105 terms

Administrative Final

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Which is most important when the medical assistant answers the telephone?

A. Be willing to keep callers on hold; this is the sign of a busy office and a good doctor.
B. Be courteous with a positive attitude and personality.
C. Be able to answer any inquiry a caller to the medical office may have.
D. Obtain insurance information from new patients.
B. Be courteous with a positive attitude and personality
What is the first thing the medical assistant should do when answering a telephone call?

A. Put the caller on hold.
B. Identify the practice and himself or herself.
C. Finish with the patient who is at your desk.
D. Find out who the caller is.
B. Identify the practice and himself or herself
When answering the telephone, what is the best question for the medical assistant to ask to find out a caller's name?

A. "What is your name?"
B. "Who are you?"
C. "Who is this?"
D. "May I ask who is calling, please?"
D. "May I ask who is calling, please?"
How often should the medical assistant check back with a caller who is on hold?

A. At least every minute
B. At least every 30 seconds
C. At least every 20 seconds
D. At least every 10 seconds
B. At least every 30 seconds
Which is done by an answering service if one is used by the medical office?

A. Answer calls when the office is closed
B. Answer calls only when the office is very busy
C. Answer all of the physician's telephone calls
D. Make it unnecessary for the office to hire a receptionist
A. Answer calls when the office is closed
In the family practice office where Vicki is employed, there is a policy that all patients older than 18 are addressed by the title Mr., Mrs., or Ms. unless they specifically ask to be called by their first name. What is using a courtesy title an example of?

A. Medical ethics
B. Social etiquette
C. Legal requirement
D. Acceptable standard of care
B. Social etiquette
Vicki knows that when deciding whether or not to undergo a procedure recommended by the physician, a patient has the right to autonomy. How would she define "right" in this case?

A. Something a person wants
B. Something a person needs
C. Something a person is required to do
D. Something to which a person is entitled
D. Something to which a person is entitled
Like all health professionals, Vicki knows that she has a duty to patients to tell the truth. What is another name for truthfulness?

A. Fidelity
B. Veracity
C. Beneficence
D. Nonmalfeasance
B. Veracity
Vicki is aware that there is controversy over the use of fetal tissue and discarded fertilized embryos for scientific research. What does this controversy usually relate to?

A. Gene therapy
B. Human cloning
C. Stem cell research
D. Genetic engineering
C. Stem cell research
Although a patient might ask a physician to help end his life, Vicki knows that in most states, assisting a patient to commit suicide is a crime. What is the name for this type of crime?

A. Murder
B. Misdemeanor
C. Manslaughter
D. Wrongful death
A. Murder
When Vicki administers an injection in the office, she knows that she is expected to give the injection with the same expertise as any other professional who administers injections. What word or phrase describes the level of expertise that is required?

A. Liability
B. Standard of care
C. Assumption of risk
D. Respondeat superior
B. Standard of care
Vicki is aware that if a patient initiates a lawsuit against a health professional, four Ds must be established. Which of the following is not one of those Ds?

A. Duty to the patient
B. Damage or injury to the patient
C. Direct cause or no intervening circumstances
D. Disinterest or lack of sufficient attention to detail
D. Disinterest or lack of sufficient attention to detail
Vicki knows that discrimination providing insurance coverage is prohibited by law in many situations. Which law prevents discrimination against individuals who carry the trait for sickle cell anemia or cystic fibrosis ?

A. Americans with Disability Act Amendments
B. Patient Protection and Affordable Care Act
C. Genetic Information Nondiscrimination Act
D. Employee Retirement Income Security Act
C. Genetic Information Nondiscrimination Act
If another medical assistant is ill, Vicki may be asked to work in her stead. Because Vicki is paid on an hourly basis, what calculation is used in a week where she works more than 40 hours under the Fair Labor Standards Act?

