Elance Medical Billing Test Answers
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An illegal practice of assigning an ICD-9 diagnosis code that does not agree with the patient records for the purpose of increasing the reimbursement from the insurance payor is called:
Code banking
Upcoding
ICD skimming
Pocketlining
In which month do commercial insurance and Medicare deductibles start each year?
January
March
June
October
Is a co-payment an out of pocket expense?
Sometimes
No
Yes
A patient on an HMO plan typically needs a _________ to receive care from a specialist.
prescription
referral
validation
clearance
What is Dx refer to?
Diagnosis
code
Cancelled diagnosis
Bill cancellation
Post-mortem diagnosis
The predetermined (flat) fee, a patient usually has to pay on each office visit is a:
Code
Co-pay
Carrier
Co-insurance
What organ is measured in an EKG/ECG?
Heart
Lung
Kidney
Brain
Which of these would be a valid reasons for a claim to be denied?
The medical condition was deemed by the insurance company as being
preexisting
The service was considered as not being medically necessary
The service was not covered under the patient’s health insurance
contract.
All
are valid reasons
What is COBRA insurance?
It is an insurance plan specific to the military
Insurance for exotic injuries
Insurance
available to individuals after they become unemployed
It is a slang term used to describe uninsured emergency room patients
The date the insurance policy is set to begin or when benefits or covered services are allowed is most commonly known as the:
Effective
date
Startup date
Float date
Coverage blanket date
Which federal law strengthens the privacy of a patient's PHI and allows a patient to review their medical record?
Medicare
HEDIS
COBRA
HIPAA
Place of service codes on claims are there to define?
The type of service
The time of service
The
place of service where services were rendered
The payment qualifier
True or false? Sometimes multiple treatments will fall under one billing code.
False
True
The amount paid, often in monthly installments, for an insurance policy by the employer or patient themselves, is the:
Deductible
Co-pay
Premium
OOP
What does COB commonly refer to?
Course of Body
Cost of Billing
Cost on Bottom
Coordination
of Benefits
The federal law that allows a worker to continue to purchase employer paid health insurance for up to 18 months if they lose their job or your coverage is otherwise terminated is known as:
Medicaid
COBRA
NOSSCR
HMO
What is a premium?
Name-brand medication
The
amount paid for an insurance policy
The copay
Paying extra for a private hospital room
What do the CPT codes refer to?
The
procedures performed by a physician or a practitioner
The procedures performed by Medical biller
The diagnoses performed on the patient
The names of the medicines prescribed by the practitioner
The disease that the patient is suffering from
In medical billing, what is the function of a clearinghouse?
It
checks bills for errors then transmits them to the insurance company
It runs background checks on patient credit history
It calculates total patient bills
It processes all of the payments
True or False? Tertiary insurance is intended to cover gaps in coverage the primary and secondary insurance may not cover.
True
False
HIPAA stands for:
Health Insurance Protected Act of America
Health
Insurance Portability Accountability Act
This health insurance coverage is available to an individual and their dependents after becoming unemployed - either due to voluntary or involuntary termination of employment for reasons other than gross misconduct.
USICA
COBRA
Insurance
Medicare Insurance
GovCare
Co - Insurance
The exact abbreviation of RA in medical billing terminology?
Rheumatoid Arthritis
Regular Appointment
Remote Agent
Remittance
Advice
Right Atrium
Which of these are NOT standard statuses of a claim in a typical EOB?
Paid
Denied
Pending
Transition
________ billing is when a patient is charged for the difference between what a doctor bills and what the provider and insurance company agree upon.
Fair
Balanced
Upcoding
Downcoding
Health Insurance Claim (HICN) is a number assigned by the Social Security Administration to an individual identifying him/her as a _______ beneficiary
Medicare
COBRA
Medicaid
CHIP
Hospital beds, wheelchairs and oxygen equipment would be considered examples of:
COBRA
DME
EBSA
DOS
A type of health coverage that typically allows a patient to go to any doctor or provider without permission is known as:
On-call fees
Fee-for-Service
Contractor insurance
Descriptor insurance
If a physician uses an open-panel HMO, can they see non-HMO patients?
Yes
No
True or False? AWP laws are state laws that require health insurance companies to accept into their PPO and HMO networks any provider willing to agree to the insurance company's terms and conditions.
False
True
When submitting a secondary claim, what is the name of the document that must be attached?
Certificate of codding
Certificate of Medical Necessity
Explanation
of Benefits
Benefits of Explanation
Explanation of Medical Necessity
What is capitation?
A
system that pays physicians and nurses a set amount per enrolled patient
assigned to them
A payment scheduling method
The hierarchy of payments
The process of cutting down the price of a medical bill
What is the purpose of an Advanced Beneficiary Notice?
To alert a patient to a change in their premium payments
To alert the hospital to changes in Medicare's coverage policies
To
alert a patient that Medicare may deny payment for a specific procedure or
treatment
To confirm receipt of a patient's payment
Which of the following would you likely use if billing Medicare?
HCFA1500
UB-92
UB-04
W-4
With the implementation of HIPAA, all the following systems became mandatory EXCEPT:
HCPCS
ADT
CPT
ICD
Which part of Medicare is the drug prescription coverage?
Part A
Part B
Part
D
Part C
The Employer Identification Number is also known as the:
Health Department Identification Number
Federal
Tax Identification Number
Social Security Identification Number
Employer Group Health Plan
What is a clearing house?
Payment clearing authority
Intermediary
between provider and insurance
None of these
Hygienic Place
All of these
True or False? ERISA includes PPOs, POS, and HMO benefit plans.
