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BIM II Fall Semester Review Part 1
Test Description: CW103 Certification review
Instructions: Answer all questions to get your test result.
1) Billing for services not provided is an example of _____________.
A
Fraud
B
Incentives
C
Abuse
D
Pre-planning
2) Claims for services deemed not medically necessary by insurance plans or programs are examples of _____________.
A
Abuse
B
Fraud
C
Hardship waivers
D
Improper delegation
3) For the physician involved, Medicare or Medicaid program-related crimes result in _____________.
A
Embezzlement charges
B
Higher malpractice insurance premiums
C
Exclusion from program participation
D
Insurance cancellation
4) Misconduct that occurs within a physician’s field of expertise and results in injury or loss to the recipient of services is called _____________.
A
Liability
B
Slander
C
Negligence
D
Malpractice
5) Before performing surgery, what must the physician obtain from the patient?
A
Second opinion
B
Informed consent
C
Diagnosis and prognosis
D
Admission of fault
6) If a patient does not follow instructions, does not take recommended medications, and fails to return for an appointment, the physician may _____________.
A
Recommend further tests
B
Terminate further care of the patient
C
Waive an arbitration agreement
D
Prescribe medication for mental issues
7) A form sent to the insurance company to find out the maximum dollar amount that will be paid for a procedure is called an insurance _____________.
A
Preauthorization form
B
Precertification form
C
Certification form
D
Predetermination form
8) A government program that provides medical services for dependents of active military personnel is known as _____________.
A
TRICARE
B
Medicare
C
Medicaid
D
CHAMPVA
9) An organization that provides a wide range of services for a specified group at a fixed periodic payment is call a(n) _____________.
A
PPS
B
HMO
C
PPO
D
PMO
10) In California, Medicaid program is called _____________.
A
Medi-Cal
B
Medicare
C
HMO
D
Calimed
11) A program that insures a person against on-the-job injury or illness is called _____________.
A
Workmen’s insurance
B
Workers’ compensation
C
Prepaid health
D
State disability
12) One of the first steps in processing an insurance claim is to _____________.
A
Evaluate the laboratory results
B
Obtain a release of information sheet
C
Post payment to the day sheet
D
Take a comprehensive history
13) A convenient arrangement for following up on the progress of paper insurance claims is to use a _____________.
A
Ledger
B
Tickler file
C
Calendar
D
Rolodex
14) Third party payers require all the following information EXCEPT _____________.
A
DOS
B
POS
C
Triplicate copies of invoices
D
Diagnoses using ICD-9-CM codes
15) Careful and thorough recording of information at the time of the initial office visit _____________.
A
Is always done by the insurance specialist
B
Enables one to handle insurance claims promptly
C
Takes too long
D
Is done only when the patient is schedule for surgery
16) Obtaining all the names of insurance companies from patients is important for _____________.
A
Purging the alpha file
B
Coordinating benefits
C
Notifying next of kin
D
Making future appointments
17) Another name for the release of information form is the _____________.
A
Spreadsheet
B
Consent form
C
Assignment of benefits
D
Requisition form
18) If a claim is filed after the submission time limit for the carrier, payment is usually _____________.
A
Denied
B
Suspended
C
Processed
D
Guaranteed
19) The number of views, part of the body, and type of view are necessary pieces of information for itemizing _____________.
A
Laboratory work
B
Level of E/M service
C
X-rays
D
Location of a tumor
20) The amount that a physician normally or usually charges the majority of his or her patients is the ____________.
A
UCR
B
Customary fee
C
RBRVS
D
RUV
*select an answer for all questions
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