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WorksheetsExCPT CH16: Insurance and Billing
Total questions: 73
Worksheet time: 37mins
Name
Class
Date
1.
Which of the following is an example of fraud?
a)
Miscoding a diagnosis unintentionally
b)
Leaving a field blank on the CMS-1500 by mistake
c)
Altering a patient’s chart to increase the amount reimbursed
d)
Releasing a patient’s medical records without the patient’s permission
2.
Which of the following Medicare programs covers hospital charges?
a)
Part A
b)
Part B
c)
Part C
d)
Part D
3.
Which of the following is a third-party health plan that is funded by the federal government?
a)
Blue Cross and Blue Shield
b)
Starmark
c)
Aetna
d)
TRICARE
4.
Which of the following is true about Blue Cross and Blue Shield?
a)
It offers prepaid health services.
b)
It helps Medicare to determine covered health services.
c)
It helps Medicaid to determine covered health services.
d)
It offers prepaid Medicare Part D.
5.
Providers are required by law to file which of the following for all eligible Medicare patients?
a)
CMS
b)
HCPCS
c)
RBRVS
d)
CMS-1500
6.
The most common insurance claim form is the:
a)
superbill.
b)
charge sheet.
c)
ICD-9.
d)
CMS-1500.
7.
TRICARE is a health care benefit program for all of the following, except:
a)
Coast Guard.
b)
Navy.
c)
families of uniformed personnel.
d)
families of veterans with service-related disabilities.
8.
Medicare Part B covers:
a)
hospital care.
b)
outpatient services.
c)
hospice care.
d)
nursing facility care.
9.
Medicaid is:
a)
always the primary carrier.
b)
secondary carrier when the patient has Medicare.
c)
type of Medigap insurance policy.
d)
governmental insurance plan with which all physicians must comply.
10.
Which of the following plans covers spouses of veterans with permanent, service-related disabilities?
a)
Medicare
b)
Medicaid
c)
CHAMPUS
d)
CHAMPVA
11.
Which of the following can include Medicare Part D?
a)
Part A
b)
Part C
c)
Part B
d)
Parts A and B
12.
Most outpatient IV therapies require a:
a)
waiting period.
b)
premium.
c)
preauthorization.
d)
deductible.
13.
An insurance plan that covers a group of employees usually has:
a)
fewer benefits.
b)
lower premiums.
c)
separate policies for each member of the group.
d)
higher premiums.
14.
If a patient has two insurance plans, and the primary insurance carrier pays 80% of the charges, what is the most that the secondary will pay?
a)
10%
b)
20%
c)
80%
d)
100%
15.
An individual contract for health insurance:
a)
has lower premiums.
b)
has more benefits.
c)
is also called personal insurance.
d)
is for people in the military only.
16.
The Blue Cross part of the Blue Cross and Blue Shield Association plans covers:
a)
physician services.
b)
hospital services.
c)
dental services.
d)
vision.
17.
What is true about Health Maintenance Organizations (HMOs)?
a)
Physicians are often paid only for patient visits.
b)
Physicians are responsible for the administrative tasks.
c)
Members of an HMO select a primary care physician (PCP) from a group.
d)
The HMO selects the PCP on behalf of the patient.
18.
For patients who have an HMO, what option will allow them to utilize an out-of-network provider?
a)
Preferred provider option
b)
Point-of-service option
c)
Out-of-network option
d)
Non-HMO physician option
19.
The Kaiser Foundation Health Plans:
a)
offer no-deductible physician visits.
b)
contract with physicians for their services.
c)
are essentially a type of HMO.
d)
own the medical facilities and employ the physicians.
20.
Workers’ Compensation benefits usually include:
a)
weekly income replacement.
b)
comprehensive health care for entire companies.
c)
survivor benefits when applicable.
d)
weekly income replacement and survivor benefits when applicable.
21.
With workers’ compensation, it is the injured worker’s responsibility to:
a)
notify the employer promptly of an injury.
b)
pay all medical bills until reimbursed by the employer.
c)
pay a 20% deductible for all medical bills.
d)
pay for coinsurance.
22.
What is true regarding a Preferred Provider Organization (PPO)?
a)
Enrollees can see any physician they wish
b)
It is a type of Health Maintenance Organization (HMO)
c)
Enrollees can see a specialist without prior authorization from a primary care physician
d)
Enrollees can go to any hospital for care
23.
Government-sponsored health plans include all of the following, except:
a)
TRICARE.
b)
Medicaid.
c)
CHAMPVA.
d)
Kaiser Foundation Health Plan.
24.
