Question 1

A feature of Blue Cross/Blue Shield (BCBS)  is ____.

Accepted Answer

A)   routine cancellation of a patient's policy because of poor health
B)   there is no provision for conversion to individual coverage
C)   specific plans for BCBS can vary greatly
D)   denial of transfer of benefits from one state to another
E)   it is a national nonprofit service organizationF) D) and E)
G) A) and E)

Question 2

Federal law requires employers to purchase and maintain a certain minimum amount of workers' ________ insurance for their employees.

Accepted Answer

The answer of Federal law requires employers to purchase and...

Question 3

Greg Owen is in the office today for treatment of a small but deep cut he received while cutting laminate for the new floor in his kitchen. He has employer-provided insurance and is also listed as a dependent on his wife's insurance. His DOB is 7/19/1973 and his wife's DOB is 5/23/1978. Which plan will be the primary payer for the children?

Accepted Answer

A)   Greg's insurance, because he was born 5 years earlier than his wife
B)   Greg's wife's insurance, because her birthday occurs earlier in the calendar year
C)   Medicare, because Greg is over 65
D)   Medicaid, because Greg does not think he can afford to have sutures
E)   Workers' Compensation, since Greg is employed full-timeF) A) and C)
G) A) and B)

Question 4

Which of the following must be verbally discussed with a Medicare beneficiary to enable the beneficiary to consider options and make informed choices?

Accepted Answer

A)   CHIP
B)   DRG
C)   RBRVS
D)   ABN
E)   GAFF) C) and D)
G) None of the above

Question 5

A patient who has been hospitalized up to 90 days for each benefit period is covered under ____.

Accepted Answer

A)   Medicare Part A
B)   CHAMPVA
C)   Medicare Part B
D)   Medicaid
E)   TRICARE PrimeF) All of the above
G) A) and B)

Question 6

A fixed prepayment is made to a physician for each plan member in the ________ payment method.

Accepted Answer

The answer of A fixed prepayment is made to a...

Question 7

Which of the following guidelines is applicable when filing a Medicaid claim and interacting with Medicaid patients?

Accepted Answer

A)   Allow a 2-year time limit on all claim submissions
B)   Submit claims without proving patient eligibility for benefits
C)   Treat the patient as if he or she has private insurance
D)   Submit claims without proving Medicaid membership
E)   Send claims to the national claims centerF) C) and D)
G) A) and D)

Question 8

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 9

Under a Medicare Managed Care Plan, the PCP provides treatment and manages the patient's medical care through ________ to specialists when additional care is required.

Accepted Answer

The answer of Under a Medicare Managed Care Plan, the...

Question 10

A small fee that is collected at the time of service is called a(n) _______.

Accepted Answer

The answer of A small fee that is collected at...

Question 11

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) B) and E)

Question 12

Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older.

Accepted Answer

A)   Medicaid
B)   Medicare
C)   disability insurance
D)   liability insurance
E)   CHAMPVAF) C) and E)
G) D) and E)

Question 13

Billing the patient for the difference between a higher usual fee and a lower allowed charge is called ________ billing.

Accepted Answer

The answer of Billing the patient for the difference between...

Question 14

Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional insurance called a(n) ________ plan.

Accepted Answer

The answer of Because Medicare pays 80% of approved charges...

Question 15

The request for approval for payment from a third-party payer prior to a procedure is the ____.

Accepted Answer

A)   coinsurance
B)   elective procedure
C)   preauthorization
D)   predetermination
E)   explanation of paymentF) C) and D)
G) A) and E)

Question 16

The determination of the amount of money paid by a third-party payer for a procedure is ____.

Accepted Answer

A)   preauthorization
B)   copayment
C)   precertification
D)   deductible
E)   predeterminationF) A) and E)
G) C) and D)

Question 17

TRICARE and CHAMPVA cover ____.

Accepted Answer

A)   active military personnel
B)   veterans who served in active combat
C)   non-military government employees
D)   families of all military personnel
E)   disabled veteransF) A) and B)
G) B) and D)

Question 18

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) C) and E)
G) B) and D)

Question 19

The ________ is a fixed amount that must be paid by the policyholder each year before a third-party payer begins to cover medical expenses.

