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MA210 Final Exam Review (revised) Flashcards | StudBud
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MA210 Final Exam Review (revised)
MA210 Final Exam Review (revised)
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1
______ is a method of reimbursement in which Medicare payment for pt services is based on a predetermined, fixed amount.
prospective payment system
geographic practice cost index
diagnosis-related group
conversion factor
2
Part ___ of Medicare is for payment of medical expenses such as office visits and X-ray and laboratory services.
C
D
B
A
3
Ins offered by private companies to pts eligible for Medicare & specifically designed to supplement such benefits:
Medicaid
TRICARE
CHAMPVA
Medigap
4
Which level of the HCPCS includes codes that identify products, supplies, and services not included in CPT?
Level III
Level IV
Level II
Level I
5
Who publishes Current Procedural Terminology (CPT)?
World Health Organization (WHO)
Department of Health and Human Services (HHS)
American Public Health Association (APHA)
American Medical Association (AMA)
6
If a Dr. doesn't accept assignment from Medicare, the maximum chargeable amount is __% of the Medicare-approved amount
85
150
100
115
7
Which of the following are considered third-party (insurance) plans?
group health plans
Medicare
court-ordered health coverage
all responses are correct
8
A provider may not charge a patient for:
the part of the deductible thathas not been met.
any coinsurance that is due.
an amount reimbursed after accepting assignment.
a service not covered by the patient's insurance
9
When a patient arrives at the medical office, you should copy of the insurance card(s):
only the back
only the front
neither side
both sides
10
Which of the following statements is true regarding Healthcare Common Procedural Coding System (HCPCS) Level II codes?
Developed to identify products & supplies which there are no CPT codes
Level II codes are composed of one alpha and four numeric characters.
All of the above
Level II G codes are temporary codes for procedures/professional services.
11
MDs who see pts under workers’ comp plans are usually required to register with the state Workers’ Compensation Board:
only once, unless they move or change the name of the medical practice.
every five years
on an annual basis.
anytime they need to file a claim.
12
When patients without health insurance are seen in the medical practice, they are classified as as ____ patients.
reimbursement
pro bono
self-pay
TRICARE
13
Part ___ of Medicare was created to provide coverage for both generic and brand-name drugs.
B
C
A
D
14
Which type of HMO is composed of providers who practice in their own offices & retain their own staff and operations?
group model
staff model
preferred provider organization (PPO)
independent practice association
15
Information required to file a third-party claim on the CMS-1500 form includes all but:
the co-pay receipt given to patient at time of visit
the insured’s name, full address, and telephone number.
the relationship to the insured.
access to a photocopy of the patient’s insurance card.
16
A professional courtesy discount is an example of a(n)
overpayment
deposit
balance
adjustment
17
Which of the following would
not
be a required step in utilizing medical necessity guidelines?
Reviewing the narrative diagnostic finding(s) indicated
Reviewing the order from provider
Reviewing the family history section of the progress note
Ensuring all procedures, services & diagnoses are identified on encounter
18
Since 2005, providers have been urged to:
send claims electronically.
send claims manually.
bill patients directly, requiring them to seek reimbursement on their own.
require patients to pay the full balance before leaving the office.
19
If a provider doesn't accept assignment, the most that can be charged to the pt is ___ % of the Medicare-approve amount
85
115
100
150
20
When a pt leaves the hospital, ____ is used to ensure that the pt is being discharged to the most appropriate setting.
discharge planning
utilization review
diagnostic planning
capitation
21
The process of billing a secondary insurance company involves which of the following?
Bill at the same time you bill the initial claim to the primary insurance.
Click the unprinted paper claims link.
Once primary ins payment is received, a new bill with balance is sent
Check the set to bill link.
22
34: Medicare will ______ pay for services/supplies considered medically reasonable & necessary for the diagnosis given.
none of the above
sometimes
not
only
23
A(n) _____ form lists the procedures performed in a medical office and their respective codes.
confidentiality
encounter
coding
credit
24
Medicare pays ____ percent of the approved medical bill amount once the deductible is satisfied.
