Question 1

Where do medical insurance companies summarize the payments they may make for medically necessary medical services?

Accepted Answer

A)   encounter form
B)   medical necessity document
C)   workers' compensation document
D)   schedule of benefits documentE) C) and D)
F) B) and D)

Question 2

Another term used for a primary care physician (PCP)  is

Accepted Answer

A)   gatekeeper.
B)   specialist.
C)   controller.
D)   practitioner.E) B) and D)
F) A) and B)

Question 3

Identify another name for a point-of-service (POS)  plan.

Accepted Answer

A)   restricted HMO
B)   open HMO
C)   closed HMO
D)   free HMOE) B) and C)
F) All of the above

Question 4

A capitated payment amount is called a

Accepted Answer

A)   prospective payment.
B)   retroactive payment.
C)   copayment.
D)   coinsurance payment.E) A) and C)
F) B) and D)

Question 5

What is a premium?

Accepted Answer

A)   a prepayment covering provider's services for a plan member for a specified period
B)   the amount that the insured pays on covered services before benefits begin
C)   the percentage of each claim that the insured pays
D)   the periodic payment the insured is required to make to keep a policy in effectE) C) and D)
F) B) and D)

Question 6

A physician has a contract to receive a $2,000 monthly capitation fee, based on a fee of $50 for 40 patients who are in the plan. If only 10 patients visited the practice in the last month, the capitation payment will be

Accepted Answer

A)   $500.
B)   $2,000.
C)   $4,000.
D)   $1,000.E) None of the above
F) B) and D)

Question 7

Which of the following programs covers people who cannot otherwise afford medical care?

Accepted Answer

A)   TRICARE
B)   Medicaid
C)   Medicare
D)   CHAMPUSE) A) and B)
F) A) and C)

Question 8

In large medical practices, a medical insurance specialist is more likely to

Accepted Answer

A)   handle a variety of billing and collections tasks.
B)   have more specialized duties.
C)   have less specialized duties.
D)   need to use professionalism.E) A) and C)
F) B) and C)

Question 9

Identify the type of HMO cost-containment method that limits members to receiving services from the HMO's physician network.

Accepted Answer

A)   cost-sharing
B)   restricting patients' choice of providers
C)   controlling drug costs
D)   requiring preauthorization for servicesE) C) and D)
F) None of the above

Question 10

Medical insurance specialists ensure financial success of the medical practice by

Accepted Answer

A)   using health information technology.
B)   failing to communicate effectively.
C)   setting their own rules and regulations.
D)   recording only cash payments.E) A) and B)
F) C) and D)

Question 11

Employers that offer health plans to employees without using an insurance carrier are

Accepted Answer

A)   self-funded (insured)  health plans.
B)   third-party payers.
C)   independent contractors.
D)   third-party administrators.E) C) and D)
F) B) and C)

Question 12

Scheduling appointments is part of which revenue cycle step?

Accepted Answer

A)   Step 5, review coding compliance.
B)   Step 1, preregister patients.
C)   Step 10, follow up on patient payments.
D)   Step 8, monitor patient adjudication.E) A) and B)
F) A) and C)

Question 13

If a POS HMO member elects to receive medical services from out-of-network providers they usually

Accepted Answer

A)   pay an additional cost.
B)   pay less than in-network benefits.
C)   will receive inferior treatment.
D)   need only pay the standard copayment.E) None of the above
F) A) and D)

Question 14

What is the formula for calculating an insurance company payment in an indemnity plan?

Accepted Answer

A)   charge ? deductible ? coinsurance
B)   deductible ? coinsurance
C)   deductible + coinsurance
D)   charge ? deductibleE) B) and C)
F) A) and D)

Question 15

Collecting copayments is part of which revenue cycle step?

Accepted Answer

A)   Step 3, check in patients.
B)   Step 10, follow up payments and collections
C)   Step 8, monitor patient adjudication.
D)   Step 5, review billing complianceE) A) and B)
F) B) and D)

Question 16

To be fully covered, patients who enroll in an HMO may use the services of

Accepted Answer

A)   only HMO network providers.
B)   only out-of-network providers.
C)   any provider within 50 miles.
D)   any provider.E) None of the above
F) A) and B)

Question 17

Calculate the amount of money a patient would owe for a noncovered service costing $900 if their indemnity policy has a coinsurance rate of 80-20, and they have already met their deductible.

Accepted Answer

A)   $0
B)   $180
C)   $900
D)   $720E) A) and C)
F) All of the above

Question 18

Consumer-driven health plans combine a health plan with a special "savings account" that is used to pay what before the deductible is met?

Accepted Answer

A)   medical bills
B)   excluded services
C)   coinsurance
D)   non-medically necessary servicesE) A) and D)
F) B) and C)

Question 19

Determine which method a self-funded health plan most often uses in setting up its provider network.

Accepted Answer

A)   buy the use of existing networks from managed care organizations
B)   hire a PCP to provide a network
C)   are not required to set up a network
D)   set up their own provider networkE) A) and B)
F) None of the above

Question 20

In what ways can insurance policies be written?

Accepted Answer

A)   only individual
B)   only workers
C)   an individual or group
D)   only groupE) A) and B)
F) B) and C)

Exam 1: Introduction to the Medical Billing Cycle

Where do medical insurance companies summarize the payments they may make for medically necessary medical services?

Correct AnswerverifiedShow Answer

A physician has a contract to receive a $2,000 monthly capitation fee, based on a fee of $50 for 40 patients who are in the plan. If only 10 patients visited the practice in the last month, the capitation payment will be

Correct AnswerverifiedShow Answer

What is the formula for calculating an insurance company payment in an indemnity plan?

Correct AnswerverifiedShow Answer

Another term used for a primary care physician (PCP) is

Correct AnswerverifiedShow Answer

To be fully covered, patients who enroll in an HMO may use the services of

Correct AnswerverifiedShow Answer

Scheduling appointments is part of which revenue cycle step?

Correct AnswerverifiedShow Answer

Employers that offer health plans to employees without using an insurance carrier are

Correct AnswerverifiedShow Answer

Medical insurance specialists ensure financial success of the medical practice by

Correct AnswerverifiedShow Answer

Determine which method a self-funded health plan most often uses in setting up its provider network.

Correct AnswerverifiedShow Answer

Calculate the amount of money a patient would owe for a noncovered service costing $900 if their indemnity policy has a coinsurance rate of 80-20, and they have already met their deductible.

Correct AnswerverifiedShow Answer

What is a premium?

Correct AnswerverifiedShow Answer

In large medical practices, a medical insurance specialist is more likely to

Correct AnswerverifiedShow Answer

Collecting copayments is part of which revenue cycle step?

Correct AnswerverifiedShow Answer

A capitated payment amount is called a

Correct AnswerverifiedShow Answer

In what ways can insurance policies be written?

Correct AnswerverifiedShow Answer

Which of the following programs covers people who cannot otherwise afford medical care?

Correct AnswerverifiedShow Answer

Consumer-driven health plans combine a health plan with a special "savings account" that is used to pay what before the deductible is met?

Correct AnswerverifiedShow Answer

Identify the type of HMO cost-containment method that limits members to receiving services from the HMO's physician network.

Correct AnswerverifiedShow Answer

Identify another name for a point-of-service (POS) plan.

Correct AnswerverifiedShow Answer

If a POS HMO member elects to receive medical services from out-of-network providers they usually

Correct AnswerverifiedShow Answer

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