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Ch. 12,13,14,15,16
Insurance Handbook for the Medical Office Ch. 12,13,14,15,16 Pretest
| Question | Answer |
|---|---|
| Of the following, who is eligible for Medicare benefits? | Retired people over 65 and on Social Security, Disabled workers of any age, Kidney donors *(all of the above)* |
| Which of the following is not covered under the Medicare preventive care benefits? | Glaucoma screening once every 3 months |
| The medical insurance billing specialist should inquire about a Medicare patient's: | auto liability insurance, disability insurance, employee group health plan *(all of the above)* |
| The time limit for filing a claim is: | the end of the calendar year after the fiscal year when services were furnished. |
| If Medicare overpays a reimbursement, you should: | deposit the check. |
| An alien may be eligible for Medicare benefits if he or she has lived in the United States as a permanent resident for _____ years. | 5 |
| Medicare Part A covers ___________ benefits; Medicare Part B covers ___________ benefits. | hospital and medical |
| If the Medicare guidelines are not known for a certain procedure or service, ask the patient to sign a(n) ____________________. | Advance Beneficiary Notice of Noncoverage (ABN) |
| Medicare's ________________________ is implemented by CMS to eliminate unbundling or other inappropriate reporting of Current Procedural Terminology (CPT) codes. | Correct Coding Initiative (CCI) |
| A Medicare _________________ may limit the number of times a given procedure can be billed. | prepayment screen |
| ___________________ is a federally aided, state-operated, and state-administered program that provides medical benefits for certain low-income persons in need of health and medical care. | Medicaid |
| In California, Medicaid is known as _____________. | Medi-Cal |
| Medically indigent low-income individuals and families, and low-income persons losing employer health insurance are categorized under Medicaid as ____________. | medical needy |
| Most states have _________________ for Medicaid payments if a patient requires medical care while out of state. | reciprocity |
| Each state has a(n) __________________ to investigate and prosecute cases of fraud and other violations, including complaints of mistreatment in long-term care facilities. | medicaid fraud control |
| In all states, the Maternal Child Health Program includes children who have some kind of handicap that requires _________________. | orthopedic treatment |
| Which of the following are exempt from copayment requirements? | Emergency care, Pregnancy care *(both a and b)* |
| Which of the following is an aid program under Medicare for low-income patients? | Medicaid Qualified Medicare Beneficiary Program, Specified Low-Income Medicare Beneficiary Program, Qualifying Individuals Program *(all of the above)* |
| When a Medicaid patient has Medicare, TRICARE, or CHAMPVA, Medicaid should be billed: | second. |
| Though the time limit to appeal a claim varies from state to state, generally an appeal must be filed within: | 30-60 days. |
| In 1994, __________________ became the new title for CHAMPUS. | TRICARE |
| To be a covered member of TRICARE, you must be enrolled in __________________. | Defense Enrollment Eligibility Reporting System (DEERS) |
| TRICARE and Veterans Health Administration (or CHAMPVA) beneficiaries who wish to receive treatment as inpatients from a civilian hospital need certification called a(n) _______________. | Nonavailability Statement |
| Medically necessary treatment needed for an illness or injury that would not result in further disability or death if not immediately treated is _______________. | urgent care |
| The catchment area is defined by an area surrounding ______________ of each U.S. military treatment facility (MTF). | 40 miles |
| What is a term for an active duty service member who qualifies for TRICARE? | Sponsor |
| What type of health coverage plan is TRICARE Prime? | HMO |
| Active duty service members (ADSMs) who live and work more than 50 miles or 1 hour from military treatment facilities are eligible for which program? | TRICARE Prime Remote Program |
| Which individual would NOT be eligible for Veterans Health Administration (or CHAMPVA)? | A 19-year-old child of a veteran who is not enrolled in an approved educational institution |
| To be effective, claims for TRICARE Standard and Veterans Health Administration (or CHAMPVA) must be filed within how much time from the date of service is provided? | 1 year |
| OSHA standards have been implemented to protect employees against: | on-the-job hazards. |
| A proceeding in which an attorney obtains testimony under oath but not in an open court is called a: | deposition. |
| An unexpected event that injures an individual and is not of his or her own making is called a(n): | accident. |
| If a worker is injured on the job, the employer must complete and sign which of these documents? | Employer's Report of Occupational Injury or Illness and a medical service order. |
| Another word for encumbrance is: | lien. |
| If a patient disagrees with an insurance decision, he or she may file a(n) _______________. | appeal/petition |
| The __________________ fund assumes all or part of the liability for benefits due to the combined effect of a work-related incident and a preexisting condition. | second injury |
| Temporary disability describes the recovery period after a work-related injury during which the employee is able/not able __________________ to work. | perform duty |
| Therapy using real or stimulated work duties to build up an injured employee's strength and endurance after an injury is called __________________. | work hardening |
| Before worker's compensation weekly benefits become payable, a(n) _________________ must elapse. | waiting period |
| The ____________________ is the maximum amount of time for which benefits are paid for a disability. | benefit period |
| Supplemental Security Income is a disability program administered by the _____________________ government. | federal |
| In group disability insurance plans, the ____________________ is the policyholder. | employer |
| Employees of nonprofit organizations, schools, and churches are not covered under _____________________ disability insurance plans. | state |
| Provisions written into a disability insurance contract that deny coverage or limit the scope of coverage are called ___________________. | exclusions |
| The Supplemental Security Income (SSI) program is under Title XVI of the Social Security Act and provides ____________________ to people (adults and children) with limited income and few resources. | disability payments |
| ________________________ is also known as temporary disability insurance or unemployment compensation disability. | State disability insurance |
| Before a physician completes and submits disability income claim forms, it is essential to obtain the patient's _________________ for release of medical information. | signed authorization |
| The Armed Services Disability benefits program is available to what groups? | Active duty armed service members only |
| Which state was the first state to implement a successful disability plan? | Rhode Island |
Created by:
mamajesski