A. 1 ½ times the regular rate of pay for overtime hours
B. 2 times the regular rate of pay for overtime hours.
C. 2 ½ times the regular rate of pay for overtime hours.
D. The rate of pay is only required to be greater than the regular rate if Vicki belongs to a union.
A. 1 ½ times the regular rate of pay for overtime hours.
The office where Vicki works has completed all the requirements for accreditation by the Joint Commission. Which of the following is true about this type of accreditation for medical offices?

A. It is voluntary
B. It is required by state law.
C. It is required by federal law.
D. Although technically voluntary, it is difficult to obtain a state license without accreditation.
A. It is voluntary
Channa is answering telephone calls for the medical office. While speaking to a caller, the phone rings indicating a second call. She puts the first caller on hold to answer the new call. What should she say first?

A. Good morning. This is Evans Family Practice, Channa speaking.
B. Can I put you on hold for a minute?
C. Good morning. Who am I speaking with?
D. This is Channa, the medical assistant. Who is calling please?
A. Good morning. This is Evans Family Practice, Channa speaking.
Which of the following should Channa always avoid while speaking to a caller on the telephone?

A. Locating a patient's account information in the computer
B. Looking at the appointment schedule to find a free appointment
C. Writing a letter related to supplies that were ordered but not received
D. Jotting down information about the caller and telephone call
C. Writing a letter related to supplies that were ordered but not received
Channa has placed a telephone call on hold to transfer the call to the office manager. She notices that the light for that extension continues to blink slowly. What should she do?

A. Return to the call within 30 seconds and ask if she can take a message
B. Return to the call after about a minute and say that the office manager seems to be away from her desk
C. Assume that the call has gone to voice mail and the caller is leaving a message
D. Assume that the office manager has placed the call on hold and will return to the call shortly
A. Return to the call within 30 seconds and ask if she can take a message
When Channa answers the telephone, Joanne Hightree, a patient, asks for Dr. Bennett. Channa explains that the physician is busy with patients and offers to take a message. Ms. Hightree gives her date of birth and telephone number. She wants to know the results of a CT scan. What other information must Channa include in the message?

A. Patient's temperature
B. Medications taken by Ms. Hightree
C. Medication allergies
D. Where and when the CT scan was performed
D. Where and when the CT scan was performed
During a telephone call, the caller becomes increasingly upset and angry. How should Channa respond to help the caller calm down?

A. Get angry in return
B. Keep the tone of voice as normal as possible
C. Transfer the call to the office manager immediately
D. Tell the caller to calm down or she will hang up
B. Keep the tone of voice as normal as possible
Dr. Bennett has asked Channa to place a call to a colleague who is attending a conference in San Francisco. The colleague will have a midmorning break at 10:30 AM Pacific Time. Evans Family Practice is located in Philadelphia. At what time should Channa place the call?

A. 11:30 AM
B. 12:30 PM
C. 1:30 PM
D. 2:30 PM
C. 1:30 PM
During the early morning Channa is alone in the office when she receives a call from a mother whose 4-year-old daughter has eaten some berries from a bush in the yard. The daughter does not seem ill, but the mother is worried. What should Channa advise the mother to do?

A. Call an ambulance
B. Call the Poison Control Center
C. Wait by the telephone until the physician returns her call
D. Bring the child to the office just before the first afternoon appointment at 12:45 PM
B. Call the Poison Control Center
When talking on the telephone, Channa always tries to enunciate clearly. What does this mean?

A. She articulates her words clearly.
B. She speaks in a low tone of voice and avoids a high pitch.
C. She speaks a little more loudly than she would for normal conversation.
D. She makes sure that she uses words at the level of understanding of each caller.
A. She articulates her words clearly
Delores Reading calls to request laboratory results from a blood test that was done recently. Some of the results were elevated. What should Channa say to Ms. Reading?

A. "All the results are pretty close to normal."
B. "If you haven't heard from the physician by now, you can assume everything is normal."
C. "You will be getting a letter from the laboratory with the results in a few days."
D. "The physician will need to review your results, so I will have to take a message."
D. "The physician will need to review your results, so I will have to take a message."
Channa receives a telephone call from a patient who wants to speak to the physician. Channa says that the physician is not in the office and offers to take a message. Then the patient asks for the physician's pager number. What should Channa do?

