Health Insurance & Medical Billing: BPA

Health insurance that is provided through an employer is known as ____.

a. government sponsored

b. company sponsored

c. parent sponsored

d. individual sponsored

b. company sponsored

The purpose of health insurance is to ______.

a. help pay for the cost of healthcare services

b. keep the patient healthy

c. provide access to healthcare

d. all are correct

d. all are correct

Coinsurance is what a patient pays for a covered healthcare service, AFTER their deductible is met.

a. true

b. false

a. true

Prior authorizations are required for all healthcare services

a. true

b. false

b. false

If a patient has a $20 copay for all office visits, and a 20% coinsurance for all procedures. What would a patient pay for an office visit with a $500 procedure.

a. $80

b. $100

c. $120

d. $140

c. $120

When an insurance company review a proposed healthcare service before that service is provided, and then provides an approval or denial that service, this is called ______.

a. review

b. prior authorization

c. insurance process

d. both a review & prior authorization

b. prior authorization

Medical records can be accessed by which of the following individuals?

a. the patient

b. the patient's representative

c. healthcare providers involved in the patient's care

d. all are correct

d. all are correct

Cost-share refers to the _____.

a. amount insurance pays towards covered health services

b. amount the patient pays towards covered health services

c. total amount paid by patient and insurance towards health services

d. total amount billed by a healthcare provider for health services

b. amount the patient pays towards covered health services

A patient has a $1,000 deductible and a 30% coinsurance for a $10,000 covered procedure. How much must the patient pay for this procedure?

a. $3,700

b. $2,700

c. $4,000

d. $3,000

a. $3,700

The form CMS 1500 is used to _____.

a. submit medical records to insurance companies

b. submit claims to insurance companies

c. process lab results

d. none of these are correct

b. submit claims to insurance companies

A patient is considered an "inpatient" at a healthcare facility when _____.

a. their doctor has checked them in

b. the patient stays overnight at a healthcare facility

c. the patient goes to the emergency room

d. the doctor classifies them as inpatient

b. the patient stays overnight at a healthcare facility

Place of service codes are used to designate _____.

a. where healthcare services took place

b. where a surgery is scheduled

c. where a patient's home is located

d. none of these are correct

a. where healthcare services took place

A patient can be billed a copay, coinsurance, and deductible for the same healthcare service.

a. true

b. false

a. true

Secondary insurance means that the patient has only one insurance plan.

a. true

b. false

b. false

Revenue Cycle Management refers to _____.

a. a financial process that tracks patient accounts from initial registration to final balance payment

b. a financial process that tracks money received by a physician's office

c. a management process that tracks payments made to vendors

d. the process of managing a revenue for a hospital

a. a financial process that tracks patient accounts from initial registration to final balance payment

Which of the following is not one of the three types of health insurance?

a. government sponsored

b. company sponsored

c. parent sponsored

d. individual sponsored

c. parent sponsored

The patient is financially responsible for paying which of the following items to the insurance company or medical provider?

a. deductible

b. coinsurance

c. copay

d. all of the above

d. all of the above

A patient can have both a copay and a coinsurance for a medical procedure.

a. true

b. false

a. true

Elective procedures are always covered by health insurance

a. true

b. false

b. false

If a procedure costs $325 and a patient has a 20% coinsurance, the patient must pay the doctor

a. $325

b. $65

c. $75

d. $125

b. $65

A prior authorization request must be submitted when _____.

a. an insurer requires a pre-review of medical necessity

b. the dollar amount of the procedure is above a certain limit

c. an insurer does not cover elective procedures

d. both A & B

d. both A & B

In medical billing, CMS stands for ______.

a. Central Medical System

b. Centers for Medicare & Medicaid Services

c. Central Mechanism Structures

d. Centers for Medications

b. Centers for Medicare & Medicaid Services

In medical billing, HCPCS codes refers to a(n) _____.

a. collection of standardized codes that represent medical procedures, supplies, products & services

b. numeric code with no decimal points

c. code detailing the diagnosis of a medical condition

d. ICD-10 code

a. collection of standardized codes that represent medical procedures, supplies, products & services

If a patient has a $1,000 deductible and a 20% coinsurance for a $4,000 covered procedure. How much must the patient pay out of pocket?

a. $1,200

b. $1,800

c. $1,600

d. $1,400

b. $1,800

The form most commonly used to submit a medical bill to an insurance company is called ____.

a. CPT 98021

b. CMT 1390

c. CMS 1500

d. none of the above

c. CMS 1500

The point of service codes in medical billing are meant to signify ____.

a. where a medical service was conducted

b. where the doctor received his/her training

c. what hospital a doctor is affiliated with

d. the zip code where the patient lives

a. where a medical service was conducted

In order to practice medicine, a doctor must have ______.

a. a diploma from an accredited medical school

b. a passing grade on the board exams

c. a license from the state where he/she will practice

d. all of the above

d. all of the above

A CPT code signifies _____.

a. numeric codes, not required for medical billing

b. numbers used to determine how long a doctor has been in practice

c. numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services

d. none of the above

c. numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services

How many categories of CPT codes are there

a. 3

b. 2

c. 1

d. 0

a. 3

Health insurance guarantees that a patient's medical bills will be paid for:

a. true

b. false

b. false

In medical billing, E&M codes are defined as ____>

a. Evolutionary Medicine

b. Evaluation and Management

c. Elevation and Maintenance

d. Erasing and Motivating

b. Evaluation and Management

All of the following are considered "Places of Service" except ____.

a. telemedicine

b. office

c. home

d. car

d. car

A patient can have a copay and coinsurance for the same procedure

a. true

b. false

a. true

Medicaid is a ____.

a. government sponsored health insurance for low-income Americans

b. government sponsored health insurance for older Americans

c. corporate sponsored health insurance for employees

d. government sponsored health insurance for Veterans

a. government sponsored health insurance for low-income Americans

An Out of Pocket Maximum (OOP) is defined as a(n) _____.

a. amount the patient has to pay every plan year

b. amount the patient has to pay ever doctors visit

c. cap, or limit, on the amount of money the insurance company will pay for a given patient

d. cap, or limit, on the amount of money you have to pay for covered health care services in a plan year

d. cap, or limit, on the amount of money you have to pay for covered health care services in a plan year

Revenue Cycle Management refers to ______.

a. a financial process that tracks patient accounts from initial registration to final

b. a financial process that tracks money received by a physician's office

c. a management process that tracks payments made to vendors

d. the process of managing a revenue for a hospital

a. a financial process that tracks patient accounts from initial registration to final

How many digits or letters are contained in CPT modifier codes?

a. 1

b. 2

c. 3

d. 4

b. 2

What are the subsystems of HCPCS codes?

a. level I

b. level II

c. level IV

d. A & B only

d. A & B only

Which facility can submit medical claim for UB-04 to Medicare?

a. Doctor's office

b. Dentist's office

c. Chiropractor's office

d. hospital

d. chiropractor's office

The CPT professional code book is modified every year on ____.

a. February 1st

b. September 30th

c. January 1st

d. June 15th

c. January 1st