Deck 7: Insurance and Coding

Question 1

The greater the medical insurance coverage, the more ________________ the plan.

A) quality
B) expensive
C) inexpensive
D) friendly

Answer 1

expensive

Question 2

The Birthday Rule ensures that the maximum benefit will not exceed ______ percent of the charge for covered services.

A) 20
B) 50
C) 100
D) 80

Answer 2

100

Question 3

According to contract law, when a physician agrees to treat a patient who is seeking medical services, there is a(n) ____________ contract between the two.

A) Unwritten
B) Written
C) Verbal
D) Agreed

Answer 3

Unwritten

Question 4

The rate charged by the insurance policy to the policy holder is the ___________________.

A) Statement
B) Deductible
C) Co-pay
D) Premium

Question 5

Which type of insurance plan generally includes coverage of hospitalization, lab tests, surgery, and x-rays?

A) Limited
B) General
C) Basic
D) Liability

Question 6

________ payment is made by the insurance carrier after the patient has received medical services.

A) Fee-for-services
B) Co-pay
C) Deductible
D) Capitation

Question 7

Patient John Parks had a CBC and a PFT performed. Which type of insurance will cover the services?

A) Major medical
B) Surgical
C) Basic
D) Disability

Question 8

Which type of payment is made in advance?

A) Co-pay
B) Capitation
C) Fee-for-service
D) Deductible

Question 9

The oldest form of managed care is:

A) HMO
B) PPO
C) PPD
D) HPO

Question 10

PPOs _______ require referrals to specialists.

A) Do
B) Do not
C) May
D) Always

Question 11

Which is the largest private-sector payer in the U.S.?

A) UHC
B) Well Point
C) Aetna
D) BCBS

Question 12

A physician who joins an insurance plan is a(n) _____________________.

A) participating provider
B) nonparticipating provider
C) active provider
D) attending provider

Question 13

A physician who accepts an assignment of benefits agrees to receive payment directly from the __________.

A) Benefit coordinator
B) Patient
C) Patient's insurance carrier
D) Patient plan

Question 14

Hope's insurance policy states she has a coinsurance of 90/10 of covered services. When she received her notice from the insurance carrier, it stated that the charges for her last office visit were not allowed. How much of the charges is Hope responsible for?

A) 90%
B) 10%
C) 0%
D) 100%

Question 15

Under his insurance plan, Scott is required to have prior approval for his upcoming knee replacement. Before the surgery, the surgeon must have which approval document from the insurance carrier for the surgery?

A) Informed consent
B) Expressed consent
C) Patient encounter form
D) Preauthorization/precertification approval

Question 16

Carol and her husband, Greg, just had a baby. Carol is laid off from her job and Greg works part-time at a gas station. They are without insurance coverage. The administrative medical assistant should supply Carol and Greg with information to contact:

A) Medicare
B) Medicaid
C) TRICARE
D) CHAMPVA

Question 17

Dr. Rodriguez receives payment from BCBS for services rendered to patients covered by the plan. This is known as:

A) Assignment of benefits
B) Accepting assignment
C) Balance billing
D) Preauthorization of services

Question 18

If the standard fee for a Medicare covered service is $150 and the Medicare non-PAR fee schedule for the service is $80, what is the limiting charge for the services?

A) $120
B) $92
C) $30
D) $50

Question 19

Which type of fee is a charge for a certain procedure?

A) Customary
B) Usual
C) Reasonable
D) Service

Question 20

Which type of fee is determined by what physicians with similar training and experience in certain geographic location typically charge for a procedure?

A) Usual
B) Customary
C) Reasonable
D) Service

Question 21

Which type of fee is approved by the insurance carrier for a difficult or complicated service?

A) Usual
B) Customary
C) Reasonable
D) Service

Question 22

The payment system used by Medicare is the __________.

A) Relative value scale
B) Resource-based relative value scale
C) National relative value limit
D) Diagnosis relative scale

Question 23

How many coding systems are used to keep track of the many thousands of possible diagnoses and of procedures and services by the physicians, and to simplify the process of verifying the medical necessity of each procedure?

A) Three
B) Six
C) Four
D) Two

Question 24

Which type of code is used to report what is wrong with the patient or what brought the patient to see the physician?

A) Diagnostic
B) Procedural
C) HCPCS
D) Medical

Question 25

Which type of code is used for reporting each procedure and service that the physician has documented in treating the patient?

A) Diagnostic
B) Procedural
C) HCPCS
D) Medical

Question 26

Codes used for the diagnosis of external causes in ICD-10-CM begin with which letter or letter range?

