Module 3 Week 2

Question 1

Which of the following would be considered a step or steps to verify insurance coverage and eligibility?

Answer 1

All of the responses are necessary steps.

Question 2

Part ___ of Medicare was created to provide coverage for both generic and brand-name drugs.

Answer 2

Part D

Question 3

The standard claim form (format) designed by CMS to submit provider services for third-party payment is known as the:

Answer 3

CMS-1500

Question 4

A nonprofit organization created to improve patient care quality and health plan performance is known as:

Answer 4

National Committee for Quality Assurance (NCQA)

Question 5

Because a primary care physician (PCP) in an HMO makes referrals and approves additional care, they are known as the:

Answer 5

Gatekeeper

Question 6

Ideally, a person in the medical office is designated the ___ and is expected to submit accurate claims in compliance with rules.

Answer 6

Claims filer

Question 7

Part ___ of Medicare is for payment of medical expenses such as office visits and X-ray and laboratory services.

Answer 7

Part B

Question 8

Once a patient is ready to leave the hospital, ___ is used to ensure safe discharge to the appropriate setting.

Answer 8

Discharge planning

Question 9

Which of the following are considered third-party (insurance) plans?

Answer 9

All of the responses are correct.

Question 10

Which type of health maintenance organization (HMO) is composed of providers who practice in their own offices and retain staff?

Answer 10

Independent Practice Association (IPA)

Question 11

When a patient arrives at the medical office, you should copy (or scan) ___ of the insurance card(s).

Answer 11

Both sides

Question 12

In a(n) ___ plan, patients can see specialists without referrals from another physician.

Answer 12

Indemnity-type insurance

Question 13

The traditional type of insurance that covers costs of care and allows patients to see any provider is:

Answer 13

Fee-for-service

Question 14

Under the birthday rule, if divorced parents retain plans, the parent with ___ is primary.

Answer 14

Custody

Question 15

When patients without health insurance are seen in the medical practice, they are classified as ___ patients.

Answer 15

Self-pay

Question 16

Which type of insurance does not require a referral for patient care and specialists?

Answer 16

Indemnity-type insurance

Question 17

Which of the following would be considered steps to obtain precertification or preauthorization?

Answer 17

All of the responses are necessary steps.

Question 18

An amount reimbursed after accepting assignment

Answer 18

A provider may not charge a patient for:

Question 19

Physicians who treat workers’ compensation patients are required to register with the state Workers’ Compensation Board:

Answer 19

On an annual basis.

Question 20

For the entire cost of treatment if unauthorized.

Answer 20

Under workers’ compensation, a patient with an industrial injury is billed:

Question 21

Medicare pays ___ percent of the approved bill once the deductible is satisfied.

Answer 21

80%

Question 22

The term ___ refers to the maximum amount an insurer will pay for services such as surgery or consultation.

Answer 22

Predetermination

Question 23

Which of the following statement(s) is/are true about insurance plans and Medicare?

Answer 23

All of the responses are correct.

Question 24

When a provider does not accept assignment from Medicare, the most that can be charged to the patient is ___ percent of the Medicare-approved amount.

Answer 24

115%

Question 25

Health insurance offered by private companies to supplement Medicare benefits is called:

Answer 25

Medigap

Question 26

When patients arrive at the office, the administrative medical assistant should:

Answer 26

Explain all instructions thoroughly.

Question 27

The primary benefit of ___ is that patients have an opportunity to present for complaints that have an unexpected onset.

Answer 27

Walk-in/open hours scheduling.

Question 28

Accessing a patient’s record by more than one person at the same time.

Answer 28

A disadvantage of electronic appointment scheduling software (practice management) would be:

Question 29

When using a paper scheduling system, if a patient cancels at the last minute, you should ___ the original entry.

Answer 29

Draw a single line through.

Question 30

If a new patient appears reluctant to complete intake forms, you should:

Answer 30

Quickly offer to assist in completing them in a separate closed room.

Question 31

During a telephone screening, you should:

Answer 31

Paraphrase the caller’s description of their symptoms.

Question 32

A ___ sets aside a portion of an employee’s pretaxable income to pay for projected medical expenses or prescription medications.

Answer 32

Medical/flexible savings account (FSA).

Question 33

One way to ease fears and maintain rapport with patients is to communicate billing/payment policies clearly. Why?

Answer 33

To help avoid misunderstandings regarding financial matters.

Question 34

A disadvantage of clustering is that:

Answer 34

If one visit goes off track, it may throw the entire appointment flow off track.

Question 35

Patients should never be expected to undergo invasive procedures without:

Answer 35

Providing informed consent.

Question 36

Posting a ___ is one way to communicate not only patient legal rights but also what rights they have ethically.

Answer 36

Patient’s Bill of Rights

Question 37

Which of the following is an advantage of a paper scheduling system?

Answer 37

Several styles of appointment books allow scheduling as far out as a year or more.

Question 38

__ refers to blocking off time slots in a paper schedule with an 'X' or having specified periods blocked in the computer system.

Answer 38

Matrix scheduling.

Question 39

The main disadvantage of single-booking is that:

Answer 39

If patient problems are easily addressed, there may be gaps in the schedule.

Question 40

If you have a patient who is habitually late, it is recommended that you:

Answer 40

Ask the office manager to discuss scheduling policy with the patient.

Question 41

To help a patient develop a payment plan for elective surgery, the medical assistant should:

Answer 41

Review insurance coverage with the patient.

Question 42

If a patient engages in clearly inappropriate behavior, you should:

Answer 42

Have a witness come in and instruct the patient to cease the behavior.

Question 43

Office policies that pertain to patients should be outlined at the initial visit.

Answer 43

Which of the following statements is true?

Question 44

When should a charge slip (encounter form) be prepared and attached to a patient’s chart?

Answer 44

Before the patient is seen.

Question 45

Which of the following is not considered an advantage of electronic scheduling?

Answer 45

Downtime resulting in lost information.

Question 46

Which method of scheduling is designed to keep a continuous flow of patients?

Answer 46

Streaming.

Question 47

When scheduling a hospital admission for a patient, you should not provide:

Answer 47

A guess of the diagnosis and plan of care for the utilization review committee.

Question 48

Insurance companies typically require patients to obtain a ___ before they will pay for a specialist visit.

Answer 48

Referral.

Question 49

A patient does not need to provide signed consent for the medical office to release information about:

Answer 49

A public health risk.

Question 50

Weekly schedules for the providers should be accessible to:

Answer 50

Everyone in the office.