Question 1

________ is a policy that covers loss or injury to a third party caused by the insured or something belonging to the insured.

Accepted Answer

A)  Automobile insurance 
B)  HMO insurance 
C)  Insurance premium 
D)  Liability insurance 
A)  Automobile insurance 
B)  HMO insurance 
C)  Insurance premium 
D)  Liability insurance D

Question 2

The ________ is the amount of money, often paid monthly, by a policyholder or insured, to an insurance company to obtain coverage.

Accepted Answer

A)  co-pay 
B)  insurance premium 
C)  insurance plan 
D)  co-insurance 
A)  co-pay 
B)  insurance premium 
C)  insurance plan 
D)  co-insurance B

Question 3

Which of the following types of insurance have physicians, hospitals, and other health care providers join together and agree to offer services to members of a group at a lower cost or discount?

Accepted Answer

A)  HMO 
B)  PPO 
C)  POS 
D)  CMS 
A)  HMO 
B)  PPO 
C)  POS 
D)  CMS B

Question 4

The Place of Service name is Assisted Living Facility. What is the POS code?

Accepted Answer

A)  10 
B)  13 
C)  17 
D)  19 
A)  10 
B)  13 
C)  17 
D)  19

Question 5

Which of the following uses a gatekeeper?

Accepted Answer

A)  CMS 
B)  POS 
C)  HMO 
D)  PPO 
A)  CMS 
B)  POS 
C)  HMO 
D)  PPO

Question 6

HMO stands for ________.

Accepted Answer

A)  High-performance Medical Operations 
B)  Health Maintenance Organizations 
C)  Habitat Module Outfitting 
D)  Health Members Only 
A)  High-performance Medical Operations 
B)  Health Maintenance Organizations 
C)  Habitat Module Outfitting 
D)  Health Members Only

Question 7

CMS computers evaluate submitted claims to look for pairs of codes being reported that are known to be mutually exclusive procedures, also known as ________ edits.

Accepted Answer

A)  MUE 
B)  PTP 
C)  NCD 
D)  LCD 
A)  MUE 
B)  PTP 
C)  NCD 
D)  LCD

Question 8

________ is an extra reduction in the rate charged to an insurer for services provided by the physician to the plan's members.

Accepted Answer

A)  Fee-for-Service Plan 
B)  Capitation Plans 
C)  Discounted FFS 
D)  HMO 
A)  Fee-for-Service Plan 
B)  Capitation Plans 
C)  Discounted FFS 
D)  HMO

Question 9

Which two abbreviations are similar and can be interchangeable by some in the industry?

Accepted Answer

A)  UCR and EOB 
B)  PPO and RA 
C)  RA and HMO 
D)  EOB and RA 
A)  UCR and EOB 
B)  PPO and RA 
C)  RA and HMO 
D)  EOB and RA

Question 10

The total management of an individual's well-being by a health care professional is known as ________.

Accepted Answer

A)  Health care 
B)  Managed care 
C)  Episodic care 
D)  Survival care 
A)  Health care 
B)  Managed care 
C)  Episodic care 
D)  Survival care

Question 11

________ reinforces accurate and proper coding in addition to preventing reimbursement of inaccurate amounts as the result of noncompliance coding methods in Part B claims.

Accepted Answer

A)  NSD 
B)  LCD 
C)  NCCI 
D)  PTP 
A)  NSD 
B)  LCD 
C)  NCCI 
D)  PTP

Question 12

TriCare covers which of the following groups?

Accepted Answer

A)  ADSM 
B)  ADSMs dependents 
C)  Surviving spouses and children of deceased retired members 
D)  All of these 
E)  None of these 
A)  ADSM 
B)  ADSMs dependents 
C)  Surviving spouses and children of deceased retired members 
D)  All of these 
E)  None of these

Question 13

________ are a type of episodic care payment plan used by Medicare to pay for treatments and services provided to beneficiaries who have been admitted into an acute care hospital.

Accepted Answer

A)  APCs 
B)  DRGs 
C)  POS 
D)  PPO 
A)  APCs 
B)  DRGs 
C)  POS 
D)  PPO

Question 14

________ is a national health insurance program that pays, or reimburses, for health care services provided to those over the age of 65.

Accepted Answer

A)  Medicaid 
B)  Medicare 
C)  TriCare 
D)  Blue Cross Blue Shield 
A)  Medicaid 
B)  Medicare 
C)  TriCare 
D)  Blue Cross Blue Shield

Question 15

The Place of Service name is Public Health Clinic. What is the POS code?

