Amca Billing & Coding Test (Answers May/May Not Be Wrong,Double Check Them)

What type of insurance allows treatment virtually anywhere with a high deductible that policy holders are willing to pay? a. COBRA b. EPO c. PPO d. HMO - answer-C Veterans with service related disabilities are eligible for case under which of the following programs: a. CHAMPUS b. Medicare c. CHAMPVA d. TRICARE - answer-C _______________________ is usually sponsored and partially paid by an employer. a. TRICARE b. Private Insurance c. Group Health Insurance d. Worker's Aide - answer-C ______________________ are used to report encounters for circumstances other than a disease or injury in the ICD-10-CM. a. A codes b. V codes c. Z codes d. E codes - answer-D The abbreviation PMPM stands for: a. Per member per month b. Provider membership per management c. Provider management provider manual d. Pre menstrual after midnight - answer-A Schedule of benefits means: a. Coordination of benefits b. HMO c. Medical service covered under the insured's policy d. Managed care organization - answer-C Medicare is funded by: a. State Funds b. Federal Funds c. Employers d. The patient - answer-B Physicians establish a list of their usual fees for: a. The charges they have written off b. The procedures and services they frequently perform c. Workers' Compensation patients d. Their Medicare patients - answer-B The insurance carrier is allowed to use nay method to determine the amount for a service, also known as the: a. Allowed amount b. Fee schedule c. Deductible d. Insurance premium - answer-B Which of the following statements is true under the doctrine of respondeat superior? a. The billing and coding specialist is superior to other members of the medical staff b. The billing and coding specialist is responsible for any errors made by the medical staff c. The physician is responsible for any errors made by the medical staff d. The person who has been employed for the longest period of time is responsible for any errors made by the medical staff - answer-C HIPAA, stands for which of the following? a. Health Insurance Portability and Accountability Act b. Health Insurance Privacy Assessment and Agreement c. Health Insurance Privacy and Agreements d. Health Insurance Practices and Agreements - answer-A Information given by a patient to medical personnel that cannot be disclosed without consent constitutes: a. Judgment b. Duty of care c. Privileged communication d. Negligence - answer-C Why is a superbill/encounter form an important document in the office? a. It is used when considering purchasing medical billing software b. It has information needed for vendors c. It ensures the correct spelling of the patient's name d. It ensures the correct patient data information and procedure codes - answer-D Which of the following facilities does not use CMS-1500 forms? a. ASC (Ambulatory Surgery Center) b. Nursing Home c. Acute care d. Dialysis clinic - answer-D Physicians usually submit claims for patients and receive payments directly for the payers. The policy holder authorizes this by signing and dating a: a. Accept assignment b. Schedule of benefits c. Assignment of benefits d. Encounter form - answer-C Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a patients PHI for TPO purposes. What does TPO stand for? a. Treatment, patient protection, operations b. Treatment, payment and health care operations c. Type of payment, patient and observation d. Type of insurance, payment, and health care operations - answer-B If both parents cover dependents on their plan, the child's primary insurance is usually determined by the birthday rule. What is meant by the birthday rule? a. If the mother is older than the father than she is primary b. The parent whose birthday is earlier in the calendar year is the primary c. The father is usually older than the mother so he is the primary d. The parent whose birthday is closest to the child's birthday is the primary - answer-B There are three participants in the medical insurance relationship: the first party, the second party and the third party. Who is referred to as the second party? a. Physician b. Secondary insurance c. Patient d. Insurance company - answer-C Co-insurance is calculated based on: Select One: a. A capitation rate b. The numbers of policy holders in a plan c. A fixed charge for each visit d. A percentage of a charge - answer-D If a health plan member receives medical services from a provider who does not participate in the plan, the cost for the member is typically: a. Lower b. Negotiable c. Higher d. The Same - answer-C The tertiary insurance pays: a. After the first and second payer b. After the receipt of the claim c. After the patient has paid the co-insurance d. After the payer - answer-A A certification number for a procedure is the result of which transaction and process? a. Claims status b. Coordination of benefits c. Referral and authorization d. Health care payments and remittance advice - answer-C Which of the following is one of the sections in the CPT Coding Manual? a. Encounters b. Vaccinations c. Pharmacy d. Pathology and Laboratory - answer-D A late effect may be indicated in documentation by the use of the