Health Insurance Billing Practice Exam

These questions are part of the practice quiz. Start practicing

• What is the coinsurance amount paid by the patient for a provider who submitted a charge of $75 and a Medicare physician fee schedule of $60?
• What is preprinted in Block 21 of the CMS-1500 claim?
• What is the term for the amount an insured must pay before the insurance company begins to pay claims?
• Which is the financial record source document usually generated by a hospital?
• What is the process called for transmitting claims data to payers or clearinghouses?
• What is the maximum amount of benefits payable to a health plan participant called?
• Which program provides benefits to dependents of personnel serving in the armed forces as well as other uniformed branches?
• Which term refers to a record of outstanding balances owed to the hospital for services rendered?
• What describes services that are not covered by a patient's health insurance policy?
• What is a fundamental responsibility of a medical billing specialist?
• Which was implemented to reduce provider costs and cycle time by minimizing and eventually eliminating paper processing and mailing of medical documentation to review contractors, and to reduce costs and time for review contractors?
• Which professional organization publishes the monthly Certified Medical Assistant journal and offers the Certified Medical Assistant (CMA) credential?
• Which act protects information collected by consumer reporting agencies?
• What is the process of sorting claims upon submission to collect and verify information about the patient and provider called?
• Resource utilization groups (RUGs) use which reimbursement methodology by skilled nursing facilities?
• Which principle ensures that individuals have the right to access their health care information?
• Which of the following is considered Medicare fraud?
• Which covers physicians and other health care professionals for liability as to claims arising from patient treatment?
• What is commonly a key responsibility of an insurance specialist when handling medical records requests?
• What entity establishes a utilization management program and performs external reviews?
• A centralized health care system funded by taxes where the government pays for each resident's health care is called:
• Which action grants prior approval for reimbursement of a health care service?
• In public health insurance, which type of coverage involves free or subsidized health care funded by government revenue?
• Which is responsible for supervising and coordinating health care services for enrollees?
• An automobile insurance policy typically includes:
• What is the maximum duration for which Medicare requires providers to maintain documentation for audits?
• What is the correct format for birth date entry on the CMS-1500 claim?
• What is essential for timely reimbursement from third-party payers?
• Which entity is responsible for reviewing managed care organization health care?
• What kind of payment system does the Inpatient psychiatric facility rely on?
• Which is a health information exchange network for securely sharing clinical information over the Internet nationwide, spanning all 50 states and is the largest health information exchange infrastructure in the United States?
• What process involves determining eligibility and benefits before providing services to a patient?
• A physician fee schedule is:
• Which legislation prohibits sharing of medical information among health insurers and other financial institutions for use in making credit decisions?
• Health reimbursement arrangements (HRAs) can be offered by employers with more than how many employees?
• What is sent by the third-party payer to the patient detailing the results of processing a claim?
• What is a health care insurance company that provides coverage, like BlueCross BlueShield, classified as?
• What type of organization is usually owned by physicians or a hospital and provides practice management services to individual physician practices?
• Which program provides health care benefits for dependents of permanently disabled veterans?
• When submitting claims, what does the term "coordination of benefits" refer to?
• Which step occurs first in the claims process after data completion?
• According to the birthday rule, who is considered the primary policyholder when both parents have group health insurance policies?
• The safekeeping of patient information by controlling access to hard-copy and computerized records is a form of __________.
• The Resource-Based Relative Value Scale (RBRVS) system is now known as what?
• The financial responsibility amount before an insurance policy pays is known as what?
• Which claim form is mainly submitted by institutions?
• A condition existing at the time of an inpatient admission order is described as what?
• The primary purpose of a medical record is to ensure which of the following?
• If an enrollee seeks health services from a non-managed care panel specialist without a referral from the primary care physician, this is known as what?
• What is the Minimum Data Set primarily used for?
• What is required of managed care plans contracting with Medicare or Medicaid regarding physician incentive plans?
• What is one of the main components of a quality assurance program in health care?
• What is the coding system used to report outpatient and physician office procedures and services?
• Up to how many modifiers can be entered to the right of each CPT or HCPCS level II code on the CMS-1500 claim?
• In what situation would a patient receive a bill after their insurance has processed a claim?