70
80
60
20
25
Which of the following is
not
considered an error when a claim is rejected?
the correct place of service code
incorrect patient birth date
a patient’s nickname is used instead of their legal name
the sex of the patient is missing
26
In 2019, the penalty, per violation of the federal anti-kickback statute was:
$20,504
$52,308
$102,522 per violation
$10,461
27
Which type of insurance does not require a referral for patient care and specialists?
indemnity-type insurance
health maintenance organization (HMO)
preferred provider organization (PPO)
all require a referral to see a specialist or another provider
28
International Classification of Diseases (ICD) codes are descriptive of the:
medications used in treatment.
presenting disease or condition.
form of treatment used.
presenting symptoms.
29
What is the requirement to generate a referral for a patient with a managed care insurance plan?
The provider (or MA) must obtain verification of eligibility for services.
The PCP must generate a referral in order for the pt to see a specialist.
Patient must first see his or her primary care provider (PCP).
All of the above
30
_____ serves as amiddleman between providers, billing groups, payers, & other medical offices to clean & transmit claims
CMS-1500.
UB-04.
clearinghouse.
crossover claim.
31
A _____ is used to inform third-party payers that circumstances for a particular code have been altered.
translator
modifier
qualifier
provision
32
Upcoding can result in:
none of the above.
capturing all related procedures and diagnoses for the patient visit.
increased revenue to the practice.
serious fines and penalties.
33
The term ___ refers to the discovery of the max amount of money that insurance will pay for surgery, consultations , etc
precertification
predetermination
preauthorization
pretreatment
34
When following up on a delinquent claim, if the carrier tells you that it is still in process, you should:
request an anticipated date of payment.
resubmit the claim by mail.
send the patient a statement.
resubmit the claim by fax.
35
Main rule to remember of ICD coding rules, says that the reason for the pt visit (encounter) is coded first is known as:
reason rule.
indexing rule.
supporting rule.
classification rule.
36
When coding, the primary reason for the office visit is listed first, and other reasons are listed in what order?
numerical order
order of importance
alphabetical order
chronological order
37
The standard claim form designed by CMS to submit provider services for third-party (ins companies) payment is known as:
fee disclosure.
Affordable Care Act (ACA).
coordination of benefits (COB).
CMS-1500.
38
Which form is also known as the UB-04 form?
CMS-1500
CMS-1450
FCC Form 159-C
explanation of benefits (EOB) form
39
Who publishes Current Procedural Terminology (CPT)?
World Health Organization (WHO)
Department of Health and Human Services (HHS)
American Medical Association (AMA)
American Public Health Association (APHA)
40
Which of the following would be considered a step (s) to obtain precertification or preauthorization for a procedure?
All of the above are necessary steps.
Determine if precertification or preauthorization is required.
Find form on the ins company website or call to obtain
Complete the form correctly; fax to the ins company or send electronically
41
When records are reviewed by third-party payers, if a procedure is not documented, it:
will be reimbursed at only 10 percent of the standard rate.
must be resubmitted with a statement of explanation from the provider.
is considered to never have been performed.
will be reimbursed at only 50 percent of the standard rate.
42
When a third-party payer identifies an error on the claim form, the claim is:
held indefinitely until the med office calls to inquire about its status.
rejected and barred from resubmission.
rejected with a request to resubmit the form with corrections.
paid, with a penalty fee subtracted for the error.
43
Discounts must generally be authorized by the:
clinical medical assistant
provider
patient
administrative medical assistant
44
When coding, the primary reason for the office visit is listed first, and other reasons are listed in what order?
numerical order
chronological order
alphabetical order
order of importance
45
Which below is
not
one of the necessary pieces of info to have before you follow up on a delinquent insurance claim?
the patient’s name, identification number, and group name or number
the amount of co-pay received from the patient
your practice’s tax identification number
if the patient is not the insured, the insured’s (e.g., spouse’s) name
46
Which of the following are considered third-party (insurance) plans?
Medicare
court-ordered health coverage
group health plans
All of the above
47
In the past, the ____ system was exclusively used to record financial transactions.
pegboard
investment
checking
computerized
48
Computerized practice management software does not:
allow instant access to up-to-date financial information.
decrease errors
require a lot of time to post procedures to patient accounts.
increase efficiency.
49
The CPT manual uses symbols to indicate specific information about code numbers. For example, the + symbol stands for:
new code.
revised text.
modifier -51 exempt.
add-on code.
50
The primary insurance information will be placed in _______ of the CMS-1500 form for secondary billing.
Block 9
the FECA number block
the resubmission code block
the [Reserved for NUCC use] block
