Question:* A Remittance Advice statement is most similar to a(n):
Answer: • EOB
Question:* True or False? A Medicaid MCO provides comprehensive services to Medicaid beneficiaries, but not commercial or Medicare enrollees.
Answer: • True
Question:* The exact abbreviation of RA in medical billing terminology?
Answer: • Remittance Advice
Question:* Is a co-payment an out of pocket expense?
Answer: • Yes
Question:* The predetermined (flat) fee, a patient usually has to pay on each office visit is a:
Answer: • Co-pay
Question:* What is Dx refer to?
Answer: • Diagnosis code
Question:* What organ is measured in an EKG/ECG?
Answer: • Heart
Question:* What is a premium?
Answer: • The amount paid for an insurance policy
Question:* Which of these would be a valid reasons for a claim to be denied?
Answer: • All are valid reasons
Question:* What is COBRA insurance?
Answer: • Insurance available to individuals after they become unemployed
Question:* A patient on an HMO plan typically needs a _________ to receive care from a specialist.
Answer: • referral
Question:* The date the insurance policy is set to begin or when benefits or covered services are allowed is most commonly known as the:
Answer: • Effective date
Question:* True or false? Sometimes multiple treatments will fall under one billing code.
Answer: • True
Question:* Place of service codes on claims are there to define?
Answer: • The place of service where services were rendered
Question:* Which federal law strengthens the privacy of a patient's PHI and allows a patient to review their medical record?
Answer: • HIPAA
Question:* The amount paid, often in monthly installments, for an insurance policy by the employer or patient themselves, is the:
Answer: • Premium
Question:* What does COB commonly refer to?
Answer: • Coordination of Benefits
Question:* The federal law that allows a worker to continue to purchase employer paid health insurance for up to 18 months if they lose their job or your coverage is otherwise terminated is known as:
Answer: • COBRA
Question:* What do the CPT codes refer to?
Answer: • The procedures performed by a physician or a practitioner
Question:* In medical billing, what is the function of a clearinghouse?
Answer: • It checks bills for errors then transmits them to the insurance company
Question:* True or False? Tertiary insurance is intended to cover gaps in coverage the primary and secondary insurance may not cover.
Answer: • True
Question:* This health insurance coverage is available to an individual and their dependents after becoming unemployed - either due to voluntary or involuntary termination of employment for reasons other than gross misconduct.
Answer: • COBRA Insurance
Question:* HIPAA stands for:
Answer: • Health Insurance Portability Accountability Act
Question:* ________ billing is when a patient is charged for the difference between what a doctor bills and what the provider and insurance company agree upon.
Answer: • Balanced
Question:* Which of these are NOT standard statuses of a claim in a typical EOB?
Answer: • Transition
Question:* Health Insurance Claim (HICN) is a number assigned by the Social Security Administration to an individual identifying him/her as a _______ beneficiary
Answer: • Medicare
Question:* In which month do commercial insurance and Medicare deductibles start each year?
Answer: • January
Question:* If a physician uses an open-panel HMO, can they see non-HMO patients?
Answer: • Yes
Question:* Hospital beds, wheelchairs and oxygen equipment would be considered examples of:
Answer: • DME
Question:* True or False? AWP laws are state laws that require health insurance companies to accept into their PPO and HMO networks any provider willing to agree to the insurance company's terms and conditions.
Answer: • True
Question:* A type of health coverage that typically allows a patient to go to any doctor or provider without permission is known as:
Answer: • Fee-for-Service
Question:* What is capitation?
Answer: • A system that pays physicians and nurses a set amount per enrolled patient assigned to them
Question:* When submitting a secondary claim, what is the name of the document that must be attached?
Answer: • Explanation of Benefits
Question:* What is the purpose of an Advanced Beneficiary Notice?
Answer: • To alert a patient that Medicare may deny payment for a specific procedure or treatment
Question:* Which of the following would you likely use if billing Medicare?
Answer: • HCFA1500
Question:* With the implementation of HIPAA, all the following systems became mandatory EXCEPT:
Answer: • ADT
Question:* Which part of Medicare is the drug prescription coverage?
Answer: • Part D
Question:* The Employer Identification Number is also known as the:
Answer: • Federal Tax Identification Number
Question:* What is a clearing house?
Answer: • Intermediary between provider and insurance
Question:* True or False? ERISA includes PPOs, POS, and HMO benefit plans.
