Billing and Coding Test Questions and Answers Graded A+
The health care plan that reimburses providers
for individual health care services provided is a -
ANSWER -fee for service plan A plan offered either by a single insurance plan
or as a joint venture by two or more insurance
carriers and which provides subscribers or
What Organization is responsible for the health employees with a choice of MO, PPO, or
of a group of enrollees and can be a health plan, triditional health plan is a - ANSWER -1.
hospital physician group, or health system - Triple option 2. cafeteria plan 3. flexible benefit
ANSWER -Managed Car Organization plan
(MCO) All 3 insurance plan offer this.
Managed care plan enrollees received care from This is created when a number of people are
- ANSWER -Their Primary Care Provider grouped for insurance purposes and the cost of
(PCP) health care coverage is determined by
employees, health status, age sex, and
occupation. - ANSWER -Risk Pool
A method of controlling health care costs and
quality of care by reviewing the appropriateness
and neccessity of care provided to patients prior Voluntary process that a health care facility or
to the adminstration of care is - ANSWER - organization (e.g hospital or managed care plan
Utilization management undergoes to demonstrate that it has met
standards beyond those required by law -
ANSWER -Accreditation
Prior to scheduling elective surgery managed
care plans often require - ANSWER -
Second Surgical Opinion When the individual selects one of each type of
provider to create a customized network and
pays the resulting customized insurance
Which of the following would be considered an premium, what type of consumer-directed health
example of a managed care plan - plan would this be - ANSWER -Customized
ANSWER -Point of service plan subcapitation plan (CSCP)
What organization is owned by hospital(s) and Consumer - Directed health plans provide
physician groups that obtain managed care plan incentives for controlling health care expenses
and give individuals a (an) ______ to traditional
contracts? - ANSWER -Physician hospital
health insurance and managed care coverage -
organization
ANSWER -Alternative
A network of physicians and hospitals that have
joined together to contract with insurance Health insurance is available to -
companies to provide health care to subscribers ANSWER -1. Individuals who participate in
for a discounted fee is a - ANSWER - individual (personal) health plans.
Prefered provider organization (PPO) 2. of a prepaid health plan
3. individuals who participate in group ( employer
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, Billing and Coding Test Questions and Answers Graded A+
- sponsored ) health plans 2. Technical Services
A contract that protects the insured form loss. It The CMS 1500 Claim form requires responses to
guarantees payment to the insured for an standard questions pertaining to whether the
unforeseen event in return for the payment of patient's condition is related to - ANSWER -
premiums - ANSWER -Insurance 1. Auto Accident
2. Secondary Insurance
3. Employment
Indentification of disease and the provision of
care and treatment such as that provided by
members of the health care team to persons who The check in procedure for a patient who is ____
are sick, injured, or concerned about their health to the provider's office is more extensive thatn for
- ANSWER -Medical Care a ___ patient. - ANSWER -New and
Returning
A contract between a policy holder and a third-
arty payer or government program to reimburse The ________ is the person responsible for
the policy holder for all or a portion of the cost of paying the charges - ANSWER -Guarantor
medically necessary treatment. -
ANSWER -Health Insurance
Health Insurance information that is needed so
the claim can be processed includes -
The most common form of Medicare fraud is - ANSWER -1. Name and Phone of the third
ANSWER -1. Billing for services not party payer
provided 2. Name of policy holder
2. Misrepresenting the diagosis to justify
payment
3. Soliciting offering, or receiving a kick back. Copayments are to be paid - ANSWER -At
All of the above the time of the visit
Not an Example of Abuse - ANSWER - Before scheduling an appointment with a
Falsifying Certificates of Medical Necessity plans specialist, a managed care patient must obtain a
of treatment - ANSWER -Referral from the PCP or Case
manager
The development of an _______ begins when
the patient contacts a health care provider's Generate a deparate __record and ____ for each
office and schedules an appointment. - patient to maintain each type of information -
ANSWER -Patient File ANSWER -Financial and Medical
The CMS 1500 Claim form is used to report - Contracts with participation providers and
ANSWER -1. Professional Services accepts whatever the plan pays for services
2/6
The health care plan that reimburses providers
for individual health care services provided is a -
ANSWER -fee for service plan A plan offered either by a single insurance plan
or as a joint venture by two or more insurance
carriers and which provides subscribers or
What Organization is responsible for the health employees with a choice of MO, PPO, or
of a group of enrollees and can be a health plan, triditional health plan is a - ANSWER -1.
hospital physician group, or health system - Triple option 2. cafeteria plan 3. flexible benefit
ANSWER -Managed Car Organization plan
(MCO) All 3 insurance plan offer this.