• Which PPS provides a predetermined payment based on the patient's principal diagnosis, comorbidities, complications, and procedures?
• What term is also used to describe a triple option plan?
• Which term describes guidelines written by administrative agencies (such as CMS) that are based on laws passed by legislative bodies?
• Which opportunity affords students the chance to receive on-the-job experience prior to graduation and assists them in obtaining permanent employment?
• Which is employed by a provider to perform both administrative and clinical tasks that keep the office or clinic running efficiently?
• What should the patient registration clerk do to ensure coverage for a surgical procedure?
• What is the primary funding source for Medicaid programs in the United States?
• Which document typically outlines the amount that a patient is responsible for after insurance processing?
• An optical scanner converts printed or handwritten characters into text that can be viewed by a(n):
• What type of rate is used by the Inpatient PPS?
• What information is crucial to include in a claim submission to prevent denial?
• Which act signed by President Theodore Roosevelt in 1908 protects and compensates railroad workers who are injured on the job?
• What is the process of arranging appropriate health care services for discharged patients called?
• Which helps physicians, hospitals, and other health care providers work together to improve care for people with Medicare?
• Major revisions to CPT made in 1991 resulted in which of the following?
• What term describes a situation where a patient chooses to bypass primary care and go directly to a specialist?
• Which system enacted by TEFRA issues a predetermined payment for inpatient services?
• Which of the following contains data on a managed care plan's quality and cost control?
• Which type of insurance aims to provide every individual access to health coverage?
• Which information is entered in CMS-1500 Blocks 9-9d on the primary insurance claim?
• Who is responsible for conducting investigations into fraud committed by Medicare providers?
• What type of rate does the ambulance fee schedule PPS use?
• In the context of health insurance, what does the term "third-party payer" refer to?
• What is the term for an abstract of all recent claims filed on each patient, used by the payer to determine concurrent care for the same condition by multiple providers?
• Which is the process that a facility undergoes to demonstrate that it meets standards beyond those required by law?
• What is the main benefit of a Managed Care Organization (MCO)?
• Which type of insurance provides financial and medical benefits to those with work-related injuries and their families, regardless of fault?
• In a scenario where Medicare was billed for a work-related injury, what should the facility have done instead?
• What is typically covered by a primary health insurance plan?
• A claim that is rejected due to an error is classified as what type of claim?
• Who primarily oversees a patient's health care decisions within a managed care framework?
• What is the system called that generally allows electronic claims to be processed faster than paper claims?
• What did the Amendment to the HMO Act of 1973 allow federally qualified HMOs to do?
• Which CMS-1500 Block requires entry of either the Social Security number (SSN) or the employer tax identification number (EIN)?
• What does a risk contract establish?
• Which are used to calculate reimbursement for hospital-based Medicare outpatient claims?
• What part of the claims process involves comparing the claim to payer edits and the patient's health plan benefits?
• Which plan allows patients to self-refer to out-of-network providers?
• What is the purpose of Block 31 on the CMS-1500 form?
• Which legislation was passed in 1997 that addresses health care fraud and abuse issues?
• Which 1988 legislation resulted in the creation of a new program, TRICARE, which includes options such as TRICARE Prime, TRICARE Extra, and TRICARE Standard?
• What is a chargemaster?
• What type of law is concerned with the relationships between individuals and entities?
• What is a sub-capitation payment?
• What process do healthcare facilities and payers use to determine anticipated care needs of patients?
• Case law is based on court decisions that establish precedent, and is also called __________ law.
• Which term refers to the official process of denying a claim after it has been submitted?
• What is the term for a contract between a policyholder and a third-party payer to reimburse for medical treatment costs?
• What is the primary purpose of health insurance deductibles?
• Which legislation allows employees to continue their health care coverage after employment ends?
• Which term describes an individual's right to keep health care information from being disclosed to others?
• What was an indirect result of the Taft-Hartley Act?
• Medicare established the Quality Improvement System for Managed Care to ensure accountability in terms of what?
• Unless state law specifies a longer period, how many years are providers required to keep copies of government insurance claims and attachments, according to Medicare Conditions of Participation?
• What is the primary focus of Medicaid as a program?
• Commercial individual health insurance policies are regulated by individual states and include which of the following?
