Question 1

Which of the following is included under Workers' Compensation insurance in most states?

Accepted Answer

A)   Rehabilitation costs are covered to return an employee to work.
B)   A monthly amount is paid to the patient for a temporary disability.
C)   There are no death benefits.
D)   Only selected medical expenses are covered, and no inpatient expenses are covered.
E)   It covers workers who are injured while they are on vacation.F) B) and D)
G) All of the above

Question 2

Mr. Johnson came to the office today complaining of headache and upset stomach. He has the traditional Medicare fee-for-service plan. Your office's usual fee for an established patient visit is $125. Medicare's allowable charge is $100. If Mr. Johnson does not have Medigap insurance, how much will he have to pay for this visit?

Accepted Answer

A)   $20
B)   $25
C)   $80
D)   $100
E)   $125F) A) and C)
G) B) and E)

Question 3

Three major methods are used to transmit claims electronically: direct transmission to the payer, ________ use, and direct data entry.

Accepted Answer

The answer of Three major methods are used to transmit...

Question 4

The ________ is a fixed percentage payable by the patient after the deductible is met.

Accepted Answer

The answer of The ________ is a fixed percentage payable...

Question 5

The provider should have the patient sign a(n) ________ of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer.

Accepted Answer

The answer of The provider should have the patient sign...

Question 6

What is the authorization called that directs an insurance carrier to pay the medical provider or the medical practice directly?

Accepted Answer

A)   Copayment
B)   Provider of medical services
C)   Assignment of benefits
D)   Health insurance provider
E)   PreauthorizationF) B) and E)
G) A) and B)

Question 7

Which statement is true regarding health maintenance organizations?

Accepted Answer

A)   They focus on medical procedures and services rather than on wellness and preventive care.
B)   They require subscribers to complete paperwork and file claims for routine procedures.
C)   Physicians with HMO contracts are often paid a capitated rate.
D)   Routine annual physical examinations are discouraged.
E)   Patients generally do not have to make copayments.F) None of the above
G) A) and B)

Question 8

The ________ fee is considered the maximum charge that the health plan will pay a provider for a particular procedure or service.

Accepted Answer

The answer of The ________ fee is considered the maximum...

Question 9

Which of the following statements applies to a physician who agrees to accept Medicaid patients?

Accepted Answer

A)   The physician can bill the patient for services that Medicaid does not cover.
B)   The physician may see Medicaid patients as a last resort when he does not have enough patients with insurance.
C)   If the physician's fee is higher than the Medicaid payment, the patient is billed for the difference.
D)   The physician does not have to agree to accept the established Medicaid payment for covered services.
E)   The physician can bill Medicare for any services not covered by Medicaid.F) D) and E)
G) A) and B)

Question 10

The electronic claim transaction preferred by Medicare is the X12 837 Health Care Claim, commonly referred to as the "________ claim."

Accepted Answer

The answer of The electronic claim transaction preferred by Medicare...

Question 11

An appropriate approach to maintaining patient confidentiality on the computer is to ____.

Accepted Answer

A)   make sure a coworker knows your password in case you are sick
B)   allow former employees to keep their passwords
C)   change your password every 90 days
D)   provide each patient with a unique password
E)   send confidential information only by fax, never by computerF) A) and B)
G) A) and D)

Question 12

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Accepted Answer

A)   copayment
B)   premium
C)   coinsurance
D)   capitation
E)   deductibleF) B) and C)
G) B) and E)

Question 13

Some payers offer an Internet-based service called ________ data entry, or DDE, that allows medical offices to enter data without EDI formatting.

Accepted Answer

The answer of Some payers offer an Internet-based service called...

Question 14

In which program can enrollees who are aged 65 and older continue to obtain medical services at military hospitals and clinics as they did before they turned 65?

Accepted Answer

A)   TRICARE Standard
B)   TRICARE for Life
C)   TRICARE Prime
D)   TRICARE Extra
E)   CHAMPVAF) A) and B)
G) A) and C)

Question 15

Insurers include either an explanation of payment or a(n) ________ advice along with payment to the practice or to the patient, depending on whether an assignment of benefits was signed.

Accepted Answer

The answer of Insurers include either an explanation of payment...

Question 16

Under a contracted or fixed prepayment called ____, physicians are paid a fixed amount of money to provide needed care.

Accepted Answer

A)   preauthorization
B)   copayment
C)   managed care
D)   capitation
E)   dual coverageF) A) and D)
G) A) and B)

Question 17

Using a clearinghouse to transmit electronic media claims ____.

Accepted Answer

A)   makes more paperwork than paper claims
B)   requires a greater amount of time to process claims
C)   includes data elements that are transmitted in a computer file.
D)   enables a 30-day turnaround time from submission to payment
E)   requires a translator and technology to conduct electronic data interchangeF) A) and B)
G) B) and E)

Question 18

The list of drugs approved by an insurance company is called a(n) ________.

Accepted Answer

The answer of The list of drugs approved by an...

Question 19

When the medical assistant confirms with the insurance company that the patient has coverage for a procedure before scheduling, the process is called ____________.

