MEDICAL INSURANCE FINAL EXAM
PRACTICE CORRECT 100%
What do providers receive in PPO for accepting lower rates? - ANSWER more patient
visits
Coding specialists that are certified are awarded the designation of CPC by: - ANSWER
AHIMA
Under an insurance contract the physician is the first party, the insured is the second
party and who is the third party? - ANSWER the insurance plan
Patient ledger records contain what? - ANSWER the patients financial card
Choose the entity that may make agreements with an MCO: - ANSWER the patient and
the provider
In what step does the medical insurance specialist verify billing compliance? - ANSWER
step 5
What is an example of private payer? - ANSWER insurance company
What is an advantage of HMO case management? - ANSWER caseworker
Calculate what insurance owes on 850 if a 500 deductible has not been met yet. -
ANSWER $350
What is the electronic version of a document? - ANSWER a transaction
A complete H&P is documented with how many types of information? - ANSWER 4 -
HPI, exam, decision and family history review
During informed consent a physician states all except - ANSWER financial issues
ACA requires the adoption of - ANSWER operating rules
Releasing protected health information (PHI) information requires what? - ANSWER
patient's signed authorization
Knowing TPO is - ANSWER treatment, payment and operations
Disclosure of which of the following requires more than a written signature? - ANSWER
release of HIV information or psych information
, What is the responsibility of licensed health care professionals? - ANSWER medical
professional liability
EHR is the abbreviation for - ANSWER electronic health record
After reviewing selected coding "use additional code" means - ANSWER you have to
have a second code and the order of the codes must be the same as in the alphabetic
index
How many key components are used in an E&M code - ANSWER three
What CPT code is used to report supplies and materials? - ANSWER 99070
IN CPT what is the bullet used for ? - ANSWER a new code
What happens when a medical practice receives a new CPT code? - ANSWER
educate, update billing software, update encounter forms
The last step of the coding process is - ANSWER modifiers
DME such as wheelchairs are reported by Medicare as - ANSWER HCPCS
The correct process for selecting CPT code is - ANSWER b. determine procedures and
services, identify codes and modifiers
Which section of CPT codes is the P1 physical status modifier? - ANSWER anesthesia
When listing multiple procedures most complex first - ANSWER and modifier 51
What is another term for contractural adjustment? - ANSWER write-off
What is one type of job reference aid? - ANSWER c. list of frequent reported diagnosis
and procedure codes
Incorrect coding - ANSWER refers to a coding problem in which age and code do not
match
Relative value units are assigned based on - ANSWER d. time and skill
Recovery Auditor Contractors uses software to analyze claims on all except - ANSWER
all are analyzed
If Medicare allows $240 and PAR is $600, what amount does the patient pay? -
ANSWER 20% of the allowed charge which is $48
PRACTICE CORRECT 100%
What do providers receive in PPO for accepting lower rates? - ANSWER more patient
visits
Coding specialists that are certified are awarded the designation of CPC by: - ANSWER
AHIMA
Under an insurance contract the physician is the first party, the insured is the second
party and who is the third party? - ANSWER the insurance plan
Patient ledger records contain what? - ANSWER the patients financial card
Choose the entity that may make agreements with an MCO: - ANSWER the patient and
the provider
In what step does the medical insurance specialist verify billing compliance? - ANSWER
step 5
What is an example of private payer? - ANSWER insurance company
What is an advantage of HMO case management? - ANSWER caseworker
Calculate what insurance owes on 850 if a 500 deductible has not been met yet. -
ANSWER $350
What is the electronic version of a document? - ANSWER a transaction
A complete H&P is documented with how many types of information? - ANSWER 4 -
HPI, exam, decision and family history review
During informed consent a physician states all except - ANSWER financial issues
ACA requires the adoption of - ANSWER operating rules
Releasing protected health information (PHI) information requires what? - ANSWER
patient's signed authorization
Knowing TPO is - ANSWER treatment, payment and operations
Disclosure of which of the following requires more than a written signature? - ANSWER
release of HIV information or psych information
, What is the responsibility of licensed health care professionals? - ANSWER medical
professional liability
EHR is the abbreviation for - ANSWER electronic health record
After reviewing selected coding "use additional code" means - ANSWER you have to
have a second code and the order of the codes must be the same as in the alphabetic
index
How many key components are used in an E&M code - ANSWER three
What CPT code is used to report supplies and materials? - ANSWER 99070
IN CPT what is the bullet used for ? - ANSWER a new code
What happens when a medical practice receives a new CPT code? - ANSWER
educate, update billing software, update encounter forms
The last step of the coding process is - ANSWER modifiers
DME such as wheelchairs are reported by Medicare as - ANSWER HCPCS
The correct process for selecting CPT code is - ANSWER b. determine procedures and
services, identify codes and modifiers
Which section of CPT codes is the P1 physical status modifier? - ANSWER anesthesia
When listing multiple procedures most complex first - ANSWER and modifier 51
What is another term for contractural adjustment? - ANSWER write-off
What is one type of job reference aid? - ANSWER c. list of frequent reported diagnosis
and procedure codes
Incorrect coding - ANSWER refers to a coding problem in which age and code do not
match
Relative value units are assigned based on - ANSWER d. time and skill
Recovery Auditor Contractors uses software to analyze claims on all except - ANSWER
all are analyzed
If Medicare allows $240 and PAR is $600, what amount does the patient pay? -
ANSWER 20% of the allowed charge which is $48
