CMAA Chapter 18 EXAM Questions AND Correct Answers
A code that represents the physician's specialty is called the:
a. UPIN
b. NPI
c. EIN
d. specialty code set
e. taxonomy code - ✔✔e. taxonomy code
A computerized report for unpaid insurance claims can be printed by:
a. dates of service
b. dates of submission
c. insurance carrier name
d. patients' names
e. a, b, and c are all correct - ✔✔e. a, b, and c are all correct
A dirty claim is a claim that:
a. is submitted with errors or one that requires manual processing
b. is held in suspense
c. has been rejected because of a technical error or payment policy
d. has been discarded by the system because of technical errors
e. is pending adjudication - ✔✔a. is submitted with errors or one that
requires manual processing
,A Medicare hospital benefit period:
a. begins the day a patient enters a facility and ends when the patient
has not been a bed patient in any facility for 60 consecutive days
b. begins the day a patient enters a facility and ends when the patient
has not been a bed patient in any facility for 10 consecutive days
c. begins the day a patient enters a facility and ends when the patient
has not been a bed patient in any facility for 30 consecutive days
d. begins the day a diagnosis is determined whi - ✔✔a. begins the day
a patient enters a facility and ends when the patient has not been a
bed patient in any facility for 60 consecutive days
A Medicare RAC auditor may go back _____________ and examine
claims from the date of original determination.
a. 1 year
b. 3 years
c. 4 years
d. 5 years
e. 2 years - ✔✔b. 3 years
A patient who is enrolled in Medicare and only qualifies for Part A
would not be covered for which of the following?
a. hospital stays
b. blood for transfusions
, c. outpatient medical services
d. hospice care - ✔✔c. outpatient medical services
A suspended claim is a:
a. claim held by the insurance company as pending because of an
error or the need for additional information
b. claim received and rejected because of a technical error
c. claim missing required information
d. claim submitted within the program's time limit, waiting to be paid,
and containing all necessary data to process
e. claim that requires manual processing - ✔✔a. claim held by the
insurance company as pending because of an error or the need for
additional information
A(n)
indemnity
insurance plan, also called fee-for-service, offers protection against
injury or loss of health and covers a preset number of services.With
self-insurance
, an employer or other group assumes risk and pays health care
expenses that are usually covered by insurance.Individuals who use
HDHPs might choose to use a(n)
Health Savings Account
A code that represents the physician's specialty is called the:
a. UPIN
b. NPI
c. EIN
d. specialty code set
e. taxonomy code - ✔✔e. taxonomy code
A computerized report for unpaid insurance claims can be printed by:
a. dates of service
b. dates of submission
c. insurance carrier name
d. patients' names
e. a, b, and c are all correct - ✔✔e. a, b, and c are all correct
A dirty claim is a claim that:
a. is submitted with errors or one that requires manual processing
b. is held in suspense
c. has been rejected because of a technical error or payment policy
d. has been discarded by the system because of technical errors
e. is pending adjudication - ✔✔a. is submitted with errors or one that
requires manual processing
,A Medicare hospital benefit period:
a. begins the day a patient enters a facility and ends when the patient
has not been a bed patient in any facility for 60 consecutive days
b. begins the day a patient enters a facility and ends when the patient
has not been a bed patient in any facility for 10 consecutive days
c. begins the day a patient enters a facility and ends when the patient
has not been a bed patient in any facility for 30 consecutive days
d. begins the day a diagnosis is determined whi - ✔✔a. begins the day
a patient enters a facility and ends when the patient has not been a
bed patient in any facility for 60 consecutive days
A Medicare RAC auditor may go back _____________ and examine
claims from the date of original determination.
a. 1 year
b. 3 years
c. 4 years
d. 5 years
e. 2 years - ✔✔b. 3 years
A patient who is enrolled in Medicare and only qualifies for Part A
would not be covered for which of the following?
a. hospital stays
b. blood for transfusions
, c. outpatient medical services
d. hospice care - ✔✔c. outpatient medical services
A suspended claim is a:
a. claim held by the insurance company as pending because of an
error or the need for additional information
b. claim received and rejected because of a technical error
c. claim missing required information
d. claim submitted within the program's time limit, waiting to be paid,
and containing all necessary data to process
e. claim that requires manual processing - ✔✔a. claim held by the
insurance company as pending because of an error or the need for
additional information
A(n)
indemnity
insurance plan, also called fee-for-service, offers protection against
injury or loss of health and covers a preset number of services.With
self-insurance
, an employer or other group assumes risk and pays health care
expenses that are usually covered by insurance.Individuals who use
HDHPs might choose to use a(n)
Health Savings Account