• What is the coding system developed by the World Health Organization known as?
• Often a commercial payer will implement changes to claims completion requirements throughout the year, and most providers discover these changes:
• Which is a legal term that indicates the provider's responsibility for their employee's actions?
• What should an insurance specialist do upon discovering an inappropriate Medicare payment?
• Which of the following accurately describes managed care systems?
• Which legislation enacted in 1916 provides civilian employees of the federal government with medical care, survivors' benefits, and compensation for lost wages?
• Which organization manages the delivery of health care services offered by hospitals and physicians employed by the organization?
• Which payer's claim should be followed up first to obtain reimbursement?
• Which act requires hospitals to provide the Medicare Outpatient Observation Notice (MOON) to outpatients receiving observation services?
• What type of contract does a Medicare risk program operate under?
• What does OASIS stand for in the context of adult home care assessment?
• Which of the following was designed to accommodate optical scanning of paper claims?
• In a managed care plan, the primary care provider (PCP) serves as a:
• What indicates that a patient has allowed the payer to reimburse the provider directly?
• Which uses data from electronic health records and health information technology systems to measure health care quality?
• What does "per diem" refer to in reimbursement systems?
• What constitutes Medicare abuse?
• What is the key responsibility of the patient registration clerk?
• Which legislation eased restrictions on PPOs?
• Which of the following is often used to measure the effectiveness of healthcare services?
• Which combines parts of the PQRS, VM, and the Medicare EHR incentive program into one single program?
• Which insurance agreement guarantees repayment for financial losses resulting from the act or failure to act of an employee?
• When unlisted codes are reported on a CMS-1500 claim, what is submitted to clarify the services rendered?
• What is the purpose of submitting a claim attachment with an unlisted code on a CMS-1500 form?
• Coinsurance refers to which of the following?
• Which model involves a blend of services offered by hospitals and independent physician groups?
• What term refers to employees and dependents who join a managed care plan?
• Which code format is primarily used for submitting claims for outpatient services?
• What is the total Medicare reimbursement for 12 cases at a nursing facility, reimbursed at $9,995 each?
• Which type of health care plan requires employees to be more responsible for health care decisions and cost sharing?
• Which reviews managed care plans and develops report cards to allow consumers to make informed decisions when selecting a plan?
• Which initiative is designed to spur innovations in health information technology by promoting research and development?
• The conduct or qualities that characterize a professional person is known as?
• A provider or beneficiary can receive a waiver of recovery of overpayment in which situation?
• Which outlines a health insurance specialist's qualifications, responsibilities, and supervisory criteria?
• What purpose do diagnosis reference numbers serve when entered on the CMS-1500 claim?
• What type of insurance generally covers emergency medical services?
• In which block of the CMS-1500 form would you typically find the patient's name?
• What should be done if a patient's spouse requests diagnostic information but is not the patient?
• What is the primary purpose of utilization review in healthcare management?
• What is the primary goal of managed care organizations?
• What is the primary purpose of the eHealth exchange?
• What is the Medicare write-off for a participating provider billing $75 when the allowed amount is $60?
• Which provides protection to independent contractors from liability as a result of errors and omissions when performing their professional services?
• Which legislation created Medicare risk programs allowing certain health plans to provide Medicare-covered services under a risk contract?
• Which type of organization is owned by hospital(s) and physician groups that maintain their own practices while providing health care services to plan members?
• What information is included in Block 24B of the CMS-1500 claim?
• In managed care, which role does a gatekeeper primarily serve?
• Which act requires the reporting of standardized patient assessment data on quality measures?
• What is the best way to prevent delinquent claims?
• A network model HMO is one in which contracted health care services are provided by which of the following?
• If a patient received $1,000 worth of services and paid $90 in coinsurance, what was the overpayment?
• Which term refers to the amount a patient must pay before insurance kicks in?
• Which payment system reimburses inpatient psychiatric facilities based on patient resource use?
• Which program serves as a cost-sharing system between federal and state governments for low-income Americans?
• What is considered a violation of a managed care plan's responsibilities according to Medicare and many states?
• What must usually be received from a payer before treatment by a specialist will be covered?
