Deck 18: Medical Insurance and Coding

Question 1

Which of the following is a mechanism that pays medical providers for their services?

A) Private health-insurance programs
B) Consumer-driven health plans
C) Government health coverage plans
D) All of the above

Answer 1

D

Question 2

Which of the following terms refers to the monetary compensation for medical care provided?

A) Documentation
B) Diagnostic coding
C) Reimbursement
D) Billing

Answer 2

C

Question 3

Which of the following terms means "A fixed fee that is received from the payment each time care is provided"?

A) Co-pay
B) Co-insurance
C) Deductible
D) Reimbursement

Answer 3

A

Question 4

Which of the following terms means "The amount an individual must pay before the insurance provider will begin paying for services"?

A) Co-pay
B) Deductible
C) Co-insurance
D) Annual premium

Question 5

_________ insurance protects people from the high costs associated with medical care.

A) Co-
B) Network
C) Health
D) Personal

Question 6

Which one of the following groups do most people in the United States receive their health insurance through?

A) Employers
B) Government
C) Fee-for-service
D) Family

Question 7

What is one of the major benefits of receiving healthcare services on a fee-for-service basis?

A) Lower out-of-pocket costs
B) Increased flexibility and choice in providers and treatment plans
C) Decreased waiting room time
D) Accessibility to better healthcare providers

Question 8

Which of the following is NOT a goal of the Affordable Care Act of 2010?

A) Expand coverage
B) Improve access to health care
C) Decrease deductibles
D) Make insurance companies more accountable for their coverage decisions

Question 9

What year will most changes outlined in the Affordable Care Act begin?

A) 2012
B) 2014
C) 2010
D) 2015

Question 10

What is the primary goal of a managed care system?

A) Provide comprehensive healthcare
B) Help patients obtain routine care
C) Reduce costs
D) Provide preventative services

Question 11

Which of the following is a privately owned and managed health-insurance provider?

A) Commercial insurance
B) Managed care
C) Health maintenance organization
D) Preferred provider organization

Question 12

Which of the following insurance plans requires individuals to select a primary care provider (PCP)?

A) Consumer-driven health plan
B) Managed care
C) Health maintenance organization
D) Preferred-provider organization

Question 13

Which of the following are accounts that can be used to pay for medical services not covered by the health-insurance provider?

A) HSA and FSA
B) CDHP
C) PPO
D) HMO

Question 14

Which of the following groups will Medicare NOT provide health insurance for?

A) People over 65
B) People who are diagnosed with ESRD
C) People who are diagnosed with CPOD
D) People who are disabled

Question 15

Which of the following individuals does Medicaid provide health-insurance coverage for?

A) Low-income families
B) Uninsured pregnant women
C) Disabled persons
D) All of the above

Question 16

_______ is the process of assigning alphanumeric designations to diagnoses, procedures, and services.

A) Reimbursement
B) Coding
C) Insured
D) Categorizing

Question 17

What is the name of the universal system of classification and record-keeping for healthcare providers?

A) International Categorization of Diseases
B) Healthcare common procedure coding system
C) International Classification of Diseases
D) Current procedural terminology

Question 18

The healthcare common procedure coding system (HCPCS) is a set of codes that standardizes the identification of medical:

A) Services, supplies, and equipment
B) Equipment, prosthetics, orthotics, and supplies
C) Medications
D) Facilities

Question 19

Which of the following are symptoms of diabetes?

A) Polydipsia
B) Polyuria
C) Polyphagia
D) All of the above

Question 20

What is the term that refers to the act of an insurance provider only paying for certain claim codes and ignoring others?

A) Unbundling
B) Bundling
C) Downcoding
D) Upcoding

Question 21

The standard medical insurance claim form submitted by most office practices and accepted by Medicare, Medicaid, and other insurance providers is a(n):

A) CMS-1400
B) CMS-1500
C) CMS-1450
D) UB-04

Question 22

What two pieces of equipment are needed to use medical coding to reflect care provided?

A) Patient encounter form and patient record
B) Form CMS-1500 and patient record
C) Patient encounter form and CPT manual
D) CPT manual and patient record

Question 23

According to requirements from the Health Insurance Portability and Accountability Act, patients must have a _________ on file for the provider to release data to the insurance company for benefit or payment information.

A) Record
B) Address
C) Signature
D) Phone number

Question 24

As a medical assistant, which skills will best ensure that maximum insurance benefits are received in a timely manner?

A) Attention to detail and accuracy
B) Accuracy and speed
C) Attention to detail and friendliness
D) Speed and telephone etiquette

Question 25

What is one of the common errors found on a claims form?

A) Assignment of incorrect codes to diagnoses or treatments
B) Including too much patient information
C) Including specific and accurate information
D) Assigning the primary concern code first and all others secondary