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Module 113 Final Review

82 Questions  I  By Lindsaystippel
Education Quizzes & Trivia

  
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1.  If an insured is in disagreement with the insurer for the settlement of a claim, a suit must begin within
A.
B.
C.
D.
2.  If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the
A.
B.
C.
D.
3.  The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as a/an
A.
B.
C.
D.
4.  When receiving payment from a private insurance carrier, check the amount of payment on the EOB with the
A.
B.
C.
D.
5.  An insurance claims register provides a/an
A.
B.
C.
D.
6.  Pending or resubmitted insurance claims may be tracked through a
A.
B.
C.
D.
7.  A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an
A.
B.
C.
D.
8.  If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to
A.
B.
C.
D.
9.  An insurance claim with an invalid prodecure code would be
A.
B.
C.
D.
10.  What should you do if an insurance carrier requests information about another insurance carrier?
A.
B.
C.
D.
11.  An insurance claim with a bundled service would be
A.
B.
C.
D.
12.  What should be done if an insurance claim denial is received because a billed service was not a program benefit?
A.
B.
C.
D.
13.  What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?
A.
B.
C.
D.
14.  When downcoding occurs, payment will
A.
B.
C.
D.
15.  If an insurance company admits that a patient signed an assignment of benefits document and that it inadvertently paid the patient instead of the physician, the insurance company should
A.
B.
C.
D.
16.  The total number of levels of redetermination that exist in the Medicare program is
A.
B.
C.
D.
17.  The first level of appeal in the Medicare program is
A.
B.
C.
D.
18.  The correct method to send documents for a Medicare reconsideration (Level 2) is by
A.
B.
C.
D.
19.  A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least
A.
B.
C.
D.
20.  How many levels of review exist for TRICARE appeal procedures?
A.
B.
C.
D.
21.  TRICARE appeals are normally resolved within
A.
B.
C.
D.
22.  In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is
A.
B.
C.
D.
23.  Cash flow is
A.
B.
C.
D.
24.  When insurance carriers do not pay claims in a timely manner, what effect does this have on the medical practice
A.
B.
C.
D.
25.  What does the insurance billing specialist need to monitor to be able to evaluate the effectiveness of the collection process
A.
B.
C.
D.
26.  The average amount of accounts receivable should be
A.
B.
C.
D.
27.   Accounts that are 90 days or older should not exceed
A.
B.
C.
D.
28.  What should be done to inform a new patient of office fees and payment policies
A.
B.
C.
D.
29.  The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process
A.
B.
C.
D.
30.  The reason for a fee reduction must be documented in the patient's
A.
B.
C.
D.
31.  Professional courtesy means
A.
B.
C.
D.
32.  When collecting fees, your goal should always be to
A.
B.
C.
D.
33.  A medical practice has a policy of billing only for charges in excess of $50. When the medical assistant requests $45 payment for the office visit, the patient states, "just bill me." How should the medical assistant respond
A.
B.
C.
D.
34.  The most common method of payment in the medical office is
A.
B.
C.
D.
35.  When the physician's office receives notice that a check was not honored, the first thing to do is to
A.
B.
C.
D.
36.  Accounts receivable are usually aged in time periods of
A.
B.
C.
D.
37.  Messages included on statements to promote payment are called
A.
B.
C.
D.
38.  What is the type of billing system in which practice management software is used
A.
B.
C.
D.
39.  Employment of a billing service is called
A.
B.
C.
D.
40.  The first statement should be
A.
B.
C.
D.
41.  What is a card called that permits bank customers to make cashless purchases from funds on deposit without incurring revolving finance charges for credit
A.
B.
C.
D.
42.  How many installments (excluding a down payment) must a payment plan have to require full written disclosure
A.
B.
C.
D.
43.  What is the name of the federal act that prohibits discrimination in all areas of granting credit
A.
B.
C.
D.
44.  What is the name of the act designed to address the collection practices of third-party debt collectors
A.
B.
C.
D.
45.  All collection calls should be placed
A.
B.
C.
D.
46.  Which group of accounts would a collector target when he or she begins making telephone calls
A.
B.
C.
D.
47.  In making collection telephone calls to a group of accounts, how should the accounts be organized to determine where to begin
A.
B.
C.
D.
48.  A plan in which employees can choose their own working hours from within a broad range of hours approved by management is called
A.
B.
C.
D.
49.  When writing a collection letter
A.
B.
C.
D.
50.  "Netback" is a term used to describe
A.
B.
C.
D.
51.  The part of the legal system that allows laypeople to settle a legal matter without use of an attorney is the
A.
B.
C.
D.
52.  In a bankruptcy case, most medical bills are considered
A.
B.
C.
D.
53.  Which type of bankruptcy is considered "wage earner's bankruptcy"
A.
B.
C.
D.
54.  America's oldest privately owned, prepaid medical group is the
A.
B.
C.
D.
55.  What plan allows memebers of Kaiser Permanente Medical Care Program to seek medical help from non-Kaiser physicians
A.
B.
C.
D.
56.  Kaiser Permanente's medical plan is a closed panel program, which means
A.
B.
C.
D.
57.  A significant contribution to HMO development was the
A.
B.
C.
D.
58.  How does an HMO receive payment for the services its physicians provide
A.
B.
C.
D.
59.  When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known as
A.
B.
C.
D.
60.  How are physicians paid who work for a prepaid group practice model
A.
B.
C.
D.
61.  What is the name of an organization of a physicians sponsored by a state or local medical association that is concerned with the development and delivery of medical services and the cost of health care
A.
B.
C.
D.
62.  In an independent practice association (IPA), physicians are
A.
B.
C.
D.
63.  An organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a/an
A.
B.
C.
D.
64.  A physician-owned business that has the flexibility to deal with all forms of contract medicine and also offers its own plans is a/an
A.
B.
C.
D.
65.  A program that offers a combination of HMO-style cost management and PPO-style freedom of choice is a/an
A.
B.
C.
D.
66.  Practitioners in an HMO program may come under peer review by a professional group called
A.
B.
C.
D.
67.  When a physician sees a patient more than is medically necessary, it is called
A.
B.
C.
D.
68.  Referral of a patient recommened by one specialist to another specialist is known as
A.
B.
C.
D.
69.  What is the correct procedure to collect a copayment on a managed care plan
A.
B.
C.
D.
70.  Medicare Part A is run by
A.
B.
C.
D.
71.  Medicare is a
A.
B.
C.
D.
72.  The letter "D" following the identification number on the patient's Medicare card indicates a
A.
B.
C.
D.
73.  The letters preceding the number on the patient's Medicare identification care indicate
A.
B.
C.
D.
74.  Part A of Medicare covers
A.
B.
C.
D.
75.  Part B of Medicare covers
A.
B.
C.
D.
76.  Medicare Part A benefit period ends when a patient
A.
B.
C.
D.
77.  The part B Medicare annual deductible is
A.
B.
C.
D.
78.  Medicare provides a one-time baseline mammographic examination for women ages 35 to 39 and preventive mammograms for women 40 years and older
A.
B.
C.
D.
79.  The frequency of Pap tests that may be billed for a Medicare patient who is low risk is
A.
B.
C.
D.
80.  Medigap insurance may cover
A.
B.
C.
D.
81.  When a Medicare beneficiary has employer supplemental coverage that is determined as the primary payer, Medicare is referred to as
A.
B.
C.
D.
82.  Some senior HMOs may provide services not covered by Medicare, such as
A.
B.
C.
D.
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