MIT 217 Chapter 7 Insurance and Coding EXAM Questions AND
Correct Answers
______ are used around synonyms, alternative wordings, or
explanations in the Tabular List. - ✔✔Brackets [ ]
______ are used in diagnostic coding around descriptions that do not
affect the code. - ✔✔Parentheses ( )
______ are used in the Tabular List after an incomplete term that
needs one of the terms that follow to make it assignable to a given
category. - ✔✔"Colons :"
______ provides voluntary Medicare prescription drug plans that are
open to people who are eligible for Medicare. - ✔✔Medicare Part D
________________ _______________ occur at the same time as the
primary diagnosis and affect the treatment of or recovery from the
primary condition. - ✔✔Blank 1: Coexisting , Comorbid, or Co-morbid
Blank 2: conditions
______, also known as Medical Advantage Plans, is a program that
permits private insurance carriers to contract with CMS to offer
Medicare benefits. - ✔✔Medicare Part C
,A "self-pay" patient is responsible for paying the __________ directly
for all services rendered. - ✔✔Blank 1: physician, doctor, or MD
A code that is used to report the physician's rendering of a service is
called a(n) ______. - ✔✔procedure code
A complete ICD-10-CM may have up to ___ alphanumeric characters. -
✔✔7
A fixed prepayment to a physician by a health plan for each patient
enrolled in the practice is called _____. - ✔✔capitation
A health insurance policy clause that applies to an individual covered
by more than one medical policy and requires that the combined
benefits paid by the policies do not exceed 100 percent of the medical
expenses is called ______. - ✔✔coordination of benefits
A Medicare provider reports a usual charge of $200 for a service and
the Medicare allowable charge is $84. The patient is responsible for
20 percent of the allowed charge. What is the total amount Medicare
will be responsible for paying? - ✔✔$67.20
A Medicare provider reports a usual charge of $200 for a service and
the Medicare allowable charge is $84. The patient is responsible for
,20 percent of the allowed charge. What is the total amount the
patient will be responsible for paying? - ✔✔$16.80
A patient who does not have insurance is referred to as ______. -
✔✔self-pay
A physician who does not join an insurance plan is a(n) ______. -
✔✔nonparticipating provider
A POS plan is a combination of ______. - ✔✔an HMO and a PPO
A provider who accepts assignment for a Medicare patient cannot
______. - ✔✔charge the patient more than the allowed charge
A provider's acceptance of an insurance plan's allowed charge as
payment in full is known as ______. - ✔✔accepting assignment
A small, fixed fee collected at the time of a visit is called a ______. -
✔✔copayment
A(n) _______ is a normal fee charged by a provider. - ✔✔usual fee
All ICD-10-CM categories have ___ alpha or numeric characters. - ✔✔3
, All ICD-10-CM codes must be verified in the ______. - ✔✔Tabular List
All Medicare beneficiaries can enroll in Medicare ______, which
provides prescription drug benefits. - ✔✔Part D
An advantage of using an FSA, HRA, or HSA is that all dollars
contributed are ___________ dollars. - ✔✔Blank 1: pretax or pre-tax
An insurance claim for a patient must show the _________ that
represents the patient's major health problem for that encounter's
claim. - ✔✔Blank 1: diagnosis
Another term for the insured is ______. - ✔✔policyholder
Assignment of benefits authorizes ______. - ✔✔the payer to send
payments directly to the provider
Blue Cross Blue Shield ______ offer many different types of managed
care options. - ✔✔member plans
Changes in the CPT are also available in a digital file, because ______.
- ✔✔some medical offices use a computer-based version of the CPT
Correct Answers
______ are used around synonyms, alternative wordings, or
explanations in the Tabular List. - ✔✔Brackets [ ]
______ are used in diagnostic coding around descriptions that do not
affect the code. - ✔✔Parentheses ( )
______ are used in the Tabular List after an incomplete term that
needs one of the terms that follow to make it assignable to a given
category. - ✔✔"Colons :"
______ provides voluntary Medicare prescription drug plans that are
open to people who are eligible for Medicare. - ✔✔Medicare Part D
________________ _______________ occur at the same time as the
primary diagnosis and affect the treatment of or recovery from the
primary condition. - ✔✔Blank 1: Coexisting , Comorbid, or Co-morbid
Blank 2: conditions
______, also known as Medical Advantage Plans, is a program that
permits private insurance carriers to contract with CMS to offer
Medicare benefits. - ✔✔Medicare Part C
,A "self-pay" patient is responsible for paying the __________ directly
for all services rendered. - ✔✔Blank 1: physician, doctor, or MD
A code that is used to report the physician's rendering of a service is
called a(n) ______. - ✔✔procedure code
A complete ICD-10-CM may have up to ___ alphanumeric characters. -
✔✔7
A fixed prepayment to a physician by a health plan for each patient
enrolled in the practice is called _____. - ✔✔capitation
A health insurance policy clause that applies to an individual covered
by more than one medical policy and requires that the combined
benefits paid by the policies do not exceed 100 percent of the medical
expenses is called ______. - ✔✔coordination of benefits
A Medicare provider reports a usual charge of $200 for a service and
the Medicare allowable charge is $84. The patient is responsible for
20 percent of the allowed charge. What is the total amount Medicare
will be responsible for paying? - ✔✔$67.20
A Medicare provider reports a usual charge of $200 for a service and
the Medicare allowable charge is $84. The patient is responsible for
,20 percent of the allowed charge. What is the total amount the
patient will be responsible for paying? - ✔✔$16.80
A patient who does not have insurance is referred to as ______. -
✔✔self-pay
A physician who does not join an insurance plan is a(n) ______. -
✔✔nonparticipating provider
A POS plan is a combination of ______. - ✔✔an HMO and a PPO
A provider who accepts assignment for a Medicare patient cannot
______. - ✔✔charge the patient more than the allowed charge
A provider's acceptance of an insurance plan's allowed charge as
payment in full is known as ______. - ✔✔accepting assignment
A small, fixed fee collected at the time of a visit is called a ______. -
✔✔copayment
A(n) _______ is a normal fee charged by a provider. - ✔✔usual fee
All ICD-10-CM categories have ___ alpha or numeric characters. - ✔✔3
, All ICD-10-CM codes must be verified in the ______. - ✔✔Tabular List
All Medicare beneficiaries can enroll in Medicare ______, which
provides prescription drug benefits. - ✔✔Part D
An advantage of using an FSA, HRA, or HSA is that all dollars
contributed are ___________ dollars. - ✔✔Blank 1: pretax or pre-tax
An insurance claim for a patient must show the _________ that
represents the patient's major health problem for that encounter's
claim. - ✔✔Blank 1: diagnosis
Another term for the insured is ______. - ✔✔policyholder
Assignment of benefits authorizes ______. - ✔✔the payer to send
payments directly to the provider
Blue Cross Blue Shield ______ offer many different types of managed
care options. - ✔✔member plans
Changes in the CPT are also available in a digital file, because ______.
- ✔✔some medical offices use a computer-based version of the CPT