Managed care plan enrollees received care from This is created when a number of people are
- ANSWER -Their Primary Care Provider grouped for insurance purposes and the cost of
(PCP) health care coverage is determined by
employees, health status, age sex, and
occupation. - ANSWER -Risk Pool
A method of controlling health care costs and
quality of care by reviewing the appropriateness
and neccessity of care provided to patients prior Voluntary process that a health care facility or
to the adminstration of care is - ANSWER - organization (e.g hospital or managed care plan
Utilization management undergoes to demonstrate that it has met
standards beyond those required by law -
ANSWER -Accreditation
Prior to scheduling elective surgery managed
care plans often require - ANSWER -
Second Surgical Opinion When the individual selects one of each type of
provider to create a customized network and
pays the resulting customized insurance
Which of the following would be considered an premium, what type of consumer-directed health
example of a managed care plan - plan would this be - ANSWER -Customized
ANSWER -Point of service plan subcapitation plan (CSCP)
What organization is owned by hospital(s) and Consumer - Directed health plans provide
physician groups that obtain managed care plan incentives for controlling health care expenses
and give individuals a (an) ______ to traditional
contracts? - ANSWER -Physician hospital
health insurance and managed care coverage -
organization
ANSWER -Alternative
A network of physicians and hospitals that have
joined together to contract with insurance Health insurance is available to -
companies to provide health care to subscribers ANSWER -1. Individuals who participate in
for a discounted fee is a - ANSWER - individual (personal) health plans.
Prefered provider organization (PPO) 2. of a prepaid health plan
3. individuals who participate in group ( employer
1/6
, Billing and Coding Test Questions and Answers Graded A+
- sponsored ) health plans 2. Technical Services
A contract that protects the insured form loss. It The CMS 1500 Claim form requires responses to
guarantees payment to the insured for an standard questions pertaining to whether the
unforeseen event in return for the payment of patient's condition is related to - ANSWER -
premiums - ANSWER -Insurance 1. Auto Accident
2. Secondary Insurance
3. Employment
Indentification of disease and the provision of
care and treatment such as that provided by
members of the health care team to persons who The check in procedure for a patient who is ____
are sick, injured, or concerned about their health to the provider's office is more extensive thatn for
- ANSWER -Medical Care a ___ patient. - ANSWER -New and
Returning
A contract between a policy holder and a third-
arty payer or government program to reimburse The ________ is the person responsible for
the policy holder for all or a portion of the cost of paying the charges - ANSWER -Guarantor
medically necessary treatment. -
ANSWER -Health Insurance
Health Insurance information that is needed so
the claim can be processed includes -
The most common form of Medicare fraud is - ANSWER -1. Name and Phone of the third
ANSWER -1. Billing for services not party payer
provided 2. Name of policy holder
2. Misrepresenting the diagosis to justify
payment
3. Soliciting offering, or receiving a kick back. Copayments are to be paid - ANSWER -At
All of the above the time of the visit
Not an Example of Abuse - ANSWER - Before scheduling an appointment with a
Falsifying Certificates of Medical Necessity plans specialist, a managed care patient must obtain a
of treatment - ANSWER -Referral from the PCP or Case
manager
The development of an _______ begins when
the patient contacts a health care provider's Generate a deparate __record and ____ for each
office and schedules an appointment. - patient to maintain each type of information -
ANSWER -Patient File ANSWER -Financial and Medical
The CMS 1500 Claim form is used to report - Contracts with participation providers and
ANSWER -1. Professional Services accepts whatever the plan pays for services
2/6
