MEDICAL BILLING AND CODING
CERTIFICATE EXAM QUESTIONS WITH
COMPLETE ANSWERS
Medicare Part C (Medicare Advantage Plans) - Answer-Health coverage option
includes part A & part b & operated by private insurance companies that are
approved by & under contract w medicare
Medicare part D - Answer-Prescription drug coverage
participating physician - Answer-Accepts assignment
payment sent to physician
nonparticipating physician - Answer-Does not accept assignment
payment sent to patient
patient pays physician
Temporary disability (TD) - Answer-patient cannot perform all functions of his or her
job for a limited period of time
weekly benefits are based on employees earnings
Permanent Disability - Answer-Injured worker is left with a residual disability
Sometimes patient can be rehabilitated in another line of work
When a patient case becomes permanent and stationary and no further
improvement is expected, the case is rated to the percentage of permanent disability
and adjudicated so a monetary settlement can be made.
Workers Compensation - Answer-A form of insurance paid by the employer providing
cash benefits to workers injured or disabled in the course of employment.
Allowed amount - Answer-the amount insurance companies consider to be an
appropriate fee for a given service
Co-insurance - Answer-the percentage of the bill for services that the policy holder
must pay
Self-insurance - Answer-employers pay directly for employees' medical bills
TRICARE - Answer-A government health program that serves dependents of active-
duty service members, military retirees and their families, some former spouses, and
survivors of deceased military members; formerly called CHAMPUS.
CHAMPVA - Answer-(Civilian Health and Medical Program of the Veteran Affairs)-
was created to provide medical benefits to spouses and children of veterans w/ total,
permanent service related disabilities or for surviving spouses and children of a
, veteran who died as a result of service related disability. It is a service benefit
therefore no premiums. Members who receive TRICARE do not qualify for
CHAMPVA
Member/Subscriber/Insured/ Policyholder - Answer-A person who owns the
insurance policy
Beneficiary - Answer-individuals who qualify for the program
Dependents - Answer-family members covered by the insurance plan
Premium - Answer-policyholder contributes to their policy by paying a set amount of
money
Sliding Fee Scale - Answer-When offices charge fees based on a patient's financial
ability to pay.
fee schedule - Answer-A list of charges or established allowances for specific
medical services and procedures
Preferred Provider Organization (PPO) - Answer-group of healthcare providers that
provide services to a specific group, often at a reduced rate
Health Maintenance Organization (HMO) - Answer-insurance method that focuses
on prevention of disease, must see providers from an approved list
Treatment, payment, and healthcare operations (TPO) - Answer-Under HIPAA
privacy rule, providers do not need specific authorization in order to release a
patient's private health information for treatment, payment and operations.
point of service plan - Answer-Hybrid of HMO & PPO w/ greater flexibility on
choosing specialists outside network w/ benefits still provided but @ higher co-pay.
consumer-driven health plan (CDHP) - Answer-medical insurance that combines a
high-deductible health plan with a medical savings plan
Healthcare Reimbursement Account (HRA) - Answer-An employer-funded plan that
reimburses employees for incurred medical expenses that are not covered by the
company's standard insurance plan.
Health Savings Account (HSA) - Answer-a tax-free savings account—funded by
employees, employer, or both—to spend on routine medical costs. Usually combined
with a high-deductible policy to pay for catastrophic care
Flexible Savings Account (FSA) - Answer-consumer driven health plan funding
options that has employer and employee contributions
PM PM - Answer-per member per month
schedule of benefits - Answer-list of medical expenses covered by a health plan
CERTIFICATE EXAM QUESTIONS WITH
COMPLETE ANSWERS
Medicare Part C (Medicare Advantage Plans) - Answer-Health coverage option
includes part A & part b & operated by private insurance companies that are
approved by & under contract w medicare
Medicare part D - Answer-Prescription drug coverage
participating physician - Answer-Accepts assignment
payment sent to physician
nonparticipating physician - Answer-Does not accept assignment
payment sent to patient
patient pays physician
Temporary disability (TD) - Answer-patient cannot perform all functions of his or her
job for a limited period of time
weekly benefits are based on employees earnings
Permanent Disability - Answer-Injured worker is left with a residual disability
Sometimes patient can be rehabilitated in another line of work
When a patient case becomes permanent and stationary and no further
improvement is expected, the case is rated to the percentage of permanent disability
and adjudicated so a monetary settlement can be made.
Workers Compensation - Answer-A form of insurance paid by the employer providing
cash benefits to workers injured or disabled in the course of employment.
Allowed amount - Answer-the amount insurance companies consider to be an
appropriate fee for a given service
Co-insurance - Answer-the percentage of the bill for services that the policy holder
must pay
Self-insurance - Answer-employers pay directly for employees' medical bills
TRICARE - Answer-A government health program that serves dependents of active-
duty service members, military retirees and their families, some former spouses, and
survivors of deceased military members; formerly called CHAMPUS.
CHAMPVA - Answer-(Civilian Health and Medical Program of the Veteran Affairs)-
was created to provide medical benefits to spouses and children of veterans w/ total,
permanent service related disabilities or for surviving spouses and children of a
, veteran who died as a result of service related disability. It is a service benefit
therefore no premiums. Members who receive TRICARE do not qualify for
CHAMPVA
Member/Subscriber/Insured/ Policyholder - Answer-A person who owns the
insurance policy
Beneficiary - Answer-individuals who qualify for the program
Dependents - Answer-family members covered by the insurance plan
Premium - Answer-policyholder contributes to their policy by paying a set amount of
money
Sliding Fee Scale - Answer-When offices charge fees based on a patient's financial
ability to pay.
fee schedule - Answer-A list of charges or established allowances for specific
medical services and procedures
Preferred Provider Organization (PPO) - Answer-group of healthcare providers that
provide services to a specific group, often at a reduced rate
Health Maintenance Organization (HMO) - Answer-insurance method that focuses
on prevention of disease, must see providers from an approved list
Treatment, payment, and healthcare operations (TPO) - Answer-Under HIPAA
privacy rule, providers do not need specific authorization in order to release a
patient's private health information for treatment, payment and operations.
point of service plan - Answer-Hybrid of HMO & PPO w/ greater flexibility on
choosing specialists outside network w/ benefits still provided but @ higher co-pay.
consumer-driven health plan (CDHP) - Answer-medical insurance that combines a
high-deductible health plan with a medical savings plan
Healthcare Reimbursement Account (HRA) - Answer-An employer-funded plan that
reimburses employees for incurred medical expenses that are not covered by the
company's standard insurance plan.
Health Savings Account (HSA) - Answer-a tax-free savings account—funded by
employees, employer, or both—to spend on routine medical costs. Usually combined
with a high-deductible policy to pay for catastrophic care
Flexible Savings Account (FSA) - Answer-consumer driven health plan funding
options that has employer and employee contributions
PM PM - Answer-per member per month
schedule of benefits - Answer-list of medical expenses covered by a health plan
