MEDICAL BILLING FINAL EXAM
QUESTIONS WITH COMPLETE
ANSWERS
Programs available to low-income individuals with out-of-pocket costs for Medicare,
including Medicare Part A & B premiums, deductibles, copayments, and coinsurance
is known as what? - Answer-MSP
Omnibus Budget Reconciliation Act (OBRA) did what? - Answer-Provided assistance
for the aged and disabled who are receiving Medicare and whose incomes are below
the poverty level
A Medicare savings program which only pays for Medicare Part A premiums is
____________? - Answer-QDWI
Medicaid was legally established by Title _______ of the Social Security Act? -
Answer-XIX
The abbreviation for the Deficit Reduction Act of 1984 is ___________? - Answer-
DEFRA
The Patient Protection and Affordable Care Act and the Health Care and Education
Reconciliation Act are federal legislation passed in what year? - Answer-2010
The Medicaid medical assistance program in California is called? - Answer-Medi-Cal
The Medicare Savings Program which was established for elderly individuals whose
income is 20% above the FPL and pays the entire Medicare Part B Premium is
called the ___________ - Answer-SLMB
Which law prevents the community spouse from being impoverished by his or her
spouse's institutionalization in a nursing facility? - Answer-The Spousal
Impoverishment Protection Law
Medicaid is not so much an insurance program as an assistance program-True or
False - Answer-True
Under Medicaid, all recipients will have the same copayment amount that must be
collected at each office visit-True or False - Answer-False
Under the PPACA legislation, states were given the option to extend Medicaid
eligibility to adults with incomes at or below 120% of the federal poverty level-True or
False? - Answer-False
It is not possible for an immigrant to have Medicaid coverage in any state-True or
False? - Answer-False
,Emergency care and pregnancy services are exempt by law from copayment
requirements-True or False? - Answer-True
TRICARE, formerly known as CHAMPUS, is funded through - Answer-The US
Congress
Effective January 1, 2018, TRICARE is available in how many US regions? -
Answer-2
A service retiree is entitled to TRICARE benefits for how long? - Answer-Until he/she
becomes eligible for the Medicare program.
What is the system called that TRICARE claims processors use to verify beneficiary
eligibility? - Answer-DEERS
A NAS is a... - Answer-certification from a military hospital stating it cannot provide
necessary care
The NAS catchment area is defined by__________? - Answer-ZIP codes and based
on an area of about 40 miles in radius surrounding each USMTF
The maximum amount paid by a TRICARE beneficiary each fiscal year for the cost-
share and annual deductible is referred to as what? - Answer-Catastrophic Cap
The TRICARE fiscal year extends from what date to what date? - Answer-October 1
to September 30
A physician who chooses not to participate in TRICARE bills______ - Answer-
TRICARE Standard
TRICARE Extra
TRICARE Standard Overseas
Active duty service member whose family members are covered under Tricare is
called the__________ - Answer-Sponsor
Individuals who qualify for TRICARE are known as_____________ - Answer-
Beneficiaries
A certification from a military hospital stating that it cannot provide the care needed is
called__________ - Answer-NAS
A specific geographic region defined by zip codes and based on an area of
approximately 40 miles in radius surrounding a MTF is referred to as a
________________ area - Answer-Catchment
The physician who provides medical care at contracted rates to beneficiaries under
the TRICARE Select program is called a/an ________________ provider - Answer-
Participating/network provider
, TRICARE provides comprehensive health coverage, except dental coverage, to all
its' members-TRUE or FALSE? - Answer-False
Military family members and retirees are issued a common access card (CAC) to
access health care benefits-TRUE or FALSE? - Answer-False
The Catastrophic Cap for an active duty family is $3000 per family, per fiscal year-
TRUE or FALSE? - Answer-False
TRICARE Select beneficiaries may receive urgent care which is a sudden and
unexpected medical condition, or the worsening of a condition, that poses a threat to
life, losing a limb, or sight and requires immediate treatment to alleviate suffering-
TRUE or FALSE? - Answer-False
A partnership program permits TRICARE-eligible people to receive inpatient
treatment from civilian providers of care in a military hospital-TRUE or FALSE? -
Answer-True
The statutes for workers' compensation laws fall under? - Answer-Federal & State
compensation laws
Due to widespread legal and medical corruption that had evolved throughout the
workers' compensation system, reform laws have been introduced in a number of
states that deal with what? - Answer-Antifraud legislation
Implementation of medical necessity requirements
Prosecution of health care organizations, physicians, lawyers, and employees who
abuse the system
The reason for workers' compensation laws is to - Answer-Ensure a prompt return to
work of any injured or ill employee
Provide income to the injured or ill worker
Encourage maximum employer interest in safety
Premiums for workers' compensation insurance are paid by the - Answer-Employer
ERISA is a federal law which sets minimum requirements for workers' compensation
and governs who? - Answer-Self-Insured Employers
Captive Insurance is a form of self-insurance designed to serve who? - Answer-
Smaller to mid-size companies
MCO stands for___________ - Answer-Managed Care Organizations
In times past, physicians in private practice billed indemnity insurance plans, and
professional services were reimbursed on a fee-for-service basis-True or False? -
Answer-True
Ross-Loos Medical Group, America's oldest privately owned prepaid medical group,
started in Texas-True or False? - Answer-False
