic

Answer 7

C. Deductible

Question 8

An organization that offers health insurance at a fixed monthly premium with little or no deductible and works through primary care provider is called a (n) ___________
A. preferred provider
B. health maintenance organization
C. member physician
D. private health provider

Answer 8

B. Health maintenance organization

Question 9

Health insurance that provides protection against the high cost of treating severe or lengthy illnesses or disabilities is called ___________
A. catastrophic
B. severe
C. third-party payer
D. no correct answer

Answer 9

A. Catastrophic

Question 10

A patient receiving ambulatory care at a hospital or other health facility without being admitted as a bed patient is called a (n) ___________
A. inpatient
B. outpatient
C. carrier
D. adjuster

Answer 10

B. Outpatient

Question 11

An injury that prevents a worker from performing one or more of the regular functions of his job would be known as a _____________
A. partial disability
B. permanent disability
C. total disability
D. resultant disability

Answer 11

A. Partial disability

Question 12

A previous injury, disease or physical condition that existed before the health insurance policy was issued is called __________
A. preexisting condition
B. prior exposure
C. foregoing condition
D. no correct answer

Answer 12

A. Pre-existing condition

Question 13

one who belongs to a group insurance paln is called ___________
A. third -party payer
B. subscriber
C. carrier
D. no correct answer

Answer 13

B. subscriber

Question 14

A sum of money provided in an insurance policy, payable for covered services is called ___________.
A. deductible
B. benefits
C. dues payable
D. premium

Answer 14

B. benefits

Question 15

To prevent the insured from receiving a duplicate payment for losses under more then one insurance policy is called _______________
A. fee-for-service
B. hospital benefits
C. coordination of benefits
D. non duplication benefits

Answer 15

C. Coordination of benefits.

Question 16

When a patient has health insurance, the percentage of covered services that is responsibility of the patient to pay is known as ___________
A. coinsurance
B. pre-defined policy
C. comprehensive
D. in percent policy

Answer 16

A. Coinsurance

Question 17

Insurance that is meant to offset medical expenses resulting from a catastrophic illness is called __________
A. primary insurance
B. major medical
C. whole life policy
D. comprehensive

Answer 17

B. Major medical

Question 18

An unexpected event which may cause injury is called ____________
A. dread disease rider
B. accident
C. adjuster
D. no correct answer

Answer 18

B. Accident

Question 19

A doctor who agrees to accept an insurance companies pre-established fee as the maximum amount to be collected is called ___________
A. subscriber
B. claim representative
C. participating physician
D. adjuster

Answer 19

C. Participating physician

Question 20

Insurance plans that pay a physician’s full charge if it does not exceed his normal charge or does not exceed the amount normally charged for the service is called ______________
A. usual, customary and reasonable
B. comprehensive
C. dual choice
D. no correct answer

Answer 20

A. Usual, customary and reasonable

Question 21

A notice of insurance claim or proof of loss must be filed within a designated ___________ or it can be denied.
A. waiting period
B. policy date
C. time limit
D. grace period

Answer 21

C. Time limit

Question 22

A health program for people age 65 and older under social security is called ____________
A. tri-care
B. Medicare
C. champva
D. workers compensation

Answer 22

B. Medicare

Question 23

A civilian health and medical program of the uniform services is called__________
A. Tri-care
B. Medicare
C. Medicaid
D. Workers compensation

Answer 23

A. Tri-care

Question 24

A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment is called _____________
A. Tri-care
B. champus
C. workers compensation
D. Medicaid

Answer 24

C. Worker’s compensation

Question 25

A recap sheet that accompanies a Medicare or Medicaid check, showing breakdown and explanation of payment on a claim is called _________ A. fee-for-service B. explanation of benefits C. coordination of benefits D. dual choices

Answer 25

B. Explanation of benefits

Question 26

A type of insurance whereby the insured pays a specific amount per unit of service and the insurer pays the rest of the cost is called ____________ A. co-payment B. coordination of benefits C. deductible D. indemnity

Answer 26

A. Co-payment

Question 27

In insurance, greater coverage of diseases or an accident, and greater indemnity payment in comparison with a limited clause is called _____________ A. co-payment B. comprehensive C. deductible D. major medical

Answer 27

B. Comprehensive

Question 28

A rider added to a policy to provide additional benefits for certain conditions is called ______________ A. hospital benefits B. dread disease rider C. preexisting conditon D. no correct answer