A. Repeat her offer to take a message and ask for a number where the physician can reach the patient
B. Say that the office does not give the physician's pager number to patients.
C. Give the pager number to the caller.
D. Offer to call the physician immediately, and promise that he will call the patient within twenty minutes.
A. Repeat her offer to take a message and ask for a number where the physician can reach the patient
When Maria completes a paper charge slip for a patient after the patient visit, what does she use to identify how much to charge the patient for each service?

A. Day sheet
B. Charge slip
C. Fee schedule
D. Patient account ledger
C. Fee schedule
Which of the following tasks must Maria complete first related to entering a patient charge if an office uses paper charge slips?

A. Be sure all procedures performed have been entered on the charge slip
B. Enter the charges into the patient account on the computer
C. Total and balance the patient ledger
D. Update the fee schedule
A. Be sure all procedures performed have been entered on the charge slip
If Maria creates a check for $125.50 to pay the electric bill, who should sign the check?

A. Maria can sign the check.
B. Two physicians must sign the check.
C. There is one physician with check- signing privileges.
D. Any physician in the practice who is authorized to sign checks.
D. Any physician in the practice who is authorized to sign checks
After all charges and payments have been posted and checked, Maria closes the day in the computer system. What does this mean?

A. The files in the computer system have been backed up.
B. No additional entries or changes can be made using that date
C. Mistakes or errors can no longer be corrected.
D. The computer day sheet will be printed automatically.
B. No additional entries or changes can be made using that date
If the office has several bank accounts, which account would Maria probably use to pay monthly bills?

A. Checking account
B. Savings account
C. Money market account
D. Whichever account has the highest balance
A. Checking account
Before entering checks from patients on the bank deposit slip, Maria stamps them with a stamp stating the name of the practice and "For deposit only." What type of endorsement is the office using?

A. Blank endorsement
B. Special endorsement
C. Restrictive endorsement
D. General endorsement
C. Restrictive endorsement
What should Maria do with a check that had a serious mistake so that it could not be used?

A. Tear it up.
B. Shred the check.
C. Write "void" on the check and place it in the recycle bin.
D. Write "void" on the check and place it with the office bank records
D. Write "void" on the check and place it with the office bank records.
Maria is responsible for making the office bank deposits for the office. How often does she usually do this?

A. Twice a day
B. Daily
C. Every third day
D. Once a week
B. Daily
Maria is responsible for reconciling the office checking account every month. When the bank statement arrives, Maria knows that ____________ should be subtracted from the period-end balance as part of the process before comparing to the office balance.

A. Any bank charges
B. Interest earned
C. Amount of any checks that have not yet cleared the bank
D. All of the above
A. Any bank charges
Maria notices that there is only $5.50 in the petty cash drawer. The petty cash fund base amount is $75. Which of the following actions should she take?

A. Replenish the petty cash fund by taking $75 in cash from the day's cash receipts.
B. Ask the physician to give her $20 to $40 from her personal funds for petty cash.
C. Replenish the petty cash fund by writing a check for $69.50 on the office checking account.
D. Wait until the petty cash fund is completely depleted before replenishing the fund.
C. Replenish the petty cash fund by writing a check for $69.50 on the office checking account.
John needs to look up a procedure code for a nursing home visit made by one of the physicians the previous week. What section of the CPT manual will contain the correct code?

A. Evaluation and Management
B. Surgery
C. Pathology and Laboratory
D. Medicine
A. Evaluation and Management
John knows that the level of service used to choose the correct code for an office visit depends on all except which of the following?

A. Extent of history
B. Extent of physical examination
C. Number of procedures performed
D. Complexity of medical decision making
C. Number of procedures performed
In the progress note written by the physician for a patient visit, the physical examination includes findings from all body systems. When choosing the correct code for the office visit, what type of history does John consider this to be?