• The concept of combining health care with the financing of services provided is called:
• Which is a type of organization that brings together health care stakeholders within a defined geographic area and governs health information exchange among them for the purpose of improving health and care in that community?
• Which reimbursement methodology increases payment if health care service fees rise?
• Who is responsible for understanding and following the regulations associated with the CMS-1500 claim?
• What term is used to describe a standard payment for a specified service in healthcare?
• Which of the following is considered a covered entity?
• Which coding system includes five-digit alphanumeric codes for services and procedures not classified in the CPT?
• What notice is sent by the insurance company to a provider that contains payment information about a claim?
• During patient discharge processing, which of the following actions is taken?
• Which term describes the strategy used to manage the costs and quality of healthcare services provided to members?
• For a nonPAR who bills Medicare with a submitted charge of $650 and a nonPAR Medicare physician fee schedule allowed amount of $450, what is the Medicare payment?
• How should the patient's name be formatted in Block 2 of the CMS-1500 claim?
• What type of insurance consists of federal and state government health programs made available to eligible individuals?
• Which program is focused on quality assurance in Medicare Advantage organizations?
• What process involves reviewing inpatient care for medical necessity before admission?
• Which document is often necessary to submit along with a claim to justify the services billed?
• What is the primary goal of preventive services in health insurance?
• The Financial Services Modernization Act (FSMA), which prohibits sharing of medical information among health insurers and other financial institutions for use in making credit decisions, is also known as the:
• Which act prohibits a payer from notifying the provider about payment or rejection of unassigned claims?
• What is the primary reason an attorney needs signed patient authorization for medical records?
• The act of falsely billing for services not rendered is categorized as __________.
• What involves securing a debtor's property as security or payment for a debt?
• What is the process of identifying disease and providing care and treatment to those who are unwell?
• What was established to integrate the administration of Medicare Parts A and B fee-for-service benefits?
• Which does a provider participate in through Medicare Part B to earn an incentive payment for participating in the innovative payment model?
• What kind of claim is used for billing provider fee-for-service claims to commercial health insurance companies?
• A patient admitted for pneumococcal pneumonia with chronic asthma and diabetes present at the time of admission has which POA indicator for pneumonia?
• What type of insurance is purchased by individuals who do not have access to group health insurance?
• What is a term for a physician or health care facility under contract to a managed care plan?
• Which law addresses the issue of patient confidentiality in medical records?
• Which program was established to provide health care assistance to uninsured, low-income children under state Medicaid programs?
• What is the process whereby the patient allows the payer to directly reimburse the provider called?
• Which legislation implemented the long-term (acute) care hospital inpatient prospective payment system?
• What is the fixed amount patients pay each time they receive health care services called?
• What type of insurance coverage allows large employers to assume the financial risk for providing health care benefits?
• The birthday rule is used to determine the primary insurance policy when the patient is:
• If a patient leaves the requisition form for a procedure at home, what should be done with the registration process if an electronic version is available?
• What review process assesses the medical necessity of tests or procedures ordered during a patient's inpatient hospitalization?
• What should a provider do if they wish to decline accepting assignment on the CMS-1500?
• What does entering an X in any of the YES boxes in Block 10 of the CMS-1500 indicate to the commercial payer?
• Which is entered in Block 11c of the CMS-1500?
• Which legislation required a significant prescription drug benefit improvement and faster Medicare appeal decisions?
• Which payment system typically involves a per-day rate structure?
• HIPAA was enacted primarily to protect __________.
• Which document outlines the agreed payment terms and conditions between providers and payers?
• Which documents record healthcare services provided to a patient and include their treatment history?
• Federal and state statutes are __________.
• Which type of HMO delivers health care services through members of an independent multispecialty group practice?
• What is the term for a healthcare provider's request for reimbursement from an insurance company?
• What type of provider must accept whatever a payer reimburses for procedures or services performed?
• When is it permissible to release patient information to a spouse without authorization?
• When a patient has both a primary and a secondary payer plan, what is the correct procedure for claims submission?
• Which of the following is true regarding the beneficiary's rights related to overpayments?
• If an insurance specialist discloses the dates of service but confirms a negative HIV status, which statement is true regarding patient confidentiality?
• What is the first step in the claim submission process?
