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Module 113 Final Review

82 Questions
Module Quizzes & Trivia
Questions and Answers
  • 1. 
    If an insured is in disagreement with the insurer for the settlement of a claim, a suit must begin within
    • A. 

      1 year

    • B. 

      2 years

    • C. 

      3 years

    • D. 

      5 years

  • 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. 

      Federal insurance commissioner

    • B. 

      State insurance commissioner

    • C. 

      State insurance federation

    • D. 

      Department of public service

  • 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. 

      EOB

    • B. 

      EOMB

    • C. 

      MRA

    • D. 

      MPS

  • 4. 
    When receiving payment from a private insurance carrier, check the amount of payment on the EOB with the
    • A. 

      Patient's financial accounting record

    • B. 

      Practice's day sheet

    • C. 

      Copy of the CMS-1500 form

    • D. 

      Patients's insurance contract

  • 5. 
    An insurance claims register provides a/an
    • A. 

      File containing the name and address of all insurance companies

    • B. 

      Follow-up report that is sent to the insurance companies

    • C. 

      Follow-up procedures for insurance claims

    • D. 

      Practice analysis

  • 6. 
    Pending or resubmitted insurance claims may be tracked through a
    • A. 

      Tickler file

    • B. 

      Clinical file

    • C. 

      Data file

    • D. 

      Patient file

  • 7. 
    A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an
    • A. 

      Inquiry

    • B. 

      Tracer

    • C. 

      Rebill

    • D. 

      Both inquiry and tracer

  • 8. 
    If an insurance claim has been lost by the insurance carrier, the procedure(s) to follow is to
    • A. 

      Ask if there is a backlog of claims at the insurance office

    • B. 

      Submit a copy of the original claim

    • C. 

      Verify the correct mailing address

    • D. 

      All of the above

  • 9. 
    An insurance claim with an invalid prodecure code would be
    • A. 

      Paid

    • B. 

      Rejected

    • C. 

      Suspended

    • D. 

      Denied

  • 10. 
    What should you do if an insurance carrier requests information about another insurance carrier?
    • A. 

      Provide the information

    • B. 

      Call the patient and advise the patient to contact the insurance carrier with the requested information

    • C. 

      The carrier should contact the other carrier and coordinate benefits

    • D. 

      None of the above

  • 11. 
    An insurance claim with a bundled service would be
    • A. 

      Paid

    • B. 

      Rejected

    • C. 

      Suspended

    • D. 

      Denied

  • 12. 
    What should be done if an insurance claim denial is received because a billed service was not a program benefit?
    • A. 

      Rebill with a letter of explanation from the physician

    • B. 

      Write off the amount on the patient's ledger

    • C. 

      Send the patient a statement with a notation of the response from the insurance company

    • D. 

      Appeal the decision with a statement from the physician

  • 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. 

      Rebill with a letter of explanation from the physician

    • B. 

      Write off the amount on the patient's ledger

    • C. 

      Send the patient a statement with a notation of the response from the insurance company

    • D. 

      Appeal the decision with a statement from the physician

  • 14. 
    When downcoding occurs, payment will
    • A. 

      Not be affected

    • B. 

      Be denied

    • C. 

      Be less

    • D. 

      Be more

  • 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. 

      Advise the physician to write off the amount as a bad debt

    • B. 

      Pay the physician within 2 to 3 weeks and honor the assignment even before the company recovers their money from the patient

    • C. 

      Pay the physician witin 2 to 3 weeks after recovering the money from the patient

    • D. 

      Notify the physician of the error and indicate in a letter that it will never happen again

  • 16. 
    The total number of levels of redetermination that exist in the Medicare program is
    • A. 

      Two

    • B. 

      Three

    • C. 

      Five

    • D. 

      Six

  • 17. 
    The first level of appeal in the Medicare program is
    • A. 

      Redetermination

    • B. 

      Inquiry

    • C. 

      Fair hearing

    • D. 

      Appeals council review

  • 18. 
    The correct method to send documents for a Medicare reconsideration (Level 2) is by
    • A. 

      Certified mail with return receipt requested

    • B. 

      Certified mail

    • C. 

      Standard mail

    • D. 

      Overnight mail

  • 19. 
    A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least
    • A. 

      $100

    • B. 

      $250

    • C. 

      $350

    • D. 

      $500

  • 20. 
    How many levels of review exist for TRICARE appeal procedures?
    • A. 

      One

    • B. 

      Two

    • C. 

      Three

    • D. 

      Five

  • 21. 
    TRICARE appeals are normally resolved within
    • A. 

      2 weeks

    • B. 

      30 days

    • C. 

      60 days

    • D. 

      90 days

  • 22. 
    In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is
    • A. 

      $100 or more

    • B. 

      $300 or more

    • C. 

