ExCPT CH16: Insurance and Billing

Which of the following is an example of fraud?

• Miscoding a diagnosis unintentionally
• Leaving a field blank on the CMS-1500 by mistake
• Altering a patient’s chart to increase the amount reimbursed
• Releasing a patient’s medical records without the patient’s permission

Which of the following Medicare programs covers hospital charges?

• Part A
• Part B
• Part C
• Part D

Which of the following is a third-party health plan that is funded by the federal government?

• Blue Cross and Blue Shield
• Starmark
• Aetna
• TRICARE

Which of the following is true about Blue Cross and Blue Shield?

• It offers prepaid health services.
• It helps Medicare to determine covered health services.
• It helps Medicaid to determine covered health services.
• It offers prepaid Medicare Part D.

Providers are required by law to file which of the following for all eligible Medicare patients?

• CMS
• HCPCS
• RBRVS
• CMS-1500

The most common insurance claim form is the:

• superbill.
• charge sheet.
• ICD-9.
• CMS-1500.

TRICARE is a health care benefit program for all of the following, except:

• Coast Guard.
• Navy.
• families of uniformed personnel.
• families of veterans with service-related disabilities.

Medicare Part B covers:

• hospital care.
• outpatient services.
• hospice care.
• nursing facility care.

Medicaid is:

• always the primary carrier.
• secondary carrier when the patient has Medicare.
• type of Medigap insurance policy.
• governmental insurance plan with which all physicians must comply.

Which of the following plans covers spouses of veterans with permanent, service-related disabilities?

• Medicare
• Medicaid
• CHAMPUS
• CHAMPVA