A. Problem-focused
B. Expanded problem-focused
C. Detailed
D. Comprehensive
D. Comprehensive
During an office visit, the physician performed an incision and drainage of an abscess using a local anesthesia administered by infiltration under the skin. How should John code the local anesthetic?

A. As local anesthesia
B. As general anesthesia
C. John should code for the local anesthetic as an injection, because that is the way it was administered.
D. John cannot code separately for the local anesthetic, because it is included in the surgical procedure
D. John cannot code separately for the local anesthetic, because it is included in the surgical procedure
John is coding for a physician who performed the same surgical procedure on both feet during the same surgery. What coding adaptation must he make?

A. He must use a modifier specifying that it was a bilateral procedure
B. He must choose two different specific codes identifying which foot was operated on.
C. He must use the same procedure code twice, with different diagnosis codes for each foot.
D. He can simply enter the same information twice without any adaptation.
A. He must use a modifier specifying that it was a bilateral procedure.
For which patient must John add a HCPCS level II code for an injection of penicillin G given in the office?

A. Lionel Stone, an 18-month-old male covered by Blue Cross/Blue Shield insurance
B. Judith Wayland, a 45-year-old female covered by an HMO insurance policy
C. Rodney Elliot, a 72-year-old male covered by Medicare insurance
D. None of the above
C. Rodney Elliot, a 72-year-old male covered by Medicare insurance
John needs to look up a diagnosis code for a patient with an infected ulcer of the left leg with varicose veins. What term should he search under in the index?

A. Infected
B. Ulcer
C. Leg
D. Vein
B. Ulcer
John needs to find the correct ICD-10 diagnosis code for a new patient with an insect bite of the left breast. He finds out that the code S20.162 is used for an insect bite of the left breast. The letter "A" must be used to specify a new patient. Where will John place the additional digit?

A. As the first digit (AS20.162)
B. Just before the decimal point (S20A.162)
C. Just after the decimal point (S20.A162)
D. As the last digit (S20.162A)
D. As the last digit (S20.162A)
For which of the following patients should John look for a "Z" code as an ICD-10 diagnosis code?

A. A 16-year-old male with a scalp wound from falling off a bicycle
B. A 62-year-old male who has been dizzy for several days and has fainted twice
C. A 24-year-old woman who had a physical examination with a Pap test
D. All of the above
C. A 24-year-old woman who had a physical examination with a Pap test
John needs to determine the correct procedure code for a patient whose blood was drawn at the office to be sent to the hospital laboratory for a complete blood count with differential. Which code(s) should he use?

A. The code for drawing a blood specimen from a vein (venipuncture) only
B. The code for a complete blood count only.
C. The codes for drawing a blood specimen from a vein and for a complete blood count.
D. None; the office cannot charge for collecting a specimen that will be tested at the hospital laboratory.
A. The code for drawing a blood specimen from a vein (venipuncture) only
Sandra is entering insurance information for a new patient who is covered by Standard Health HMO from her own full-time employment and also by Neighborhood Health Plan insurance from her husband's insurance. Sandra knows that Neighborhood Health Plan usually pays more for services than Standard Health HMO. How should Sandra enter the patient's insurance?

A. Enter only information about Standard Health HMO, because it is the patient's insurance.
B. Enter only information about Neighborhood Health Plan, because it pays more than Standard Health HMO.
C. Enter Standard Health HMO information as the primary insurance and Neighborhood Health Plan information as secondary insurance.
D. Enter Neighborhood Health Plan information as the primary insurance and Standard Health HMO information as secondary insurance.
C. Enter Standard Health HMO information as the primary insurance and Neighborhood Health Plan information as secondary insurance
Mary and Tom Weatherly have children who are covered by both parents' insurance. How will Sandra determine which parent's insurance covers the oldest child, whose birthday is August 25?

A. Whoever's income is the highest
B. Whoever's birthday comes first in the year
C. Whoever was working the longest, Mary or Tom
D. Whoever's birthday falls the closest to the child's
B. Whoever's birthday comes first in the year
Diana Holmstead is a patient with Medicare insurance. She has met her deductible for the calendar year. The Medicare allowed charge for the service Diana has received is $300. How much will Sandra expect the medical office to receive from Medicare?