• Preferred provider organizations (PPOs) are open-ended plans that allow patients to use non-PPO providers in exchange for?
• Calculate the Medicare payment for a participating provider who bills Medicare with a submitted charge of $75 and a Medicare physician fee schedule of $60. What is the Medicare payment?
• What does entering "SIGNATURE ON FILE" in Block 12 of the CMS-1500 imply about the patient's consent?
• Which components are used to compute relative-value units for the Medicare physician fee schedule?
• As part of the administrative simplification provision of HIPAA, which unique identifier is assigned to third-party payers?
• Which legislation amended the PPACA to implement health care reform initiatives, such as increasing tax credits to buy health care insurance, eliminating special deals provided to senators, closing the Medicare "donut hole," and modifying higher education assistance provisions, such as implementing student loan reform?
• Which term best describes principles of right or good conduct?
• What does the term "claims adjudication" refer to in health insurance billing?
• A flexible spending account is a type of:
• What is a critical component of a managed care plan designed to control costs?
• Who is considered the policyholder in health insurance?
• Linking every procedure or service code to a condition reported on a claim to justify the treatment is a function of:
• For a nonPAR who bills a submitted charge of $650, which amount represents the limiting charge as calculated?
• What type of organization is designed to reduce cost and improve quality through coordinated care?
• Which system was implemented to cover all costs related to services furnished to Medicare Part A beneficiaries in skilled nursing facilities?
• Which system was implemented to classify patients for Medicare reimbursement to inpatient rehabilitation facilities?
• Which act authorized $1.5 billion for grants for construction, renovation, and equipment, as well as for the acquisition of health information technology systems?
• Which model allows subscribers to obtain health care services from a broad range of providers without an exclusive network?
• What term describes the required dollar amount policyholders must pay for each medical service received?
• Which is a characteristic of delinquent commercial claims awaiting payer reimbursement?
• What are subscribers also referred to as?
• What does the Health Insurance Marketplace allow Americans to do?
• Why is confirming a patient's negative HIV status problematic in communications with insurance companies?
• Which coding system is crucial for ensuring proper billing for outpatient claims?
• In which plan type do patients often face lower premiums but higher deductibles?
• An organization of affiliated providers offering joint health care services to subscribers is known as?
• Which payment system reimburses home health agencies at a predetermined rate based on OASIS?
• Which payment classification system is used for billing hospital-based Medicare outpatient claims?
• Which legislation amended the Public Health Service Act to establish an Office of National Coordinator for Health Information Technology (ONC)?
• The recognized difference between fraud and abuse is the __________.
• Which term means the patient is not responsible for paying for what the insurance plan denies?
• Which supporting documentation is crucial when submitting an insurance claim?
• What is the primary purpose of preventive services?
• Which system classifies patients based on diagnosis and is also used in prospective payment systems?
• Which systematic method of documentation includes four components?
• Which professional organization provides industry and regulatory education and networking opportunities for its members and offers the Certified Medical Reimbursement Specialist (CMRS) credential?
• Information that is converted to a secure language format for electronic transmission is __________ data.
• What is a person who performs services for another under an expressed or implied agreement called?
• Which act of legislation requires Medicare administrative contractors to attempt the collection of overpayments made under the Medicare or Medicaid programs?
• Which federal legislation was enacted in 1995 to restrict the referral of patients to organizations in which providers have a financial interest?
• If an attorney requests a medical record and it’s not accompanied by a signed authorization, what should the insurance specialist do?
• What is a common requirement before patients can receive specialized treatment in a managed care plan?
• What document do providers who do not accept Medicare assignment miss, which is sent to the patient?
• What does the Office of Managed Care assess?
• Who provides services or supplies to the insured as a professional member of the health care team?
• Which system is designed to provide comprehensive and preventive healthcare that is controlled by a government entity?
• What do Ambulatory Payment Classifications (APCs) primarily relate to?
• Performance measures developed by NCQA and used to evaluate managed care plans are found in the:
• What do managed care plans sometimes require prior to scheduling elective surgery?
• Which type of health plan involves a network of providers that offer services at reduced costs?
• Which organization is responsible for the health of a group of enrollees?
• It is important to remain current regarding news from which administrative agency?
• Which type of single-payer system has the government owning and operating health care facilities while providers receive salaries?