      $500 or more

    • D. 

      $1000 or more

  • 23. 
    Cash flow is
    • A. 

      The amount of money available in the cash drawer

    • B. 

      The amount of money taken into the office in a given period of time

    • C. 

      The ongoing availability of cash in the medical practice

    • D. 

      The amount of money in accounts receivable

  • 24. 
    When insurance carriers do not pay claims in a timely manner, what effect does this have on the medical practice
    • A. 

      Increased cash flow

    • B. 

      Decreased cash flow

    • C. 

      Decreased accounts receivable

    • D. 

      Decreased copayments

  • 25. 
    What does the insurance billing specialist need to monitor to be able to evaluate the effectiveness of the collection process
    • A. 

      Number of statements sent

    • B. 

      Number of claims processed

    • C. 

      Accounts payable

    • D. 

      Accounts receivable

  • 26. 
    The average amount of accounts receivable should be
    • A. 

      1.5 to 2 times the charges for 1 month of services

    • B. 

      2 to 2.5 times the charges for 1 month of services

    • C. 

      2.5 to 3 times the charges for 1 month of services

    • D. 

      3 to 3.5 times the charges for 1 month of services

  • 27. 
     Accounts that are 90 days or older should not exceed
    • A. 

      5% to 11% of the total accounts receivable

    • B. 

      10% to 15% of the total accounts receivable

    • C. 

      15% to 18% of the toal accounts receivable

    • D. 

      20% to 25% of the toal accounts receivable

  • 28. 
    What should be done to inform a new patient of office fees and payment policies
    • A. 

      Send a patient information brochure

    • B. 

      Send a confirmation letter

    • C. 

      Discuss fees and policies at the time of the initial contact

    • D. 

      All of the above

  • 29. 
    The patient is likely to be the most cooperative in furnishing details necessary for a complete registration process
    • A. 

      Before any services are provided

    • B. 

      Right after services are provided

    • C. 

      At the time of the first statement

    • D. 

      In a follow-up telephone call

  • 30. 
    The reason for a fee reduction must be documented in the patient's
    • A. 

      Financial accounting record

    • B. 

      Medical record

    • C. 

      Insurance file

    • D. 

      Registration

  • 31. 
    Professional courtesy means
    • A. 

      Applying a discount (percentage) to the entire fee

    • B. 

      Applying a discount after the insurance company has paid its portion

    • C. 

      Writing off the balance of an account after the insurance company has paid its portion

    • D. 

      Making no charge to anyone, patient or insurance company, for medical care

  • 32. 
    When collecting fees, your goal should always be to
    • A. 

      Leave the impression that you are a nice person

    • B. 

      Collect at least one half the fee

    • C. 

      Collect the full amount

    • D. 

      Collect as much as possible

  • 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. 

      Say, "all right" and bill the patient

    • B. 

      State the office policy and ask for the full fee

    • C. 

      Indicate that because it is such a small sum, it can be paid later

    • D. 

      Ask that the payment be mailed to the office

  • 34. 
    The most common method of payment in the medical office is
    • A. 

      Personal check

    • B. 

      Credit card

    • C. 

      Cash

    • D. 

      Debit card

  • 35. 
    When the physician's office receives notice that a check was not honored, the first thing to do is to
    • A. 

      Send a NSF demand letter

    • B. 

      File a claim in small claims court

    • C. 

      Call the bank or the patient

    • D. 

      Notify the patient that future payments need to be in the form of cash or money orders

  • 36. 
    Accounts receivable are usually aged in time periods of
    • A. 

      1,4,6, and 8 weeks

    • B. 

      30,60,90, and 120 days

    • C. 

      1,2,3, and 6 months

    • D. 

      30,60,90,120, and 180

  • 37. 
    Messages included on statements to promote payment are called
    • A. 

      Billing messages

    • B. 

      Statement slogans

    • C. 

      Dun messages

    • D. 

      Payment prompters

  • 38. 
    What is the type of billing system in which practice management software is used
    • A. 

      Electronic billing

    • B. 

      Manual milling

    • C. 

      Computer billing

    • D. 

      Insurance balance billing

  • 39. 
    Employment of a billing service is called
    • A. 

      Statement of service

    • B. 

      Centralized billing

    • C. 

      Outsourcing

    • D. 

      Cycle billing

  • 40. 
    The first statement should be
    • A. 

      Presented at the time of service

    • B. 

      Mailed right after the date of service

    • C. 

      Mailed 2 weeks after the date of service

    • D. 

      Mailed 30 days after the date of service

  • 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. 

      Private-label card

    • B. 

      Credit card

    • C. 

      Debit card

    • D. 

      Verifone card

  • 42. 
    How many installments (excluding a down payment) must a payment plan have to require full written disclosure
    • A. 

      Three or more

    • B. 

