Understanding Health Insurance

30 Questions  I  By Auilda on February 13, 2010
Mid term practice test.

  
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Question Excerpt

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1.  A commercial insurance company sends a letter to the physician requesting copy of a patient's entire medical record in order to process payment, No other documents accompany the letter. The Insurance Specialist should:
A.
B.
C.
D.
2.  Which is considered Medicare Abuse?
A.
B.
C.
D.
3.  When the CMS-1500 requires a response to Yes or No entries, enter:
A.
B.
C.
D.
4.  When a child who is covered by two or more plans lives with his married parents, the primary policyholder is the parent:
A.
B.
C.
D.
5.  When the CMS-1500 claim requires spaces for entry of a date, the entry looks like which of the following?
A.
B.
C.
D.
6.  Health reform was initiated in 1930 when the _____ was funded by charitable organizations to address the concerns about the cost and distribution of medical care.
A.
B.
C.
D.
7.  When an X is entered on one or moreof the YES boxes in Block 10 of the CMS-1500 claim, payment might be the  responsibility of a ________ insurance company.
A.
B.
C.
D.
8.  Workers compensation is an insurance program that requires employers to cover medical expenses and
A.
B.
C.
D.
9.  A health care practioner is also called a:
A.
B.
C.
D.
10.  When a SIGNATURE ON FILE is the appropriate entry for a CMS-1500 claim block, which is also acceptable as an entry?
A.
B.
C.
D.
11.  If health plan preauthorization requirement are not met by providers,
A.
B.
C.
D.
12.  Outpatient surgery and surgeon charges for inpatient surgery are billed according to a global fee. Which means that the presurgical evaluation an mangement, initial and subsequent hospital visits, surgical procedure, discharge visit, and uncomplicated postoperative followup care in the surgeon's office are billed as:
A.
B.
C.
D.
13.  Block 33a of the CMS-1500 claim contains the provider's:
A.
B.
C.
D.
14.  Which is considered Medicare Fraud?
A.
B.
C.
D.
15.  Remittance advice contains:
A.
B.
C.
D.
16.  When a patient is covered by a large employer group health plan (EGHP) and Medicare, which is primary?
A.
B.
C.
D.
17.  When an insurance company uses the patient's social security number as the patient's insurance identification number, Block 1a of the CMS-1500 claim:
A.
B.
C.
D.
18.  When Block 25 of the CMS-1500 contains the provider's EIN, enter _____ after the first two digits of the EIN (Employer Identification Number)
A.
B.
C.
D.
19.  By 1880 , how many insurance companies offered health insurance policies?
A.
B.
C.
D.
E.
20.  When completing a CMS-1500 claim using computer software, text should be entered in ____ case.
A.
B.
C.
D.
21.  A patient develps surgical complications and returns to the operating room to undergo surgery related to the orginal procedure. The return surgery is :
A.
B.
C.
D.
22.  When a patient is covered by the same primary and seconday commercial health insuranceplan,
A.
B.
C.
D.
23.  Which coding system is used to report diagnoses and conditions on claims?
A.
B.
C.
D.
24.  In what year were prepaid health health plans introduced?
A.
B.
C.
D.
25.  Block 14 of the CMS-1500 claim requires entry of the date the patien first experienced signs or symptoms of an illness or injury (or date of last menstrual period for obstetric visits). Upon completion of Jean Mandel's claim, you notice that there is no documentation of that date in the in the record. The provider does document that her pain began five days ago. Today is May 10, YYYY.  What do you enter in block 14?
A.
B.
C.
D.
26.  Which situtation requires the provider to write a letter explaining special circumstances?
A.
B.
C.
D.
27.  When entering the patient's name in Block 2 of the CMS-1500 claim, separate the last name, first name, and middle name, and middle intial (if known) with:
A.
B.
C.
D.
28.  Which report is sent to the patient to detail the results of claims processing?
A.
B.
C.
D.
29.  The process of assigning diagnoses, procedures, and services using numeric and alphanumeric characters is called:
A.
B.
C.
D.
30.  Medical malpractice insurance is a type of _______________ insurance.
A.
B.
C.
D.
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