• What is the term used to describe the practice of excluding members who are sicker than the general population?
• Testimony under oath taken outside the court (e.g., at the provider's office) is a(n) __________.
• Which of the following is NOT a component typically covered under an automobile insurance policy?
• Which insurance covers losses to a third party caused by the insured?
• What does MIPS stand for in relation to Medicare?
• Which identifier was developed by CMS to assign unique health care provider and health plan identifiers?
• What type of records are submitted electronically to bill for health care services?
• Which protects business contents against fire, theft, and other risks?
• What legislation added new prescription drug and preventive benefits to Medicare?
• Which legislation discontinued the use of the SGR formula for determining Medicare payments?
• The policyholder's commercial group number, if the patient is covered by a group health plan, is entered in which block of the CMS-1500?
• Which of the following is most characteristic of a managed care organization?
• Who reviews health-related claims to determine whether charges are reasonable and medically necessary?
• Which payment system is based on the physician's work, practice expenses, and malpractice insurance expenses?
• Who is responsible for preparing and reviewing claims for accuracy to ensure prompt payment?
• Which group health insurance policy provision prevents multiple payers from reimbursing benefits covered by other policies?
• Which is an example of a health care setting that would use the UB-04 claim to bill for institutional services?
• What type of assessments does the Minimum Data Set provide?
• Which professionals are primarily responsible for billing patients directly for services rendered?
• Which is an example of a closed-panel HMO?
• Deductibles, copayments, and coinsurance are primarily associated with which type of health insurance plan?
• Which legislation established quality standards for laboratory testing to ensure accuracy and reliability?
• Who submits written confirmation authorizing treatment to the provider?
• Which classification system, implemented in 1983, determines hospital inpatient reimbursement based on resource similarity?
• A triple option plan is also called a:
• What type of insurance system is designed for covering a wide range of healthcare expenses, typically with higher premiums?
• What type of rate does the Ambulatory surgical center payment rates PPS utilize?
• Which is a professional association that was founded to elevate the standards of medical coding?
• Which document is primarily used by physicians to bill for services rendered?
• The act of stealing money from an employer is called?
• The CMS-1500 claim form is primarily used to seek reimbursement for which of the following?
• Which term describes any procedure or service reported on a claim that is not included on the payer's master benefit list?
• Which of the following is used to provide detailed information about a claim's payment?
• What process involves the payer evaluating the claim for payment and confirming coverage?
• When a Medicare provider commits fraud, which entity conducts the investigation?
• Which facility payment system uses a cost-based rate?
• What is the process of assigning numeric and alphanumeric characters to diagnoses, procedures, and services called?
• Which is an insurance agreement that protects business assets from lawsuits?
• What are medical conditions or complications that occur during hospital stays, which were not present at admission, called?
• What information is critical to have before proceeding with a scheduled procedure?
• Which regulations govern privacy, security, and electronic transaction standards in health care?
• Which evaluation process is conducted both offsite and onsite by accreditation organizations to establish standards?
• In a direct contract model HMO, contracted health care services are provided by whom?
• Which program provides healthcare services to Americans over the age of 65?
• What type of plan involves a significant financial incentive for physicians to manage care effectively?
• Which were based on fees typically charged by providers according to specialty within a region?
• Which organization is primarily responsible for developing standards for the accreditation of health care organizations?
• In CMS-1500 Block, what indicates that the services were billed properly?
• Which organization is responsible for providing comprehensive health care services to voluntarily enrolled members on a prepaid basis?
• What is true about a federally qualified HMO?
• What is the correct format for entering a patient's or policyholder's name in Block 2 or 4 on the CMS-1500?
• Which of the listed categories includes the provision of preventive services?
• What type of plan requires members to obtain referrals for specialists?
• Which of the following programs primarily serves veterans by providing healthcare services?
• How does the laboratory technician manage charge data during a blood work procedure?
• Which professional manages patient health information and medical records, and codes diagnoses and procedures?
• Medigap plans are supplemental plans that are:
• Which is a global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient?
• An X in the YES box of Block 20 indicates what?
• Which entity is authorized by CMS to perform utilization and quality control review of health care for Medicare beneficiaries?
• Which document communicates to the payer that the provider is requesting reimbursement?
