Ch. 17

Question 1

Your physician is a participation PPO providers which means

Answer 1

The physician will charge discounter fees

Question 2

HMO stands for

Answer 2

Health Maintenance Organization

Question 3

TRICARE for life covers those who

Answer 3

Are eligible for both Medicare and TRICARE

Question 4

Coordination of benefits is done to

Answer 4

Prevent duplicate of payment

Question 5

Those patients under 65 that quality for Medicare are

Answer 5

Blind or have serious long-term disabilities

Question 6

The main advantage of choosing a PPO plan over an HMO plan is

Answer 6

PPO plans offer out-of-network benefits

Question 7

Who documents the patient’s symptoms in the medical record

Answer 7

The physician

Question 8

The major difference between HMOs and PPOs when it comes to the patients financial responsibility is

Answer 8

The patients pay copays with the HMOs, patient pay a percentage of the cost with a PPO

Question 9

When claims are keyed directly into a third-party payer’s online system, the process in known as

Answer 9

DDE

Question 10

Medicare covers those who are

Answer 10

65 and older and some persons under 65 who qualify

Question 11

Worker’s compensation covers those who

Answer 11

Get hurt on the job

Question 12

Claims that are accepted by payers for processing are known as what claims

Answer 12

Clean

Question 13

The purpose of a physician’s fee schedule is to

Answer 13

List the usual fees for procedures and services

Question 14

CHAMPVA covers

Answer 14

Families of veterans with certain service-connected disabilities

Question 15

After you obtain the patient’s insurance information you should

Answer 15

Verify eligibility

Question 16

Which of the following plans covers surviving spouses and dependent children of veterans who die in the line of duty

Answer 16

CHAMPVA

Question 17

Medicare part D was created to

Answer 17

Cover prescription

Question 18

You should track claims sent to the insurance carrier because

Answer 18

You need a record of claims sent to you so you can follow up

Question 19

Which of the following is true regarding RBRVS

Answer 19

RBRVS fees are lower than usual fees

Question 20

The purpose of medical billing program is to

Answer 20

Make the process of creating and following up on claims easier

Question 21

Which of the following will you need to prepare the claim form

Answer 21

The patient charges slip

Question 22

Who provides funds to the Medicaid program

Answer 22

The federal and state governments

Question 23

Another term for patients insurance carrier is

Answer 23

Third-party payer

Question 24

Within an electronic claim, the billing provider is

Answer 24

The entry transmitting the claim to the payer

Question 25

Which of the following is true regarding HMO plans

Answer 25

They only offer in-network benefits

Question 26

The insurance carrier reviews each claim for medical necessity which means

Answer 26

The insurance carrier feels the diagnosis and treatment are complete and necessary

Question 27

The name of the form the patient should complete during her first office visit is the

Answer 27

Patient registration form

Question 28

Temporary workers compensation disability benefits are provided

Answer 28

Until the employee can return to work

Question 29

The resource-based relative valve scale (RBRVS) is a payment system used by

Answer 29

Medicare

Question 30

The claims time limit deals with

Answer 30

The time allowed from the date of service to submission of claims

Question 31

What is paid by the insured to keep an insurance policy in effect

Answer 31

Premium

Question 32

The first step in the health insurance claims process is

Answer 32

Obtaining patient information

Question 33

The universal paper claim form is currently called the

Answer 33

CMS-1500

Question 34

The federal health plan designed for those 65 and older is known as

Answer 34

Medicare