Answer 28

B. Dread disease rider

Question 29

An interval after a payment is due to the insurance company in which the policy holder may make payments, and still the policy remains in effect is called ___________________ A. extended benefits B. grace period C. coordination of benefits D. lapse time

Answer 29

B. Grace period

Question 30

An agreement by which a patient assigns to another party the right to receive payment from a third party for the service the patient has received is called ____________ A. assignment of benefits B. coordination of benefits C.non duplication of benefits D. no correct answer

Answer 30

A. Assignment of benefits

Question 31

A skilled nursing facility for patients receiving specialized care after discharge from a hospital is called _____________ A. extended care facility B. post care facility C. nursing home D. no correct answer

Answer 31

A. Extended care facility

Question 32

Payment for hospital charges incurred by an insured person because of injury or illness is called __________ A. hospital benefits B. catastrophic health benefits C. extra help benefits D. no correct answer

Answer 32

A. Hospital benefits

Question 33

An agent of an insurance company who solicits or initiates contracts for insurance coverage and services, and is the policy holder for the insurer is called ___________ A. insurance agent B. claim representative C. carrier D. member physician

Answer 33

A. Insurance Agent

Question 34

A method of charging whereby a physician presents a bill for each service rendered is called ____________ A. non duplication of benefits B. fee-for-service C. monthly statement D. no correct answer

Answer 34

B. fee-for-service

Question 35

The tri-care fiscal year is from __________ A. January 1 to December 31 B. October 1 to September 1 C. October 1 to September 30 D. July 1 to June 30

Answer 35

C. October 1st to September 30th

Question 36

The number on the Employees Withholding Exemption Certificate is ____________ A. W-2 B. W-4 C. 1040 D. W-3

Answer 36

B. W-4

Question 37

FICA provides benefits for ___________ A. Medicare B. social security C. old age D. aid to dependent children

Answer 37

B. Social security

Question 38

As part of the office bookkeeping procedures, the physicians bank statement should be reconciled with the ____________ A. daily ledger B. buisness ledger C. personal ledger D. checkbook

Answer 38

D. Checkbook

Question 39

A record of debits, credits, and balances is referred to as a patient's _____________ A. sheet B. chart C. ledger D. slip

Answer 39

C. Ledger

Question 40

A signature on the reverse side of a check is called ____________ A. kiting B. endorsment C. reconciliation D. signature card

Answer 40

B. Endorsement

Question 41

A form to itemize deposits made to savings or checking accounts is called _________ A. deposit slip B.money order C. check guarentee D. no correct answer

Answer 41

A. Deposit slip

Question 42

To correct a handwritten error in a patient's chart, it is only acceptable to ____________ A. white it out neatly and insert the correct information B. write over the error C. scratch through the error so it cannot be read D. draw a line through the error, insert the correct information. date and inital it.

Answer 42

D. draw a line through the error, insert the correct information, date and initial it

Question 43

Low income patients can be covered by what type of insurance ___________ A. Medicaid B. Medicare C. Tri-care D. blue cross/blue shield

Answer 43

A. Medicaid

Question 44

The reference procedural code book that uses a numbering system developed by the AMA is called a (n) _____________ A. reference manual B. current procedural terminology C. insurance claim manual D. manual for current procedures

Answer 44

B. Current procedural terminology.

Question 45

_____________ is a method used for determining whether a particular service or procedure is covered under a patient's policy. A. informed consent B. preauthorization C. precertification d. no correct answer

Answer 45

C. Precertification

Question 46

The International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) is used to code ____________ A. procedures B. diagnoses C. services rendered D. medications

Answer 46

B. Diagnoses

Question 47

In insurance coding using an "E" code designates ________ A. a factor that contributes to a condition or disease B. classification of enviormental events, such as poisioning C. the primary diagnosis D. cancers

Answer 47

B. classification of environmental events, such as poisioning.

Question 48

E/M codes are located in the _________ manual A. CPT B. ICD-9-CM C. ICD-10-CM D. HCPC

Answer 48

A. CPT

Question 49

Which codes can modifiers be added to, to indicate that a procedure or service has been altered in some way? A. CPT B. ICD-9-CM C. ICD-10-CM D. all of the choices

Answer 49

A. CPT

Question 50

The _______________ form is used by non-institutional providers and suppliers to bill Medicare, part B covered services? A. HCPA-1000 B.CPT C.CMS-1500 D.UB92

Answer 50

C. CMS-1500