Module 113 Final Review
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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.
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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