Accepted Answer

A)  61 
B)  65 
C)  71 
D)  99 
A)  61 
B)  65 
C)  71 
D)  99

Question 16

________ is the amount of money that patients must pay, out of their own pockets, before the insurance benefits begin.

Accepted Answer

A)  Deductible 
B)  Co-insurance 
C)  Co-payment 
D)  Premium 
A)  Deductible 
B)  Co-insurance 
C)  Co-payment 
D)  Premium

Question 17

Most third-party payers, including Medicare, prefer claim forms to be submitted ________.

Accepted Answer

A)  manually 
B)  electronically 
C)  by text 
D)  by fax 
A)  manually 
B)  electronically 
C)  by text 
D)  by fax

Question 18

________ offers the most common health care plans you will encounter when caring for individuals in the military and their families.

Accepted Answer

A)  Aetna 
B)  Medicaid 
C)  TriCare 
D)  Medicare 
A)  Aetna 
B)  Medicaid 
C)  TriCare 
D)  Medicare

Question 19

The Type of Service Indicator for Monthly Capitation Payment for Dialysis is ________.

Accepted Answer

A)  D 
B)  J 
C)  M 
D)  Q 
A)  D 
B)  J 
C)  M 
D)  Q

Question 20

________ is a health care claim form that is transmitted electronically.

Accepted Answer

A)  ERA 
B)  EOB 
C)  EMC 
D)  PPO 
A)  ERA 
B)  EOB 
C)  EMC 
D)  PPO

Exam 35: Reimbursement

________ is a policy that covers loss or injury to a third party caused by the insured or something belonging to the insured.

The ________ is the amount of money, often paid monthly, by a policyholder or insured, to an insurance company to obtain coverage.

Which of the following types of insurance have physicians, hospitals, and other health care providers join together and agree to offer services to members of a group at a lower cost or discount?

The Place of Service name is Assisted Living Facility. What is the POS code?

Which of the following uses a gatekeeper?

HMO stands for ________.

CMS computers evaluate submitted claims to look for pairs of codes being reported that are known to be mutually exclusive procedures, also known as ________ edits.

________ is an extra reduction in the rate charged to an insurer for services provided by the physician to the plan's members.

Which two abbreviations are similar and can be interchangeable by some in the industry?

The total management of an individual's well-being by a health care professional is known as ________.

________ reinforces accurate and proper coding in addition to preventing reimbursement of inaccurate amounts as the result of noncompliance coding methods in Part B claims.

TriCare covers which of the following groups?

________ are a type of episodic care payment plan used by Medicare to pay for treatments and services provided to beneficiaries who have been admitted into an acute care hospital.

________ is a national health insurance program that pays, or reimburses, for health care services provided to those over the age of 65.

The Place of Service name is Public Health Clinic. What is the POS code?

________ is the amount of money that patients must pay, out of their own pockets, before the insurance benefits begin.

Most third-party payers, including Medicare, prefer claim forms to be submitted ________.

________ offers the most common health care plans you will encounter when caring for individuals in the military and their families.

The Type of Service Indicator for Monthly Capitation Payment for Dialysis is ________.

________ is a health care claim form that is transmitted electronically.

Introduction to the Languages of Coding

Abstracting Clinical Documentation

The Coding Process

Introduction to Icd-10-Cm

Coding Infectious Diseases

Coding Neoplasms

Coding Conditions of the Blood and Immunological Systems

Coding Endocrine Conditions

Coding Mental, Behavioral, and Neurological Disorders

Coding Dysfunction of the Optical and Auditory Systems

Coding Cardiovascular Conditions

Coding Respiratory Conditions

Coding Digestive System Conditions

Coding Integumentary Conditions

Coding Muscular and Skeletal Conditions

Coding Injury, Poisoning, and External Causes

Coding Genitourinary, Gynecology, Obstetrics, Congenital, and Pediatrics Conditions

Factors Influencing Health Status Z Codes

Inpatient Hospital Diagnosis Coding

Introduction to CPT

CPT and Hcpcs Level Ii Modifiers

CPT Evaluation and Management Coding

CPT Anesthesia Section

CPT Surgery Section

CPT Radiology Section

CPT Pathology Lab Section

CPT Medicine Section

Hcpcs Level II

Introduction to Icd-10-Pcs

ICD-10-Pcs Medical and Surgical Section

Obstetrics Section

Placement Through Chiropractic Sections

Imaging, Nuclear Medicine, and Radiation Therapy Sections

Physical Rehabilitation and Diagnostic Audiology Through New Technology Section

Introduction to Health Care Law and Ethics

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