      Four or more

    • C. 

      Five or more

    • D. 

      Six or more

  • 43. 
    What is the name of the federal act that prohibits discrimination in all areas of granting credit
    • A. 

      Equal Credit Opportunity Act

    • B. 

      Fair Credit Reporting Act

    • C. 

      Fair Credit Billing Act

    • D. 

      Truth in Lending Act

  • 44. 
    What is the name of the act designed to address the collection practices of third-party debt collectors
    • A. 

      Equal Credit Opportunity Act

    • B. 

      Fair Credit Billing Act

    • C. 

      Truth in Lending Act

    • D. 

      Fair Debt Collection Practices Act

  • 45. 
    All collection calls should be placed
    • A. 

      After 9 AM and before 9 PM

    • B. 

      After 8 AM and before 9 PM

    • C. 

      After 8 AM and before 8 PM

    • D. 

      After 9 AM and before 8 PM

  • 46. 
    Which group of accounts would a collector target when he or she begins making telephone calls
    • A. 

      30-60 day accounts

    • B. 

      60-90 day accounts

    • C. 

      90-120 day accounts

    • D. 

      Accounts older then 120 days

  • 47. 
    In making collection telephone calls to a group of accounts, how should the accounts be organized to determine where to begin
    • A. 

      Organize the accounts alphabetically and start with the letter A

    • B. 

      Organize the accounts by account number and start with number 1

    • C. 

      Organize the accounts according to amounts owed and start with the largest amount

    • D. 

      Determine what patient you think may be easier to collect from and start with that account

  • 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. 

      Flex time

    • B. 

      Floating time

    • C. 

      Job share

    • D. 

      Salary

  • 49. 
    When writing a collection letter
    • A. 

      Do not try and be friendly; just get to the point

    • B. 

      Use a friendly tone and ask why payment has not been made

    • C. 

      Do not suggest that the patient has overlooked a previous statement

    • D. 

      Do not imply that the patient has good intentions to pay

  • 50. 
    "Netback" is a term used to describe
    • A. 

      Money collected on a bad check

    • B. 

      A fabricated story told by a patient with a delinquent account

    • C. 

      A collection agency's performance

    • D. 

      Money lost due to a "skip"

  • 51. 
    The part of the legal system that allows laypeople to settle a legal matter without use of an attorney is the
    • A. 

      People's court

    • B. 

      Justice court

    • C. 

      Small claims court

    • D. 

      All of the above

  • 52. 
    In a bankruptcy case, most medical bills are considered
    • A. 

      Secured debt

    • B. 

      Nonsecured debt

    • C. 

      Nonexempt assets

    • D. 

      Exempt assets

  • 53. 
    Which type of bankruptcy is considered "wage earner's bankruptcy"
    • A. 

      Chapter 7

    • B. 

      Chapter 11

    • C. 

      Chapter 12

    • D. 

      Chapter 13

  • 54. 
    America's oldest privately owned, prepaid medical group is the
    • A. 

      Ross-loos medical group

    • B. 

      Ina healthplan, inc

    • C. 

      Kaiser permanente medical care program

    • D. 

      Health net hmo, inc

  • 55. 
    What plan allows memebers of Kaiser Permanente Medical Care Program to seek medical help from non-Kaiser physicians
    • A. 

      Health maintenance organization (hmo)

    • B. 

      Point of service (pos)

    • C. 

      Independent practice association (ipa)

    • D. 

      Fee for service

  • 56. 
    Kaiser Permanente's medical plan is a closed panel program, which means
    • A. 

      Only certain illnesses are covered

    • B. 

      It limits the patient's choice of personal physicians

    • C. 

      It limits the patient's choice of a hospital for emergency care

    • D. 

      Services are provided on a fee-for-service basis

  • 57. 
    A significant contribution to HMO development was the
    • A. 

      Cigna plan

    • B. 

      Kaiser permanente plan

    • C. 

      Health maintenance act of 1973

    • D. 

      Omnibus budget reconciliation act

  • 58. 
    How does an HMO receive payment for the services its physicians provide
    • A. 

      Fee for service

    • B. 

      Usual, customary, and reasonable charges

    • C. 

      Allowable charges

    • D. 

      Prepaid health plan

  • 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. 

      Fee for service

    • B. 

      Capitation

    • C. 

      Usual charges

    • D. 

      Customary fees

  • 60. 
    How are physicians paid who work for a prepaid group practice model
    • A. 

      Salary paid by independent group

    • B. 

      Salary paid by a health plan

    • C. 

      Fee for service

    • D. 

      Usual, customary, and reasonable charges

  • 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. 

      Foundation for medical care

    • B. 

      Physician provider group

    • C. 

      Health care cost containment organization

    • D. 

      Professional review organization

  • 62. 
    In an independent practice association (IPA), physicians are
    • A. 

