Medical Billing and Coding Practice Questions with Verified Solutions

Medical Billing and Coding Practice Questions with Verified Solutions What type of insurance allows treatment virtually anywhere with a high deductible that policyholder are willing to pay? PPO Veterans with service related disabilities are eligible for care under which of the following programs: CHAMPVA ______________________ is usually sponsored and partially paid by an employer Group Health Insurance ______________________ are used to report encounter for circumstances other than a disease or injury in ICD-10-CM Z codes The abbreviation PMPM stand for Per member per month Schedule of benefits means: Medical service covered under the insured's policy Medicare is funded by Federal funds Physician's establish a list of their usual fees for? The procedures and services they frequently perform The insurance carrier is allowed to use any method to determine the amount for a service, also known as th Allowed amount Which of the following statements is true under the doctrine of respondeat superior? The physician is responsible for any errors made by the medical staff HIPAA stands for which of the following? Health Insurance Portability and Accountability Act Information given by a patient to medical personnel that cannot be disclosed without consent constitutes Privileged communication Why is a superbill/encounter form an important document in the office? It ensures the correct patient data information and procedure codes Which of the following facilities does not use CMS-1500 forms? Acute care Physicians usually submit claims for patients and receive payments directly from the payers. The policy holder authorized this by signing and dating a: Assignment of benefits Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a patient's PHI for TPO purposes. What does TPO stand for? Treatment, payment and health care operations If both parents cover dependents on their plan, the child's primary insurance is usually determined by the birthday rule. What is meant by the birthday rule? The parent whose birthday is earlier in the calendar year is the primary There are three participants in the medical insurance relationship the first party, the second party and the third party. Who is referred to as the second party? Physician Co-insurance is calculated based on: A percentage of a charge If a health plan member received medical services from a provider who does not participate in the plan, the cost for the member is typically: Higher The tertiary insurance pays after the first and second payers A certification number for a procedure