QUESTIONS WITH COMPLETE
ANSWERS
Programs available to low-income individuals with out-of-pocket costs for Medicare,
including Medicare Part A & B premiums, deductibles, copayments, and coinsurance
is known as what? - Answer-MSP
Omnibus Budget Reconciliation Act (OBRA) did what? - Answer-Provided assistance
for the aged and disabled who are receiving Medicare and whose incomes are below
the poverty level
A Medicare savings program which only pays for Medicare Part A premiums is
____________? - Answer-QDWI
Medicaid was legally established by Title _______ of the Social Security Act? -
Answer-XIX
The abbreviation for the Deficit Reduction Act of 1984 is ___________? - Answer-
DEFRA
The Patient Protection and Affordable Care Act and the Health Care and Education
Reconciliation Act are federal legislation passed in what year? - Answer-2010
The Medicaid medical assistance program in California is called? - Answer-Medi-Cal
The Medicare Savings Program which was established for elderly individuals whose
income is 20% above the FPL and pays the entire Medicare Part B Premium is
called the ___________ - Answer-SLMB
Which law prevents the community spouse from being impoverished by his or her
spouse's institutionalization in a nursing facility? - Answer-The Spousal
Impoverishment Protection Law
Medicaid is not so much an insurance program as an assistance program-True or
False - Answer-True
Under Medicaid, all recipients will have the same copayment amount that must be
collected at each office visit-True or False - Answer-False
Under the PPACA legislation, states were given the option to extend Medicaid
eligibility to adults with incomes at or below 120% of the federal poverty level-True or
False? - Answer-False
It is not possible for an immigrant to have Medicaid coverage in any state-True or
False? - Answer-False
,Emergency care and pregnancy services are exempt by law from copayment
requirements-True or False? - Answer-True
TRICARE, formerly known as CHAMPUS, is funded through - Answer-The US
Congress
Effective January 1, 2018, TRICARE is available in how many US regions? -
Answer-2
A service retiree is entitled to TRICARE benefits for how long? - Answer-Until he/she
becomes eligible for the Medicare program.
What is the system called that TRICARE claims processors use to verify beneficiary
eligibility? - Answer-DEERS
A NAS is a... - Answer-certification from a military hospital stating it cannot provide
necessary care
The NAS catchment area is defined by__________? - Answer-ZIP codes and based
on an area of about 40 miles in radius surrounding each USMTF
The maximum amount paid by a TRICARE beneficiary each fiscal year for the cost-
share and annual deductible is referred to as what? - Answer-Catastrophic Cap
The TRICARE fiscal year extends from what date to what date? - Answer-October 1
to September 30
A physician who chooses not to participate in TRICARE bills______ - Answer-
TRICARE Standard
TRICARE Extra
TRICARE Standard Overseas
Active duty service member whose family members are covered under Tricare is
called the__________ - Answer-Sponsor
Individuals who qualify for TRICARE are known as_____________ - Answer-
Beneficiaries
A certification from a military hospital stating that it cannot provide the care needed is
called__________ - Answer-NAS
A specific geographic region defined by zip codes and based on an area of
approximately 40 miles in radius surrounding a MTF is referred to as a
________________ area - Answer-Catchment
The physician who provides medical care at contracted rates to beneficiaries under
the TRICARE Select program is called a/an ________________ provider - Answer-
Participating/network provider
, TRICARE provides comprehensive health coverage, except dental coverage, to all
its' members-TRUE or FALSE? - Answer-False
Military family members and retirees are issued a common access card (CAC) to
access health care benefits-TRUE or FALSE? - Answer-False
The Catastrophic Cap for an active duty family is $3000 per family, per fiscal year-
TRUE or FALSE? - Answer-False
TRICARE Select beneficiaries may receive urgent care which is a sudden and
unexpected medical condition, or the worsening of a condition, that poses a threat to
life, losing a limb, or sight and requires immediate treatment to alleviate suffering-
TRUE or FALSE? - Answer-False
A partnership program permits TRICARE-eligible people to receive inpatient
treatment from civilian providers of care in a military hospital-TRUE or FALSE? -
Answer-True
The statutes for workers' compensation laws fall under? - Answer-Federal & State
compensation laws
Due to widespread legal and medical corruption that had evolved throughout the
workers' compensation system, reform laws have been introduced in a number of
states that deal with what? - Answer-Antifraud legislation
Implementation of medical necessity requirements
Prosecution of health care organizations, physicians, lawyers, and employees who
abuse the system
The reason for workers' compensation laws is to - Answer-Ensure a prompt return to
work of any injured or ill employee
Provide income to the injured or ill worker
Encourage maximum employer interest in safety
Premiums for workers' compensation insurance are paid by the - Answer-Employer
ERISA is a federal law which sets minimum requirements for workers' compensation
and governs who? - Answer-Self-Insured Employers
Captive Insurance is a form of self-insurance designed to serve who? - Answer-
Smaller to mid-size companies
MCO stands for___________ - Answer-Managed Care Organizations
In times past, physicians in private practice billed indemnity insurance plans, and
professional services were reimbursed on a fee-for-service basis-True or False? -
Answer-True
Ross-Loos Medical Group, America's oldest privately owned prepaid medical group,
started in Texas-True or False? - Answer-False
