BIM II Fall Semester Review Part 1 Question Preview (ID: 22456)
CW103 Certification Review.
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Billing for services not provided is an example of _____________.
a) Fraud
b) Abuse
c) Incentives
d) Pre-planning
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
For the physician involved, Medicare or Medicaid program-related crimes result in _____________.
a) Exclusion from program participation
b) Higher malpractice insurance premiums
c) Insurance cancellation
d) Embezzlement charges
Misconduct that occurs within a physician’s field of expertise and results in injury or loss to the recipient of services is called _____________.
a) Malpractice
b) Negligence
c) Slander
d) Liability
Before performing surgery, what must the physician obtain from the patient?
a) Informed consent
b) Diagnosis and prognosis
c) Admission of fault
d) Second opinion
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) Recommend further tests
c) Waive an arbitration agreement
d) Prescribe medication for mental issues
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) Predetermination form
b) Precertification form
c) Preauthorization form
d) Certification form
A government program that provides medical services for dependents of active military personnel is known as _____________.
a) TRICARE
b) CHAMPVA
c) Medicaid
d) Medicare
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) PPO
d) PPS
In California, Medicaid program is called _____________.
a) Medi-Cal
b) Medicare
c) HMO
d) Calimed
A program that insures a person against on-the-job injury or illness is called _____________.
a) Workers’ compensation
b) Workmen’s insurance
c) State disability
d) Prepaid health
One of the first steps in processing an insurance claim is to _____________.
a) Obtain a release of information sheet
b) Evaluate the laboratory results
c) Post payment to the day sheet
d) Take a comprehensive history
A convenient arrangement for following up on the progress of paper insurance claims is to use a _____________.
a) Tickler file
b) Rolodex
c) Ledger
d) Calendar
Third party payers require all the following information EXCEPT _____________.
a) Triplicate copies of invoices
b) Diagnoses using ICD-9-CM codes
c) DOS
d) POS
Careful and thorough recording of information at the time of the initial office visit _____________.
a) Enables one to handle insurance claims promptly
b) Is done only when the patient is schedule for surgery
c) Is always done by the insurance specialist
d) Takes too long
Obtaining all the names of insurance companies from patients is important for _____________.
a) Coordinating benefits
b) Making future appointments
c) Purging the alpha file
d) Notifying next of kin
Another name for the release of information form is the _____________.
a) Consent form
b) Spreadsheet
c) Requisition form
d) Assignment of benefits
If a claim is filed after the submission time limit for the carrier, payment is usually _____________.
a) Denied
b) Processed
c) Suspended
d) Guaranteed
The number of views, part of the body, and type of view are necessary pieces of information for itemizing _____________.
a) X-rays
b) Location of a tumor
c) Laboratory work
d) Level of E/M service
The amount that a physician normally or usually charges the majority of his or her patients is the ____________.
a) Customary fee
b) RBRVS
c) UCR
d) RUV
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