The largest single medical benefits program in the United States is:
a)
Medicaid.
b)
Medicare.
c)
TRICARE.
d)
CHAMPUS.
25.
Patients who can receive medical benefits under Medicare include:
a)
any person without health insurance who is a U.S. citizen.
b)
citizens 65 years of age and older.
c)
children under the age of 18.
d)
children under the age of 16.
26.
Medicare Part B covers:
a)
outpatient prescriptions.
b)
durable medical equipment.
c)
home health care.
d)
inpatient care.
27.
Medicare Part B coverage:
a)
is for those who do not qualify for Part A coverage.
b)
is free for enrollees in Medicare Part A.
c)
covers hospitalization expenses not covered under Part A.
d)
is optional.
28.
If a patient has both Medicare and Medicaid, charges must be filed with:
a)
Medicare first and then Medicaid.
b)
Medicaid first and then Medicare.
c)
both Medicaid and Medicare.
d)
only Medicaid.
29.
The Medicaid health benefits program is not used for:
a)
low income people.
b)
blind and disabled persons.
c)
veterans.
d)
families with dependent children without financial support from at least one parent.
30.
Which TRICARE program is a preferred provider organization plan?
a)
TRICARE standard
b)
TRICARE PPO
c)
TRICARE Extra
d)
TRICARE Prime
31.
TRICARE replaced which government program?
a)
Medicare Part C
b)
CHAMPVA
c)
CHAMPUS
d)
Medicare Choice Plans
32.
Which is not true regarding an insurance policy?
a)
It is a legally enforceable agreement.
b)
It becomes effective as soon as it is offered.
c)
It may include dependents of the insured.
d)
There is no standard contract for all plans.
33.
All of the following insurance programs are sponsored by the federal government, except:
a)
TRICARE
b)
CHAMPVA
c)
Medicaid
d)
Workers’ Compensation
34.
Pharmacy technicians may have more interaction with insurance companies in which of the following pharmacy settings?
a)
Hospital pharmacies
b)
Community pharmacies
c)
Both hospital and community pharmacies
d)
Neither hospital nor community pharmacies
35.
All of the following conditions are “exclusions” on insurance policies, except:
a)
cancer.
b)
heart attack.
c)
pregnancy.
d)
attempted suicide.
36.
Medicare plus Choice plan is also known as:
a)
Medicare Part A.
b)
Medicare Part B.
c)
Medicare Part C.
d)
Medicare Part D.
37.
Which of the following parts of Medicare covers drug prescriptions?
a)
Medicare Part A
b)
Medicare Part B
c)
Medicare Part C
d)
Medicare Part D
38.
A plan in which the member may seek care outside the network is called:
a)
point-of-service.
b)
policy limitation.
c)
beneficiary.
d)
group plan.
39.
The subscriber is known as a(n):
a)
dependent.
b)
coinsurance.
c)
insured.
d)
beneficiary.
40.
____________________ is the largest single medical benefits program in the United States.
a)
Medicare
b)
Medicaid
c)
TRICARE
d)
CHAMPVA
41.
Medicare Part A covers hospitals, nursing facilities, home health care, ____________________, and inpatient care
a)
hospice
b)
outpatient
c)
clinics
d)
ICU
42.
Medicaid is a health benefits program designed for ____________________ people, the blind, and the disabled.
a)
low-income
b)
middle class
c)
upper class
d)
military
43.
Medicare Part D is offered to all Medicare recipients to cover the costs of their ____________________
a)
medications
b)
in-patient care
c)
durable medical equipment
d)
out-patient labs
44.
TRICARE runs a military pharmacy as well as a(n) ____________________ pharmacy
a)
mail-order
b)
catalog-order
c)
online-order
d)
government-service
45.
The most common health insurance claim form is the ____________________ that was developed by the Centers for Medicare and Medicaid Services (CMS).
a)
CMS-1500
b)
DD-214
c)
CMS-1501
d)
CMS-99
46.
Claims may be submitted either electronically or by using actual paper ____________________.
a)
claim forms
b)
report forms
c)
insurance forms
d)
medication forms
47.
A(n) ____________________ is a specific amount of money that must be paid each year before the policy benefits begin
a)
deductible
b)
premium
c)
co-pay
d)
out-of-pocket
48.
An exclusion of certain types of coverage in an insurance policy is called a(n) ____________________
a)
policy limitation
b)
deductible limitation
c)
premium limitation
d)
copay limitation
49.
The amount of time from the date of service to the deadline the claim can be filed with the insurance company is called a(n) ____________________.
a)
time limit
b)
claim limit
c)
insurance limit
d)
company limit
50.
