FREE AND STUDY GAMES ABOUT HEALTH INS.PROCESS

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FREE AND STUDY GAMES ABOUT HEALTH INS.PROCESS

EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -100 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation Question 1: What document is used by the medical insurance specialist to update the patient billing program with the payer's payments and the amount due from the patient?a:EFT b:RA c:IRA d:OIG

Answer:

B: RA

Question 2: A conversion factor is mulitiplied by a relative value unit to arrive at a charge.

Answer:

TRUE Question 3: What percentage of the fee on the Medicare Fee Schedule is the limiting charge?a:115 percent b:100 percent c:85 percent d:80 percent

Answer:

A: 115 percent

Question 4: Under the Medicaid program,medically needy describes people with high medical expenses and low financial resources who are not receiving cash assistance.

Answer:

TRUE

Question 5: Stop-loss provisions protect providers against a:malpractice charges b:extreme financial loss c:loss of number of patients d:increases in premiums

Answer:

B:extreme financial loss

Question 6: When a claim is pulled by a payer for a manual review, the provider may be asked to submit a:revised procedure codes b:a new diagnosis c:clinical documentation d:revised charges

Answer:

C: clinical documentation

Question 7: SSDI is the abbreviation for the Socail Security Diagnosis Incidence program.

Answer:

FALSE Question 8: The claim control number and the line item control number are both used to track payments from the health plan.

Answer:

TRUE Question 9: Under RBRVS,the nationally uniform relative value is based on a:the geographic adjustment factor b:the uniform conversion factor c:the provider's work,practice cost,and malpractice insurance costs d:the UCR,practice cost,and malpractice insurance costs

Answer:

C: the provider's work,practice cost,and malpractice insurance costs.

Question 10: An aging report groups unpaid claims or bills according to the length of time that they remain due,such as 30 or 60 days.

Answer:

TRUE Question 11: The TRICARE program that offers an alternative managed care plan to TRICARE Prime with no annual enrollment fee is a:TRICARE Standard b:TRICARE Extra c:CHAMPUS

d:CHAMPVA

Answer:

B:TRICARE Extra

Question 12: If the provider has not accepted assignment,the payer sends the payment to a:the provider b:the patient c:the billing service d:the carrier

Answer:

B: the patient

Question 13: The federal law that protects companies which set up employee health and pension plans is known as? a:FEHBP b:CMS c:ERISA d:MCO

Answer:

C: ERISA

Question 14: Anyone over age 65 who receives Social Security benefits is automatically a:enrolled in Medicare Part A b: eligible for Medicare Part B c:both a and b d: neither a nor b

Answer:

C: both a and b

Question 15: Fiscal intermediaries for the Medicare program process Part B claims.

Answer:

FALSE

Question 16: DEERS is the abbreviation for Defense Emergency Entry System.

Answer:

FALSE

Question 17: HIM is the abbreviation for health information management.

Answer:

TRUE Question 18: On a HIPAA claim,which of these is assigned to a claim by the sender? a:claim control number b:line item control number c:either a or b d:neither a or b

Answer:

A: claim control number

Question 19: The RBRVS fees are usually _____than UCR fees. a:lower b:the same c:higher

d:none of the above

Answer:

A: lower

Question 20: The Medicare allowed charge is $240 and the PAR provider's usual charge is $600.What amount does the patient pay? a:$192 b:$48 c:$480 d:$120

Answer:

B: $48

Question 21: The deductibles,coinsurance,and copayments patients pay are called their a:excluded services b:out-of-pocket expenses c:capitation rate d:maximum benefit limit

Answer:

B: out-of-pocket expenses

Question 22: A plan pays 50 percent of the provider's usual charge and requires the copayment of $5 to be applied toward the provider's payment. What does the plan pay the provider when the usual charge is $200? a:$145 b:$95 c:$45 d:none of the above

Answer:

B:$95

Question 23: If a provider's charge is higher than the allowed amount, the provider's reimbursement is based on a:the amount billed b:the amount allowed

Answer:

B: the amount allowed

Question 24: The day sheet in a medical office summarizes all the charges and payments from the start of the month to the current date.

Answer:

FALSE Question 25: The family deductible can be met by one individual member of the family.

Answer:

TRUE Question 26: Accounts receivable include monies owed to a practice by both payers and patients.

Answer:

TRUE