A) E
B) Z
C) E-M
D) V-Y

Question 27

Michael last visited his physician, which is a single-physician office practice, in September 2006. He is at the office today for a sore throat and chest congestion. Since he was already a patient, the medical insurance coder submitted an established patient E/M code to Michael's insurance carrier for payment. The insurance carrier requested additional documentation regarding the visit. Which of the following may have been the reason?

A) Michael's visit should have been coded from the HCPCS code selections.
B) The medical insurance coder did not submit the claim to the insurance carrier on the actual day of Michael's visit.
C) Michael's visit should have been coded from the new patient E/M category.
D) There was no reason for the insurance carrier to request the additional documentation.

Question 28

During Michael's sick visit a CBC was performed. Which type of code(s) should be used for the service?

A) Unbundled code
B) E codes
C) Bundled code
D) Medicine code

Question 29

The Evaluation and Management section of procedure codes falls within which range of CPT codes?

A) 90281-99607
B) 70010-79999
C) 80047-89398
D) 99201-99480

Question 30

The Anesthesiology section of procedure codes falls within which range of CPT codes?

A) 90281-99607
B) 10021-79999
C) 00100-01999, 99100-99140
D) 99201-99480

Question 31

The Surgery section of procedure codes falls within which range of CPT codes?

A) 90281-99607
B) 10021-69990
C) 00100-01999, 99100-99140
D) 99201-99480

Question 32

The Radiology section of procedure codes falls within which range of CPT codes?

A) 70010-79999
B) 10021-69990
C) 80047-89398
D) 99201-99480

Question 33

The Pathology and Laboratory section of procedure codes falls within which range of CPT codes?

A) 70010-79999
B) 10021-69990
C) 80047-89398
D) 99201-99480

Question 34

CPT codes are ______ digit numbers.

A) Five
B) Six
C) Seven
D) Eight

Question 35

ICD-10-CM codes are the _______ revision of ICD.

A) First
B) Fifth
C) Tenth
D) Nineteenth

Question 36

Updates to the diagnostic coding system are published ___________________.

A) Every three years
B) Every ten years
C) Every five years
D) Every year

Question 37

The ICD-10-CM uses ________-digit codes for broad categories of diseases, injuries, and symptoms.

A) Five to seven
B) Three to seven
C) Three to five
D) Five

Question 38

Updated CPT manuals are published ______________________.

A) Every three years
B) Every ten years
C) Every five years
D) Every year

Question 39

The implementation date for the ICD-10-CM code is set for:

A) October 1, 2014
B) January 1, 2014
C) January 1, 2015
D) December 1, 2015

Question 40

Which of the following is not an advantage of ICD-10-CM?

A) A higher level of specificity
B) Expansion of and within the categories
C) Increased number of bilateral codes
D) Fewer and more concise categories

Question 41

The Medicine (except Anesthesiology) section of procedure codes falls within which range of CPT codes?

A) 70010-79999
B) 10021-69990
C) 90281-99607
D) 99201-99480

Question 42

The ________________________ is made up of three characters in ICD-10-CM coding.

A) Category
B) Subcategory
C) Code
D) Classification

Question 43

A(n) ______________________________ is the form used in the medical office to record the patient's diagnosis (or diagnoses) and the procedures performed during a patient's visit.

A) Registration form
B) Assignment of benefits form
C) Patient encounter form
D) Coordination of benefits form

Question 44

The letters "CM" in ICD-10-CM stand for ________________.

A) Controlled Modification
B) Classical Modifying
C) Computable Modifying
D) Clinical Modification

Question 45

ICD-10-CM codes are assigned and updated by the ________________________________.

A) World Health Organization
B) International Health Organization
C) Universal Health Organization
D) Global Health Organization

Question 46

Volume 1 of the ICD-10-CM manual is the _____________________________.

A) Alphabetic Index
B) Tabular Index
C) Drug Index
D) Guidelines

Question 47

Volume 2 of the ICD-10-CM manual is the _____________________________.

A) Alphabetic Index
B) Tabular Index
C) Drug Index
D) Guidelines

Question 48

ICD-10-CM is divided into _____________________________ sections.

A) One
B) Two
C) Three
D) Four

Question 49

The CPT-4 manual is published by the ________________________________.

A) WHO
B) AMA
C) HIPAA
D) DRG

Question 50

CPT-4 stands for ______________________________.

A) Contemporary Procedural Terminology, 4^th Edition
B) Current Practice Terminology, 14^th Edition
C) Current Processing Terminology, 14^th Edition
D) Current Procedural Terminology, 4^th Edition

Question 51

A coding system that uses all the codes in the CPT and additional codes that cover many supplies, such as sterile trays and durable medical equipment, is known as _______________.

