Reimbursement Exam 3 with 100%
Correct Solutions
Which occurs when a physician in the community refers a patient to the hospital for
observation, bypassing the clinic
or emergency department? - ANS-direct admission
Block 33 of the CMS-1500 claim requires entry of the name, address, and telephone
number of the billing entity,
which is the __________. - ANS-legal business name of the practice
Which is a licensed physician in good standing who, according to state regulations,
engages in the direct management
of nonphysician practitioners whose duties are encompassed by that physician's scope
of practice? - ANS-supervising physician
Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow
for entry of __________
codes, and they are reported in Block 24E. - ANS-ICD-10-CM
Postoperative complications requiring a return to the operating room for surgery related
to the original procedure are
billed as an additional procedure, and the additional procedure is linked to __________.
- ANS-a new diagnosis that describes the complication
The Away From Home Care Program(R) allows participating BCBS plan members who
are temporarily residing outside
of their home HMO service area for at least 90 days to temporarily enroll with a local
__________. - ANS-health maintenance
Third-party recovery standards for investigation of liability coverage and the process for
filing a lien in a potential
liability case vary on a federal and state basis. A lien is defined as __________. - ANS-
securing a debtor's property as security or payment for a debt
Which type of automobile insurance pays for loss of or damage to a covered vehicle,
such as that caused by fire,
flood, hail, impact with an animal, theft, vandalism, or wind? - ANS-comprehensive
The optical scanning process uses a device that converts __________ characters into
text that can be viewed by an
, optical character reader (OCR). - ANS-printed
Which type of automobile insurance pays for accidental bodily injury and property
damage to others, including medical
expenses, pain and suffering, lost wages, and other special damages? - ANS-liability
When the YES box in Block 27 of the CMS-1500 claims contains an X, the provider
agrees to receive as payment in
full whatever the payer reimburses. This concept is called __________. - ANS-accept
assignment
FEP cards contain the phrase __________ under the BCBS trademark. - ANS-
Government-Wide Service Benefit Plan
ICD-10-CM diagnosis codes are entered in Block 21 of the CMS-1500 claim. A
maximum of __________ ICD-10-
CM codes may be entered on a single claim. - ANS-12
Which of the following health care professionals is permitted to bill under a physician's
name when that physician provides direct
supervision of procedures/services? - ANS-nonphysician practitioner
Which was developed by the Centers for Medicare and Medicaid Services to assign the
unique health care provider
and health plan identifiers and to serve as a database from which to extract data? -
ANS-NPPES
The medical emergency care rider covers __________ treatment sought and received
for sudden, severe, and
unexpected conditions that if not treated would place the patient's health in permanent
jeopardy or cause permanent
impairment or dysfunction of an organ or body part. - ANS-immediate
Which type of insurance is defined as reimbursement for income lost as a result of a
temporary or permanent illness
or injury? - ANS-disability
Supplemental plans usually cover the deductible and copay or coinsurance of a primary
health insurance policy. Which
is the best known supplemental plan? - ANS-Medigap
By 1932 some plans modified the prepaid plan concept and organized community-wide
programs that allowed the
subscriber to be hospitalized in one of several member hospitals in accordance with
signed contracts to provide
services __________. - ANS-for negotiated special rates
Correct Solutions
Which occurs when a physician in the community refers a patient to the hospital for
observation, bypassing the clinic
or emergency department? - ANS-direct admission
Block 33 of the CMS-1500 claim requires entry of the name, address, and telephone
number of the billing entity,
which is the __________. - ANS-legal business name of the practice
Which is a licensed physician in good standing who, according to state regulations,
engages in the direct management
of nonphysician practitioners whose duties are encompassed by that physician's scope
of practice? - ANS-supervising physician
Diagnosis pointer letters A-L are preprinted in Block 21 of the CMS-1500 claim to allow
for entry of __________
codes, and they are reported in Block 24E. - ANS-ICD-10-CM
Postoperative complications requiring a return to the operating room for surgery related
to the original procedure are
billed as an additional procedure, and the additional procedure is linked to __________.
- ANS-a new diagnosis that describes the complication
The Away From Home Care Program(R) allows participating BCBS plan members who
are temporarily residing outside
of their home HMO service area for at least 90 days to temporarily enroll with a local
__________. - ANS-health maintenance
Third-party recovery standards for investigation of liability coverage and the process for
filing a lien in a potential
liability case vary on a federal and state basis. A lien is defined as __________. - ANS-
securing a debtor's property as security or payment for a debt
Which type of automobile insurance pays for loss of or damage to a covered vehicle,
such as that caused by fire,
flood, hail, impact with an animal, theft, vandalism, or wind? - ANS-comprehensive
The optical scanning process uses a device that converts __________ characters into
text that can be viewed by an
, optical character reader (OCR). - ANS-printed
Which type of automobile insurance pays for accidental bodily injury and property
damage to others, including medical
expenses, pain and suffering, lost wages, and other special damages? - ANS-liability
When the YES box in Block 27 of the CMS-1500 claims contains an X, the provider
agrees to receive as payment in
full whatever the payer reimburses. This concept is called __________. - ANS-accept
assignment
FEP cards contain the phrase __________ under the BCBS trademark. - ANS-
Government-Wide Service Benefit Plan
ICD-10-CM diagnosis codes are entered in Block 21 of the CMS-1500 claim. A
maximum of __________ ICD-10-
CM codes may be entered on a single claim. - ANS-12
Which of the following health care professionals is permitted to bill under a physician's
name when that physician provides direct
supervision of procedures/services? - ANS-nonphysician practitioner
Which was developed by the Centers for Medicare and Medicaid Services to assign the
unique health care provider
and health plan identifiers and to serve as a database from which to extract data? -
ANS-NPPES
The medical emergency care rider covers __________ treatment sought and received
for sudden, severe, and
unexpected conditions that if not treated would place the patient's health in permanent
jeopardy or cause permanent
impairment or dysfunction of an organ or body part. - ANS-immediate
Which type of insurance is defined as reimbursement for income lost as a result of a
temporary or permanent illness
or injury? - ANS-disability
Supplemental plans usually cover the deductible and copay or coinsurance of a primary
health insurance policy. Which
is the best known supplemental plan? - ANS-Medigap
By 1932 some plans modified the prepaid plan concept and organized community-wide
programs that allowed the
subscriber to be hospitalized in one of several member hospitals in accordance with
signed contracts to provide
services __________. - ANS-for negotiated special rates