False
True
The ICD-9-CM coding classification to identify health care for reasons other than injury or illness is
V-code
H-code
T-code
A-code
True or False? A Medicaid MCO provides comprehensive services to Medicaid beneficiaries, but not commercial or Medicare enrollees.
True
False
Which of the following is an agreement made between the insurance company and the insured to send payments directly to the physician?
Referral
Preauthorization
Coordination of Benefits
Assignment
of Benefits
Pre-Existing Conditions
True or false? Undercoding is illegal.
FALSE
True
Who is eligible for Medicare part C
An
individual who is covered under Parts A and B
An individual who has an HMO plan
An individual who pays all premiums
An individual who has a supplemental Plan
The form the provider uses to document the treatment and diagnosis for a patient visit which typically includes ICD-9 diagnosis and CPT procedural codes is the:
Advanced payment form
Superbill
Focused item bill
IPC-450 form
The HIPAA approved standard paper claim form submitted to insurance companies to have the outpatient health benefit or the contracted provider visit paid is the:
CMS 1450
HIPAA 1500
CMS
1500
HIPAA 1450
Health insurance coverage which is contracted to supplement Medicare coverage is called:
Medigap
HMO extension
Medicaid
SSDI
What does UCR stand for?
Ultra Conservative Response
Usual,
customary, or reasonable
Unique Client Referral
Unusual Chronic Illness
What could POS exactly stand for in Medical Billing?
Point of Service
Place
of Service
Polycystic Ovary Syndorme
Charging for services that are not medically necessary are included under:
Abuse
Custodial care
Information models
Low cost alternatives
What are modifiers used for?
They are an indicator to show that a procedure is linked to more than
one diagnosis
They are used to add more information about a ICD10 CM code
They are used to add more information about a ICD-9 CM code
They help in establishing "medical necessity"
They
are used to add more information about a CPT code
True or False? The difference between the Medicare and Medicaid allowable is that Medicaid does NOT pay a percentage of the allowed amount.
True
False
Level II HCPCS codes are formatted as a single letter followed by _________.
Four
numeric digits
five numeric digits and one letter
Two numeric digits and three letters
Two numeric digits and 2 letters
The claim form for billing for facility fees which replaces the UB92 form is the _______ form.
UB04
UB100A
CMS 1450
SNF20
How many digits are in a National Provider Identifier?
4
9
11
8
10
True or false? The coder should NOT correct any errors in a bill.
TRUE
False
Which one of the following was known as Medicare + Choice?
Part B
Part D
Part A
Part
C
The average amount Medicare will pay a provider or hospital for a procedure is the:
PTAN
RVU
SNF
CCRC
Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called:
Focused care
Ancillary
care
Extraneous services
All of these are correct
A 3-digit number used on hospital bills to tell the insurer where the patient was when they received treatment, or what type of item a patient received, is the:
SMI code
Policy identification number
Medical Code
Revenue
Code
Tricare was formerly known as
United States Department of Defense Military Health System
Civilian
Health and Medical Program of the Uniformed Services(CHAMPUS)
Civilian Health and Medical Program of the United States(CHAMPUS)
None of the above
Humana Military Healthcare Services
Coding for a name-brand medication when a generic brand was used is called __________.
Upcoding
Swapping
Upgrading
Value-coding
What is a challenge of processing medical bills off site?
None of these
Governmental regulations
The
biller may not be able to contact the physician
It is illegal to process medical bills off site
The difference between the summarized income rate and the summarized cost rate over a given valuation period is the:
Actuarial
Balance
Administrative discrepancy
MediGap
Cost restraints
Submitting several CPT treatment codes when only one code is necessary is called:
Unbundling
Fraud
Facility charges
Abuse
A health benefit plan allowing the patient to choose to receive a service from a group of contracted providers is a:
OOP
PCP
PPT
POS
The form which is specifically used to bill dental services is called?
UB-04 form
Dental Claim form
ADA
form
HCFA 1500 form
True or False? Med pay is a form of no-fault insurance.
True
False
The federal law that was originally created to safeguard an employees retirement benefits is abbreviated as:
COBRA
TRICARE
NOSSCR
ERISA
Will Medicare accept a UB-92 form?
No
Sometimes
Yes
What is the abbrevation for SSI?
Supplemental Security Information
Social Security Information
None of the above
Supplemental
Security Income
Social Security Income
True or false? An individual on an HMO plan would need a referral to get a yearly mammogram.
TRUE
False
Medicare Advantages Plans cover consultation codes?
Yes
No
Partially
Which one of the following is the largest Blue Cross Blue Shield member?
Highmark
Premera
WellPoint
CareFirst
This type of workers compensation would be described as: abnormal conditions or disorders caused by exposure to enviromental factors. Examples of these could be exposure to a chemical, inhalation, ingestion or direct exposure.
Federal Employment Liability Act
Industrial accident
Occupational
illness
State Workers Compensation
Occupational Safety and Health Administration
According to the MBAA, up to _____ % of US medical bills contain errors.
50%
80%
5%
35%
A ________ limits the amount of out-of-pocket expenses a patient will have to pay for TRICARE-covered medical services.
Care ceiling
HMO cap
catastrophic
cap
TRICARE cap
If a provider is non-par, any allowed claim amount that is ______ billed charges should be unacceptable.
equal to
more than
less
than
In DME claims which of the following is necessary: Referring physician or Ordering physician?
Neither
Both
Ordering Physician
Referring
Physician
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