Accepted Answer

The answer of The ________ is a fixed amount that...

Question 20

Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

Accepted Answer

A)   Medical
B)   Liability
C)   Disability
D)   Medicare
E)   MedicaidF) A) and D)
G) B) and D)

Exam 17: Insurance and Billing

Federal law requires employers to purchase and maintain a certain minimum amount of workers' ________ insurance for their employees.

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

A fixed prepayment is made to a physician for each plan member in the ________ payment method.

Correct Answer
verified

Which of the following guidelines is applicable when filing a Medicaid claim and interacting with Medicaid patients?

Correct Answer
verified

The ________ is a fixed amount that must be paid by the policyholder each year before a third-party payer begins to cover medical expenses.

Correct Answer
verified

Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older.

Correct Answer
verified

A feature of Blue Cross/Blue Shield (BCBS) is ____.

Correct Answer
verified

A patient who has been hospitalized up to 90 days for each benefit period is covered under ____.

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 request for approval for payment from a third-party payer prior to a procedure is the ____.

Correct Answer
verified

TRICARE and CHAMPVA cover ____.

Correct Answer
verified

Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

Correct Answer
verified

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

Correct Answer
verified

The determination of the amount of money paid by a third-party payer for a procedure is ____.

Correct Answer
verified

Under a Medicare Managed Care Plan, the PCP provides treatment and manages the patient's medical care through ________ to specialists when additional care is required.

Correct Answer
verified

Correct Answer
verified

A small fee that is collected at the time of service is called a(n) _______.

Correct Answer
verified

Which of the following must be verbally discussed with a Medicare beneficiary to enable the beneficiary to consider options and make informed choices?

Correct Answer
verified

Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional insurance called a(n) ________ plan.

Correct Answer
verified

Billing the patient for the difference between a higher usual fee and a lower allowed charge is called ________ billing.

Correct Answer
verified

Exam 17: Insurance and Billing

Federal law requires employers to purchase and maintain a certain minimum amount of workers' ________ insurance for their employees.

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

A fixed prepayment is made to a physician for each plan member in the ________ payment method.

Correct AnswerverifiedShow Answer

Which of the following guidelines is applicable when filing a Medicaid claim and interacting with Medicaid patients?

Correct AnswerverifiedShow Answer

The ________ is a fixed amount that must be paid by the policyholder each year before a third-party payer begins to cover medical expenses.

Correct AnswerverifiedShow Answer

Of the federal programs providing healthcare, the largest is ____, which provides health insurance for citizens aged 65 and older.

Correct AnswerverifiedShow Answer

A feature of Blue Cross/Blue Shield (BCBS) is ____.

Correct AnswerverifiedShow Answer

A patient who has been hospitalized up to 90 days for each benefit period is covered under ____.

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 request for approval for payment from a third-party payer prior to a procedure is the ____.

Correct AnswerverifiedShow Answer

TRICARE and CHAMPVA cover ____.

Correct AnswerverifiedShow Answer

Which of the following types of insurance covers injuries that are caused by the insured or that occurred on the insured's property?

Correct AnswerverifiedShow Answer

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

Correct AnswerverifiedShow Answer

The determination of the amount of money paid by a third-party payer for a procedure is ____.

Correct AnswerverifiedShow Answer

Under a Medicare Managed Care Plan, the PCP provides treatment and manages the patient's medical care through ________ to specialists when additional care is required.

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

A small fee that is collected at the time of service is called a(n) _______.

Correct AnswerverifiedShow Answer

Which of the following must be verbally discussed with a Medicare beneficiary to enable the beneficiary to consider options and make informed choices?

Correct AnswerverifiedShow Answer

Because Medicare pays 80% of approved charges and the patient is responsible for the remaining 20%, individuals enrolled in the Original Medicare Part B plan often buy additional insurance called a(n) ________ plan.

Correct AnswerverifiedShow Answer

Billing the patient for the difference between a higher usual fee and a lower allowed charge is called ________ billing.

Correct AnswerverifiedShow Answer

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