A) DRG
B) RBRVS
C) DEERS
D) HCPCS

Question 52

An analysis done in order to determine the connection between the diagnostic and procedural information is known as ____________________.

A) Balance billing
B) Code linkage
C) Managed care
D) Reasonable fee

Question 53

________ is the organization that administers Medicare and Medicaid.

A) CMS
B) DRG
C) WHO
D) HIPAA

Question 54

A(n) __________________ is a stated amount an insured must pay for an insurance policy.

A) Deductible
B) Coinsurance
C) Premium
D) COB

Question 55

Medical insurance is a policy, or certificate of coverage, between a __________, called the "policyholder," and an insurance company, or ___________.

A) Party; carrier
B) Carrier; party
C) Person; carrier
D) Carrier; person

Question 56

The person who takes out the insurance policy is referred to as the _____________.

A) Patient
B) Carrier
C) Insured
D) Payer

Question 57

If the patient has a policy with an insurance company in which the insurance company agrees to carry the risk of paying for those services, the insurance company is referred to as the "third party" and is therefore called a _________________________________.

A) Insurance payer
B) Third-party payer
C) Managed care plan
D) Carrier

Question 58

COB stands for ______________________.

A) Classification of benefits
B) Classification of balance billing
C) Coordination of balance billing
D) Coordination of benefits

Question 59

What rule is used as a guideline for determining which of two parents with medical coverage has the primary insurance for a child?

A) Birthday Rule
B) Anniversary Rule
C) HIPAA Rule
D) Third-party Payer Rule

Question 60

What type of insurance provides reimbursement for income lost because of the insured person's inability to work as a result of an illness or injury, which may or may not be work-related?

A) Hospital
B) Basic
C) Surgical
D) Disability

Question 61

A _______________________ is a certain amount of allowable or covered medical expense the insured must incur before the insurance carrier will begin paying benefits.

A) Premium
B) Copay
C) Deductible
D) Coinsurance

Question 62

_________________ is the percentage of each covered claim that the insured must pay, according to the terms of the insurance policy.

A) Premium
B) Copay
C) Deductible
D) Coinsurance

Question 63

HMOs help control access to services by requiring the patient to select a ______________.

A) Hospital of choice
B) Prepayment plan
C) Primary care provider
D) Deductible

Question 64

What type of managed care plan is more popular than an HMO?

A) DRG
B) PPO
C) RBRVS
D) DEERS

Question 65

________________ is a federal health plan that provides insurance to citizens and permanent residents aged 65 and older; people with disabilities, including kidney failure; and spouses of entitled individuals.

A) Medicare
B) Medicaid
C) Tricare
D) DEERS

Question 66

Medicare Part ____, also known as hospital insurance, covers hospital, nursing facility, home health, hospice, and inpatient care.

A) A
B) B
C) C
D) D

Question 67

What part of Medicare is also known as medical insurance?

A) A
B) B
C) C
D) D

Question 68

What part of Medicare is known as the prescription drug coverage plan?

A) A
B) B
C) C
D) D

Question 69

What insurance covers military personnel and their families?

A) Medicare
B) Medicaid
C) DEERS
D) Tricare

Question 70

Who should uniformed service members contact if they have questions on coverage?

A) WHO
B) AMA
C) HIPAA
D) DEERS

Question 71

What health insurance covers the expenses of the families of veterans with total, permanent, or service-related disabilities?

A) DEERS
B) TRICARE
C) CHAMPVA
D) HIPAA

Question 72

_________________________ is the practice of billing the patient for the unclaimed amount.

A) Balance billing
B) Reference billing
C) Code linkage
D) Reasonable fee

Question 73

What is the payment system Medicare uses for establishing payment for hospital stays?

A) Age related grouping
B) Diagnosis related grouping
C) Surgery related grouping
D) In-patient related grouping

Question 74

What letter is used in ICD-10-CM codes to allow future expansion?

A) F
B) O
C) N
D) X

Question 75

What codes are used to include specified conditions that cannot be classified with any other code?

A) NOS
B) NEC
C) Includes
D) Excludes

Question 76

What codes are used when the documentation provided by the provider is insufficient?

A) NOS
B) NEC
C) Includes
D) Excludes

Question 77

What symbol is used in the alphabetic index in ICD-10-CM to indicate an additional character is required?

A) Forward slash /
B) Colon :
C) Dashes -
D) Parentheses ( )

Question 78

What is placed in the tabular index in ICD-10-CM after an incomplete portion of a code description?

A) Forward slash /
B) Colon :
C) Dashes -
D) Parentheses ( )

Question 79

In ICD-10-CM, what would be an indication that the code you have selected can never be used at the same time as the code preceding the note?

A) Includes
B) Excludes 1
C) Excludes 2
D) Code First