The requirement of notification and permission to receive additional types of services prior to obtaining those services is called ____________________
a)
preauthorization
b)
authorization
c)
service authorization
d)
post-authorization
51.
In a preferred provider organization, patients may see specialists without ____________________ from their primary care physicians.
a)
preauthorization
b)
authorization
c)
service authorization
d)
post-authorization
52.
The period of time that an individual must wait to become eligible for insurance coverage is referred to as the ____________________.
a)
waiting period
b)
eligibility period
c)
authorization period
d)
confirmation period
53.
The Kaiser Foundation Health Plan is a type of prepaid group practice ____________________.
a)
Health Maintenance Organization (HMO)
b)
Preferred-Provider Organization (PPO)
c)
Affordable Care Act (ACA)
d)
Children's Health Insurance Program (CHIP)
54.
Monthly automatic premium deductions for Medicare Part B are taken out of monthly ____________________ checks, railroad retirement checks, or civil service checks.
a)
Social Security
b)
Pension
c)
Government Security Plan
d)
Retirement
55.
If the patient chooses coverage and Medicare Part C, she will not need coverage under ____________________ and ____________________.
a)
Part A
b)
Part B
c)
Part D
d)
Part E
56.
If a patient has both Medicare and Medicaid, charges must be filed with ____________________ first, and ____________________ is the secondary payer.
a)
Medicare, Medicaid
b)
Medicaid, Medicare
c)
Medicare, Part A
d)
Part A, Medicaid
57.
All claims processing involving pharmacies is now done ____________________.
a)
electronically
b)
by mail
c)
by fax
d)
by phone
58.
Paper claims can only be used by offices that do not handle any other ____________________ related transactions
a)
Health Insurance Portability and Accountability Act (HIPAA)
b)
Patient Protection and Affordable Care Act (ACA)
c)
National Association of Insurance Commissioners (NAIC)
d)
Financial Stability Oversight Council (FSOC)
59.
A payment made by either an insurer or a patient that is greater than the actual amount due is called a(n) ____________________.
a)
overpayment
b)
excessive payment
c)
overdraft
d)
underpayment
60.
insurance policy that is a legally enforceable agreement
a)
contract
b)
dependents
c)
overpayment
d)
subscriber
e)
eligibility
61.
spouse and children of the insured person who are also covered under terms of the policy
a)
dependents
b)
overpayment
c)
subscriber
d)
contract
e)
eligibility
62.
determination of the exact coverage to which the insured person is entitled
a)
eligibility
b)
dependents
c)
overpayment
d)
subscriber
e)
contract
63.
insurance policy’s coinsurance or cost-sharing requirement in which the insured must make a payment of a specified amount at the time of treatment or purchase of a prescription
a)
co-payment
b)
dependents
c)
overpayment
d)
subscriber
e)
contract
64.
cost of the coverage that the insurance policy contains
a)
premium
b)
dependents
c)
overpayment
d)
subscriber
e)
contract
65.
payment by the insurer or by the patient of more than the amount due
a)
overpayment
b)
dependents
c)
subscriber
d)
contract
e)
eligibility
66.
insured or a member, policyholder, or recipient
a)
subscriber
b)
dependents
c)
overpayment
d)
contract
e)
eligibility
67.
person designated by an insurance policy to receive benefits or funds
a)
beneficiary
b)
dependents
c)
overpayment
d)
subscriber
e)
contract
68.
specific amount of money that must be paid yearly before the policy benefits begin
a)
deductible
b)
dependents
c)
overpayment
d)
subscriber
e)
contract
69.
arrangement in which the insured must pay a percentage of the cost of medical services covered by the insurer
a)
coinsurance
b)
dependents
c)
overpayment
d)
subscriber
e)
contract
70.
Civilian Health and Medical Program of the Department of Veterans Affairs, a program to cover medical expenses of dependents of veterans with permanent service-connected disabilities
a)
TRICARE
b)
CHAMPUS
c)
Medicare
d)
Medicaid
e)
CHAMPVA
71.
federal/state medical assistance program to provide health insurance for specific populations
a)
TRICARE
b)
CHAMPUS
c)
Medicare
d)
Medicaid
e)
CHAMPVA
72.
replaced by TRICARE, a benefit for families of military personnel and retirees from the uniformed services
a)
TRICARE
b)
CHAMPUS
c)
Medicare
d)
Medicaid
e)
CHAMPVA
73.
comprehensive health benefits program offering three types of plans for dependents of men and women in the military
a)
TRICARE
b)
CHAMPUS
c)
Medicare
d)
Medicaid
e)
CHAMPVA
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