Accepted Answer

The answer of When the medical assistant confirms with the...

Question 20

Which insurance covers a patient who has been hospitalized up to 90 days for each benefit period?

Accepted Answer

A)   Medicare Part A
B)   CHAMPVA
C)   Medicare Part B
D)   Medicaid
E)   TRICARE PrimeF) C) and E)
G) None of the above

Exam 17: Insurance Billing

What is the authorization called that directs an insurance carrier to pay the medical provider or the medical practice directly?

Correct Answer
verified

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Correct Answer
verified

In which program can enrollees who are aged 65 and older continue to obtain medical services at military hospitals and clinics as they did before they turned 65?

Correct Answer
verified

The list of drugs approved by an insurance company is called a(n) ________.

Correct Answer
verified

Under a contracted or fixed prepayment called ____, physicians are paid a fixed amount of money to provide needed care.

Correct Answer
verified

Which statement is true regarding health maintenance organizations?

Correct Answer
verified

The electronic claim transaction preferred by Medicare is the X12 837 Health Care Claim, commonly referred to as the "________ claim."

Correct Answer
verified

Which insurance covers a patient who has been hospitalized up to 90 days for each benefit period?

Correct Answer
verified

Which of the following is included under Workers' Compensation insurance in most states?

Correct Answer
verified

The provider should have the patient sign a(n) ________ of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer.

Correct Answer
verified

The ________ fee is considered the maximum charge that the health plan will pay a provider for a particular procedure or service.

Correct Answer
verified

An appropriate approach to maintaining patient confidentiality on the computer is to ____.

Correct Answer
verified

Which of the following statements applies to a physician who agrees to accept Medicaid patients?

Correct Answer
verified

Some payers offer an Internet-based service called ________ data entry, or DDE, that allows medical offices to enter data without EDI formatting.

Correct Answer
verified

Three major methods are used to transmit claims electronically: direct transmission to the payer, ________ use, and direct data entry.

Correct Answer
verified

The ________ is a fixed percentage payable by the patient after the deductible is met.

Correct Answer
verified

Using a clearinghouse to transmit electronic media claims ____.

Correct Answer
verified

Insurers include either an explanation of payment or a(n) ________ advice along with payment to the practice or to the patient, depending on whether an assignment of benefits was signed.

Correct Answer
verified

Correct Answer
verified

When the medical assistant confirms with the insurance company that the patient has coverage for a procedure before scheduling, the process is called ____________.

Correct Answer
verified

Exam 17: Insurance Billing

What is the authorization called that directs an insurance carrier to pay the medical provider or the medical practice directly?

Correct AnswerverifiedShow Answer

The fixed dollar amount a subscriber must pay or "meet" each year before the insurer begins to cover expenses is the ____.

Correct AnswerverifiedShow Answer

In which program can enrollees who are aged 65 and older continue to obtain medical services at military hospitals and clinics as they did before they turned 65?

Correct AnswerverifiedShow Answer

The list of drugs approved by an insurance company is called a(n) ________.

Correct AnswerverifiedShow Answer

Under a contracted or fixed prepayment called ____, physicians are paid a fixed amount of money to provide needed care.

Correct AnswerverifiedShow Answer

Which statement is true regarding health maintenance organizations?

Correct AnswerverifiedShow Answer

The electronic claim transaction preferred by Medicare is the X12 837 Health Care Claim, commonly referred to as the "________ claim."

Correct AnswerverifiedShow Answer

Which insurance covers a patient who has been hospitalized up to 90 days for each benefit period?

Correct AnswerverifiedShow Answer

Which of the following is included under Workers' Compensation insurance in most states?

Correct AnswerverifiedShow Answer

The provider should have the patient sign a(n) ________ of benefits statement under which the provider agrees to prepare healthcare claims for the patient and to receive payments directly from the payer.

Correct AnswerverifiedShow Answer

The ________ fee is considered the maximum charge that the health plan will pay a provider for a particular procedure or service.

Correct AnswerverifiedShow Answer

An appropriate approach to maintaining patient confidentiality on the computer is to ____.

Correct AnswerverifiedShow Answer

Which of the following statements applies to a physician who agrees to accept Medicaid patients?

Correct AnswerverifiedShow Answer

Some payers offer an Internet-based service called ________ data entry, or DDE, that allows medical offices to enter data without EDI formatting.

Correct AnswerverifiedShow Answer

Three major methods are used to transmit claims electronically: direct transmission to the payer, ________ use, and direct data entry.

Correct AnswerverifiedShow Answer

The ________ is a fixed percentage payable by the patient after the deductible is met.

Correct AnswerverifiedShow Answer

Using a clearinghouse to transmit electronic media claims ____.

Correct AnswerverifiedShow Answer

Insurers include either an explanation of payment or a(n) ________ advice along with payment to the practice or to the patient, depending on whether an assignment of benefits was signed.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

When the medical assistant confirms with the insurance company that the patient has coverage for a procedure before scheduling, the process is called ____________.

Correct AnswerverifiedShow Answer

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