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Which one of the following is an insurance claim processing
error?
a. Entering all diagnoses on the claim
b. Using "rule out" diagnosis
c. Recording one item per line
d. Using both ICD-10 and CPT codes - ANSWER-b. Using "rule
out" diagnosis
Traditional health insurance plans that pay for all or a share of
the cost of covered services, regardless of which physician,
hospital, or other licensed healthcare provider is used.
Policyholders and their dependents choose when and where to
get healthcare services.
a. Indemnity
plan
b. Health maintenance
organization plan
,c. Self-insured
plan
d. Managed care plan - ANSWER-a.
Indemnity plan
The term "total permanent impairment" means that the patient
a. is unable to work for one year.
b. is unable to perfor duties for 30 days.
c. may return to full occupational duty.
d. is unable to perform previous occupational duties. -
ANSWER-d. is unable to perform previous occupational
duties.
An example of a Medicare HCPCS code number is
a.
934.6
b.
99211
c.
J0540
d. V72.3 - ANSWER-c.
J0540
Claims for Medicaid patients enrolled in a managed care
plan are paid
,according to what fee
schedule?
a.
PPO
b.
Medicaid
c.
Medicare
d. Capitated - ANSWER-d.
Capitated
A written authorization by the patient giving the insurance
company the right to
pay the physician directly for billed services is
known as the
a. copayment.
b. deductible.
c. Assigment of Benefits.
d. premium. Incorrect - ANSWER-c. Assigment of Benefits.
A person who holds a health benefit plan is a
a.
subscriber.
b. rider.
, c.
dependent.
d. medical indigent. - ANSWER-a.
subscriber.
Medicare patients treated by a non-participating physician
a. are responsible for billing Medicare.
b. are covered at 100% of the physician's charge.
c. pay a higher deductible.
d. are responsible for a portion of the fee. - ANSWER-d. are
responsible for a portion of the fee.
Claims with a signed assignment of benefits are paid to the
a.
physician.
b.
patient.
c.
employer.
d. billing agency. - ANSWER-a.
physician.
Medicare Part B pays physicians on a fee scale consisting of
three parts: 1. Physician's work. 2. Charge-based professional
liability expenses. 3. Chargebased overhead. This fee scale is
known as