expression(s): a. Primary or secondary b. Missile, puncture, with foreign body c. Due to an old—due to a previous d. Malignant - answer-C Multigravida is a term associated with: a. Arthritis b. Glaucoma c. Bronchitis d. Pregnancy - answer-D What insurance company is the payer of last resort? a. Blue Cross and Blue Shield b. Workers Compensation c. Medicaid d. Group Insurance - answer-C An unintentional, harmful reaction to the correct dosage of a drug is called: a. A manifestation b. A co-existing condition c. A late effect d. An adverse effect - answer-D Which of the following CPT conventions indicates the code description is revised? a. Red dot b. Plus sign c. Blue triangle d. Lightning bolt - answer-C What is meant by the term "Code to the Highest Level of Specificity"? a. Using the most specific code possible b. Using the code the doctor annotates, even if the physician notes do not coincide c. Code using the four-digit subcategory code, even when a five-digit code is available. d. Code using inconclusive and rule out diagnoses - answer-A A medical term that contains the root word meaning "uterus": a. Oophrectomy b. Colporrhaphy c. Hysterectomy d. Salpingectomy - answer-C If the patient is treated for both an acute and chronic condition, each of which has a separate code, how should the codes be listed? a. Acute code, chronic code b. Chronic code, acute code c. V code, condition code d. Acute code, V code - answer-A A new patient is one who has not received services from the physician or any other physician in that group for: a. 3 years b. 1 year c. 2 years d. 90 days - answer-A The abbreviation for PFSH is: a. Present, family and social history b. Past, family and/or social history c. Patient, family and/or systems history d. Past, family and systems history - answer-B The three key factors in selecting E/M codes are: a. Time, severity of presenting problem and history b. History, examination and time c. History, examination and medical decision making d. Past history, history of present illness and chief complaint - answer-C When a panel code from the Pathology and Laboratory section is reported: a. 50% of the listed tests must have been performed b. 90% of the listed tests must have been performed c. All the listed tests must have been performed d. All of the listed tests must have been performed on the same day - answer-C What is the Medicare Coverage Gap also know as the "donut hole"? a. The amount of out of pocket costs after a certain amount of money has been spent from Medicare on prescription drugs b. It is the gap in coverage from month to month c. It is out of pocket costs associated with a hospital stay d. It is a specific part of Medicare coverage that can be subscribed to - answer-A CPT is what level of Healthcare Common and Procedure coding system? a. Level IV b. Level III c. Level I d. Level II - answer-C Most individuals receiving TANF payments are limited to a _____________ - year benefit period. a. 1 b. 7 c. 10 d. 5 - answer-A Which of the following is not a commonly used transmission method for HIPAA claims? a. Direct transmission b. Fax c. Clearinghouse d. Direct data entry - answer-D Medicare Part A covers: a. Physician services b. MACs c. Hospital services d. Prescription drugs - answer-A A payer's initial processing of a claim screens for: a. Utilization guidelines b. Medical edits c. Claim attachments d. Basic errors in claim data or missing information - answer-D A claim may be downcoded because: a. The claim does not list a charge for every procedure code b. The claim is for non-covered services c. The documentation does not justify the level of service d. The procedure code applies to a patient of the other gender - answer-C Payers should comply with the required: a. Insurance aging report b. Remittance advice c. Claim turnaround time d. Retention schedule - answer-C What is a capitated payment? a. This is when a provider can only see specific patients with specific insurance b. This is when a physician can only charge a specific amount of money c. This is a regular payment received by the physician d. This when a physician has a contract with an insurance company to be paid whether he sees the patient or not - answer-D The patient aging report is used to: a. Collect overdue accounts from patients b. Enter write-offs to a patient's account c. Enter payments into the patient billing system d. Track overdue claims from payers - answer-D A deviated septum dur to a nasal fracture could be considered a: a. Allergic effect b. Early effect c. Adverse effect d. Late effect - answer-D What is a correctly completed claim submitted within the policy time limit? a. Dirty b. Draft c. Clean d. Incomplete - answer-C The day sheet produced by the practice management program shows: a. What each patient owes the practice as of that date b. What each payer owes the practice as of that date c. They payments and charges that occurred on that date d. The overdue accounts on that date - answer-C The word used in medical terminology to mean "toward the midline of the body" is: a. Dorsal b. Medial c. Lateral d. Ventral - answer-B To indicate that something lies nearer the surface, use the term: a. Distal b. Superficial