      Paid salaries by their own independent group

    • B. 

      Paid salaries by their own practice association

    • C. 

      Not employees and are not paid salaries

    • D. 

      Not paid until the end of the year in which services were rendered

  • 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. 

      Health maintenance organization (HMO)

    • B. 

      Managed care organization (MCO)

    • C. 

      Preferred provider organization (PPO)

    • D. 

      Exclusive provider organization (EPO)

  • 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. 

      IPA

    • B. 

      PPO

    • C. 

      PPG

    • D. 

      POS

  • 65. 
    A program that offers a combination of HMO-style cost management and PPO-style freedom of choice is a/an
    • A. 

      Point of service (pos) plan

    • B. 

      Exclusive provider organization (EPO)

    • C. 

      Managed care organization (MCO)

    • D. 

      Physician provider group (PPG)

  • 66. 
    Practitioners in an HMO program may come under peer review by a professional group called
    • A. 

      Peer review group

    • B. 

      Quality control group

    • C. 

      Quality improvement organization

    • D. 

      Utilization management corporation

  • 67. 
    When a physician sees a patient more than is medically necessary, it is called
    • A. 

      Buffing

    • B. 

      Turfing

    • C. 

      Churning

    • D. 

      Stirring

  • 68. 
    Referral of a patient recommened by one specialist to another specialist is known as
    • A. 

      Primary care

    • B. 

      Secondary care

    • C. 

      Concurrent care

    • D. 

      Tertiary care

  • 69. 
    What is the correct procedure to collect a copayment on a managed care plan
    • A. 

      There is no copayment with a managed care plan

    • B. 

      Bill the plan for the copayment

    • C. 

      Bill the patient for the copayment

    • D. 

      Collect the copayment when the patient arrives for the office visit

  • 70. 
    Medicare Part A is run by
    • A. 

      The local social security administration office

    • B. 

      A regional fiscal intermediary

    • C. 

      The center for medicare and medicaid services

    • D. 

      The national blue cross association

  • 71. 
    Medicare is a
    • A. 

      State health insurance program

    • B. 

      Federal health insurance program

    • C. 

      Regional health insurance program

    • D. 

      Local health insurance program

  • 72. 
    The letter "D" following the identification number on the patient's Medicare card indicates a
    • A. 

      Disabled adult

    • B. 

      Disabled child

    • C. 

      Wage earner

    • D. 

      Widow

  • 73. 
    The letters preceding the number on the patient's Medicare identification care indicate
    • A. 

      Wage earner, husband's number, widow and disabled adult

    • B. 

      Outpatient or hospital benefits

    • C. 

      Railroad retiree

    • D. 

      Medicaid eligibility

  • 74. 
    Part A of Medicare covers
    • A. 

      Physician outpatient medical services

    • B. 

      Blood transfusions

    • C. 

      Physical therapy

    • D. 

      Hospice care

  • 75. 
    Part B of Medicare covers
    • A. 

      Diagnostic tests

    • B. 

      Hospital rooms

    • C. 

      Hospice care

    • D. 

      Nursing facility care

  • 76. 
    Medicare Part A benefit period ends when a patient
    • A. 

      Is discharged from the hospital

    • B. 

      Has not been a bed patient in any hospital or nursing facility for 60 consecutive days

    • C. 

      Has not been a bed patient in any hospital or nursing facility for 30 consecutive days

    • D. 

      Has not been a bed patient in any hospital or nursing facility for 90 consecutive days

  • 77. 
    The part B Medicare annual deductible is
    • A. 

      $60

    • B. 

      $135

    • C. 

      $150

    • D. 

      $760

  • 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. 

      Once a year

    • B. 

      Every other year

    • C. 

      Once every 3 years

    • D. 

      Once every 5 years

  • 79. 
    The frequency of Pap tests that may be billed for a Medicare patient who is low risk is
    • A. 

      Once every 12 months

    • B. 

      Every other year

    • C. 

      Once every 24 months

    • D. 

      Once every 5 years

  • 80. 
    Medigap insurance may cover
    • A. 

      All physician and hospital deductibles

    • B. 

      The deductible not covered under medicare

    • C. 

      80% of the medicare allowed amount

    • D. 

      75% of the medicare allowed amount

  • 81. 
    When a Medicare beneficiary has employer supplemental coverage that is determined as the primary payer, Medicare is referred to as
    • A. 

      Medigap

    • B. 

      Medicaid

    • C. 

      Msp

    • D. 

      Lghp

  • 82. 
    Some senior HMOs may provide services not covered by Medicare, such as
    • A. 

      Laboratory and x-ray services

    • B. 

      Vaccines and ambulance services

    • C. 

      Mammograms and pap smears

    • D. 

      Eyeglasses and prescription drugs

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