Question 1

The statement that "coding professionals should not change codes. . .to increase billings" is an example of

Accepted Answer

A)   professional ethics.
B)   professional etiquette.
C)   professional services.
D)   personal ethics.

Question 2

Under a capitated rate for each plan member, which of the following does a provider share with the third-party payer?

Accepted Answer

A)   the premium
B)   risk
C)   services
D)   payments

Question 3

Which of the following conditions must be met before payment is made under an indemnity plan?

Accepted Answer

A)   payment of the deductible
B)   payment of the premium and coinsurance
C)   payment of the copayment
D)   payment of premium, deductible, and coinsurance

Question 4

When is a deductible paid?

Accepted Answer

A)   at the end of the year
B)   never
C)   after benefits begin
D)   before benefits begin

Question 5

What do providers participating in a PPO generally receive in exchange for accepting lower fees?

Accepted Answer

A)   capitation payments
B)   less patient visits
C)   more patient visits
D)   increased hospitalization rates

Question 6

For a patient insured by an HMO, the phrase "out-of-network" means providers who are

Accepted Answer

A)   only acting as a specialist.
B)   not under contract with the payer.
C)   licensed by the state.
D)   whose offices are more than 50 miles from the patient.

Question 7

Pick the most accurate definition of certification.

Accepted Answer

A)   recognition of higher level of degree of schooling
B)   recognition of professionalism
C)   recognition of a superior level of skill by an official organization
D)   recognition of a successful career

Question 8

Dependents of a policyholder may include his/her

Accepted Answer

A)   only children.
B)   physician.
C)   only spouse.
D)   spouse and children.

Question 9

Identify the type of HMO cost-containment method that requires the patient to pay a copayment.

Accepted Answer

A)   restricting patients' choice of providers
B)   controlling drug costs
C)   cost-sharing
D)   requiring preauthorization for services

Question 10

Calculate the amount of money a patient would owe for a covered service costing $1,200 if their indemnity policy has a coinsurance rate of 75-25, and they have already met their deductible.

Accepted Answer

A)   $1,200
B)   $900
C)   $300
D)   $0

Question 11

In a medical practice, cash flow is required to

Accepted Answer

A)   pay for hospital supplies.
B)   pay for office expenses.
C)   pay for the staff of an insurance company.
D)   pay for nursing home employees.

Question 12

Calculate the amount of money a patient would owe for a covered service costing $1,800 if their indemnity policy has a $400 deductible (which has not been met)  and their coinsurance rate is 80-20.

Accepted Answer

A)   $680
B)   $1,800
C)   $1,400
D)   $280

Question 13

In how many managed care plans may a physician participate?

Accepted Answer

A)   one
B)   two
C)   many
D)   zero

Question 14

Under a fee-for-service plan, the third-party payer makes a payment

Accepted Answer

A)   once a month under a PMPM.
B)   before medical services are provided.
C)   after medical services are provided.
D)   at the time of the visit.

Question 15

Courteous treatment of patients who visit the medical practice is an example of medical

Accepted Answer

A)   ethics.
B)   insurance.
C)   etiquette.
D)   coding.

Question 16

Medical insurance specialists use practice management programs to

Accepted Answer

A)   schedule patients.
B)   collect data on patients' diagnoses and services.
C)   record payments from insurance companies.
D)   All of these are correct.

Question 17

What skills are required for successful mastery of the tasks of a medical insurance specialist?

Accepted Answer

A)   courtesy and good attendance
B)   professional appearance and attention to detail
C)   initiative and communication skills
D)   attention to detail and ability to work as a team member

Question 18

A computerized lifelong health care record for an individual that incorporates data from all sources is known as a(n)

Accepted Answer

A)   electronic health record (EHR) .
B)   lifelong health care record (LHR) .
C)   practice management program (PMP) .
D)   computerized health record (CHR) .

Question 19

In what format are health care claims sent?

Accepted Answer

A)   electronic or hard copy
B)   claims do not need to be sent
C)   only hard copy
D)   only electronic

Question 20

Choose the entity(ies)  that may form agreements with an MCO.

Accepted Answer

A)   the patient and provider
B)   the provider
C)   the health plan
D)   the provider and health plan

Exam 1: Introduction to the Medical Billing Cycle

Identify the type of HMO cost-containment method that requires the patient to pay a copayment.

Correct AnswerverifiedShow Answer

In how many managed care plans may a physician participate?

Correct AnswerverifiedShow Answer

A computerized lifelong health care record for an individual that incorporates data from all sources is known as a(n)

Correct AnswerverifiedShow Answer

When is a deductible paid?

Correct AnswerverifiedShow Answer

In a medical practice, cash flow is required to

Correct AnswerverifiedShow Answer

Medical insurance specialists use practice management programs to

Correct AnswerverifiedShow Answer

Calculate the amount of money a patient would owe for a covered service costing $1,200 if their indemnity policy has a coinsurance rate of 75-25, and they have already met their deductible.

Correct AnswerverifiedShow Answer

Under a capitated rate for each plan member, which of the following does a provider share with the third-party payer?

Correct AnswerverifiedShow Answer

Under a fee-for-service plan, the third-party payer makes a payment

Correct AnswerverifiedShow Answer

Which of the following conditions must be met before payment is made under an indemnity plan?

Correct AnswerverifiedShow Answer

Dependents of a policyholder may include his/her

Correct AnswerverifiedShow Answer

The statement that "coding professionals should not change codes. . .to increase billings" is an example of

Correct AnswerverifiedShow Answer

What skills are required for successful mastery of the tasks of a medical insurance specialist?

Correct AnswerverifiedShow Answer

For a patient insured by an HMO, the phrase "out-of-network" means providers who are

Correct AnswerverifiedShow Answer

What do providers participating in a PPO generally receive in exchange for accepting lower fees?

Correct AnswerverifiedShow Answer

Choose the entity(ies) that may form agreements with an MCO.

Correct AnswerverifiedShow Answer

Courteous treatment of patients who visit the medical practice is an example of medical

Correct AnswerverifiedShow Answer

In what format are health care claims sent?

Correct AnswerverifiedShow Answer

Calculate the amount of money a patient would owe for a covered service costing $1,800 if their indemnity policy has a $400 deductible (which has not been met) and their coinsurance rate is 80-20.

Correct AnswerverifiedShow Answer

Pick the most accurate definition of certification.

Correct AnswerverifiedShow Answer

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