• Which coding system is utilized to report diseases, injuries, and other reasons for both inpatient and outpatient encounters?
• Which insurance is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury?
• A resident classification system that is based on data collected from resident assessments and relative weights developed from staff time data is known as:
• What act provided federal grants for modernizing hospitals that had become obsolete?
• What is created when the cost of health care coverage is determined by employees' status, age, sex, and occupation?
• What act required most employers with more than 25 employees to offer HMO coverage if local plans were available?
• What is the significance of optical character recognition (OCR) in medical billing?
• Cafeteria plan and triple option plan are alternative names for what?
• What was introduced to encourage individuals to find cost-effective health care options?
• In which model are contracted health services delivered to subscribers by physicians who remain in their independent office settings?
• Select the correct entry for the name of a provider on the CMS-1500 claim.
• What is a primary feature of the Health Care and Education Reconciliation Act?
• What type of payment structure is utilized in an inpatient rehabilitation facility under Medicare?
• The term used to describe health care coverage subsidized by employers and other organizations is called __________ insurance.
• Which professional association aims to improve the quality of medical records and current advances toward an electronic environment?
• A method of controlling health care costs by reviewing the medical necessity of care is called:
• What is the model called where health care is provided by individuals who are not employees of the HMO?
• For a patient undergoing bilateral knee replacement surgery who also has hypothyroidism, what POA indicator applies to the hypothyroidism?
• What is a defining characteristic of a group practice without walls?
• Exclusive provider organizations (EPOs) provide benefits to subscribers if they use services from?
• Which Block on the CMS-1500 is typically used to report the diagnosis for the services rendered?
• Which coding system is used to report procedures and services on inpatient hospital claims?
• What type of statement does the patient sign to authorize the payer to directly reimburse the provider?
• Where are the name, address, and telephone number of the billing entity entered in the CMS-1500?
• What act mandated reporting and disclosure requirements for group life and health plans, permitted large employers to self-insure employee health care benefits, and exempted large employers from taxes on health insurance premiums?
• What is the term for the mechanism that allows health care providers to receive compensation for services based on the conditions of eligibility and contract?
• Which refers to the contractual right of a third-party payer to recover health care expenses from a liable party?
• Health care providers accept preestablished payments for providing care to health plan enrollees over a period of time under the reimbursement method of:
• What is an HMO that meets federal eligibility for a Medicare risk contract but is not federally qualified called?
• What type of insurance covers catastrophic or prolonged illnesses and injuries?
• What is the purpose of the CMS-1500 form in medical billing?
• What does NCCI stand for in the context of coding methodologies?
• What is the main function of the CMS-1500 claim form in medical billing?
• Which type of account is tax-deferred and used for qualified health care expenses, allowing unused funds to roll over from year to year?
• Which type of insurance product is marketed to small business owners to provide employee coverage and is considered risky?
• The base period used to calculate an individual's weekly disability benefit amount usually covers:
• What is the term for a payment arrangement where providers are paid a set amount per patient per month, regardless of the number of services rendered?
• Which plan typically allows for greater flexibility and choice in healthcare providers?
• If a patient arrives at a hospital with a possible myocardial infarction and later fractures his hip, which present on admission indicator applies to the fracture?
• Which legislation, enacted in 1981, expanded Medicare and Medicaid programs?
• A hospital handling 290 inpatient cases assigned to DRG 169 with a relative weight of 1.106 has what total relative weight?
• Which system was established by Medicare to ensure accountability of managed care plans?
• What is a CDHP in which the individual selects one of each type of provider to create a customized network called?
• When reporting code 73110 on the CMS-1500 claim, how should units be reported?
• A nonprofit organization that contracts with and acquires the clinical and business assets of physician practices is called a(n):
• Which include payments made directly or indirectly to health care providers to encourage a reduction or limitation of services to save money for the managed care plan?
• Which is a type of HMO where health care services are provided to subscribers by physicians employed by the HMO?
• What is one of the key benefits of an ACO for providers?
• What are mandates classified as?
• National codes are part of which coding system?
• Which document is usually used to submit claims for outpatient services?
• When an insurance company requests a patient’s entire medical record for payment processing, what should the insurance specialist do?