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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
Pre-planning
B
Abuse
C
Incentives
D
Fraud
2) Claims for services deemed not medically necessary by insurance plans or programs are examples of _____________.
A
Abuse
B
Hardship waivers
C
Improper delegation
D
Fraud
3) For the physician involved, Medicare or Medicaid program-related crimes result in _____________.
A
Embezzlement charges
B
Insurance cancellation
C
Exclusion from program participation
D
Higher malpractice insurance premiums
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
Malpractice
C
Negligence
D
Slander
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
Terminate further care of the patient
B
Waive an arbitration agreement
C
Prescribe medication for mental issues
D
Recommend further tests
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
Certification form
B
Precertification form
C
Predetermination form
D
Preauthorization form
8) A government program that provides medical services for dependents of active military personnel is known as _____________.
A
Medicare
B
Medicaid
C
CHAMPVA
D
TRICARE
9) An organization that provides a wide range of services for a specified group at a fixed periodic payment is call a(n) _____________.
A
HMO
B
PMO
C
PPS
D
PPO
10) In California, Medicaid program is called _____________.
A
Medi-Cal
B
Medicare
C
Calimed
D
HMO
11) A program that insures a person against on-the-job injury or illness is called _____________.
A
Prepaid health
B
Workers’ compensation
C
State disability
D
Workmen’s insurance
12) One of the first steps in processing an insurance claim is to _____________.
A
Take a comprehensive history
B
Post payment to the day sheet
C
Obtain a release of information sheet
D
Evaluate the laboratory results
13) A convenient arrangement for following up on the progress of paper insurance claims is to use a _____________.
A
Ledger
B
Rolodex
C
Tickler file
D
Calendar
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
Takes too long
B
Is always done by the insurance specialist
C
Enables one to handle insurance claims promptly
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
Making future appointments
C
Coordinating benefits
D
Notifying next of kin
17) Another name for the release of information form is the _____________.
A
Spreadsheet
B
Consent form
C
Requisition form
D
Assignment of benefits
18) If a claim is filed after the submission time limit for the carrier, payment is usually _____________.
A
Denied
B
Processed
C
Suspended
D
Guaranteed
19) The number of views, part of the body, and type of view are necessary pieces of information for itemizing _____________.
A
Level of E/M service
B
Laboratory work
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
Customary fee
B
RUV
C
UCR
D
RBRVS
*select an answer for all questions
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