Answer: • True
Question:* An illegal practice of assigning an ICD-9 diagnosis code that does not agree with the patient records for the purpose of increasing the reimbursement from the insurance payor is called:
Answer: • Upcoding
Question:* The ICD-9-CM coding classification to identify health care for reasons other than injury or illness is
Answer: • V-code
Question:* Which of the following is an agreement made between the insurance company and the insured to send payments directly to the physician?
Answer: • Assignment of Benefits
Question:* True or false? Undercoding is illegal.
Answer: • True
Question:* Who is eligible for Medicare part C
Answer: • An individual who is covered under Parts A and B
Question:* The form the provider uses to document the treatment and diagnosis for a patient visit which typically includes ICD-9 diagnosis and CPT procedural codes is the:
Answer: • Superbill
Question:* Health insurance coverage which is contracted to supplement Medicare coverage is called:
Answer: • Medigap
Question:* The HIPAA approved standard paper claim form submitted to insurance companies to have the outpatient health benefit or the contracted provider visit paid is the:
Answer: • CMS 1500
Question:* Charging for services that are not medically necessary are included under:
Answer: • Abuse
Question:* What does UCR stand for?
Answer: • Usual, customary, or reasonable
Question:* What could POS exactly stand for in Medical Billing?
Answer: • Place of Service
Question:* What are modifiers used for?
Answer: • They are used to add more information about a CPT code
Question:* True or False? The difference between the Medicare and Medicaid allowable is that Medicaid does NOT pay a percentage of the allowed amount.
Answer: • True
Question:* Level II HCPCS codes are formatted as a single letter followed by _________.
Answer: • Four numeric digits
Question:* The claim form for billing for facility fees which replaces the UB92 form is the _______ form.
Answer: • UB04
Question:* True or false? The coder should NOT correct any errors in a bill.
Answer: • False
Question:* How many digits are in a National Provider Identifier?
Answer: • 10
Question:* Which one of the following was known as Medicare + Choice?
Answer: • Part C
Question:* The average amount Medicare will pay a provider or hospital for a procedure is the:
Answer: • RVU
Question:* Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called:
Answer: • Ancillary care
Question:* A 3-digit number used on hospital bills to tell the insurer where the patient was when they received treatment, or what type of item a patient received, is the:
Answer: • Revenue Code
Question:* Tricare was formerly known as
Answer: • Civilian Health and Medical Program of the Uniformed Services(CHAMPUS)
Question:* Coding for a name-brand medication when a generic brand was used is called __________.
Answer: • Upcoding
Question:* What is a challenge of processing medical bills off site?
Answer: • The biller may not be able to contact the physician
Question:* The difference between the summarized income rate and the summarized cost rate over a given valuation period is the:
Answer: • Actuarial Balance
Question:* Submitting several CPT treatment codes when only one code is necessary is called:
Answer: • Unbundling
Question:* A health benefit plan allowing the patient to choose to receive a service from a group of contracted providers is a:
Answer: • POS
Question:* The form which is specifically used to bill dental services is called?
Answer: • ADA form
Question:* True or False? Med pay is a form of no-fault insurance.
Answer: • True
Question:* The federal law that was originally created to safeguard an employees retirement benefits is abbreviated as:
Answer: • ERISA
Question:* Will Medicare accept a UB-92 form?
Answer: • No
Question:* What is the abbrevation for SSI?
Answer: • Supplemental Security Income
Question:* True or false? An individual on an HMO plan would need a referral to get a yearly mammogram.
Answer: • False
Question:* Medicare Advantages Plans cover consultation codes?
Answer: • No
Question:* Which one of the following is the largest Blue Cross Blue Shield member?
Answer: • WellPoint
Question:* This type of workers compensation would be described as: abnormal conditions or disorders caused by exposure to enviromental factors. Examples of these could be exposure to a chemical, inhalation, ingestion or direct exposure.
Answer: • Occupational illness
Question:* According to the MBAA, up to _____ % of US medical bills contain errors.
Answer: • 80%
Question:* A ________ limits the amount of out-of-pocket expenses a patient will have to pay for TRICARE-covered medical services.
Answer: • catastrophic cap
Question:* If a provider is non-par, any allowed claim amount that is ______ billed charges should be unacceptable.
Answer: • less than
Question:* In DME claims which of the following is necessary: Referring physician or Ordering physician?
Answer: • Referring Physician
No comments:
Post a Comment