A. $300
B. $280
C. $260
D. $240
D. $240
Mary Alice Jones, a foster child, is a Medicaid patient. She has a procedure performed for which the physician charged $100. The state in which Mary Alice lives allowed $64 for the procedure. For what amount can Sandra bill Mary Alice's foster parents?

A. $0
B. $12.80
C. $20
D. $36
A. $0
John Finney is covered by an insurance company that is a preferred provider organization. The physicians who employ Sandra are in the network of his insurance plan. What does Sandra expect John's financial responsibility to include?

A. A copayment, but no additional financial responsibility
B. An annual deductible and possibly a small percentage of allowed costS
C. No additional responsibility beyond what the insurance pays
D. An annual deductible, and at least 20% of the amount charged by the office
B. An annual deductible and possibly a small percentage of allowed costs
Sharon Bright is a 68-year-old patient with Medicare, as well as insurance through employment. Which insurance should Sandra submit the insurance claim to?

A. Medicare first
B. The insurance that Sharon has through employment first
C. Both insurance companies at the same time
D. If Sandra's birthday is in the first half of the year, Medicare first; otherwise, insurance obtained through employment first
B. The insurance that Sharon has through employment first
Gordon Taylor has come to the office with a laceration on his left shin that he received when he stumbled over a packing box at work. What does Sandra know about patients who are injured at work and covered by Workers' Compensation?

A. They are treated as ordinary patients.
B. Their entire medical record must be sent to the employer's insurance company.
C. They must have separate medical and financial records for the work-related treatment.
D. The patient's financial responsibility is 20% of the charge allowed by the employer's insurance company.
C. They must have separate medical and financial records for the work-related treatment.
When completing a paper insurance claim form, where does Sandra place the name and address of the insurance company?

A. In the carrier information section
B. In the patient and insured information section
C. In the physician information section
D. Only on the envelope or as part of the electronic routing information
A. In the carrier information section
The insured person for a new patient is her husband, and he is not a patient of Sandra's medical office. How will Sandra enter information about the patient's husband in the office computer?

A. The husband will be entered as a patient of his wife's physician.
B. All information about the husband will be entered into the record for the patient.
C. The information about the husband will be entered into the record for the husband's insurance company.
D. A record will be created for the husband as a guarantor, and his information will be entered there.
D. A record will be created for the husband as a guarantor, and his information will be entered there
Sandra has received a denial of an insurance claim stating that the procedure is not justified by the diagnosis. What should she do related to this claim?

A. Adjust the patient's bill, because insurance will not pay.
B. Charge the patient, because insurance has denied the claim.
C. Review the claim information, correct any errors, find a more specific code if possible, and resubmit the claim.
D. Check the insurance claim register to be sure that the claim was sent to the correct insurance company.
C. Review the claim information, correct any errors, find a more specific code if possible, and resubmit the claim
What is the term used to describe money that is owed to the medical office?

A. Cash due accounts
B. Revenue accounts
C. Accounts payable
D. Accounts receivable
D. Accounts receivable
What term is used to describe the bills that the practice has for office rent, equipment rental, and salaries?

A. Accrual accounts
B. Accounts receivable
C. Outgo accounts
D. Accounts payable
D. Accounts payable
When is income calculated in the cash basis of accounting?

A. At the end of the month in which service occurred
B. At the time a patient bill is paid
C. When a charge is posted to a patient account
D. When a bill is sent to the patient
B. At the time a patient bill is paid
What is the function of a daily journal (day sheet) in a bookkeeping system?

A. To keep a chronological record of transactions
B. To keep a record of transactions related to a single patient
C. To record financial activity for the month
D. To keep a record of cumulative financial activity
A. To keep a chronological record of transactions
What is the major disadvantage of the single entry bookkeeping system?

A. It requires more record keeping than other bookkeeping systems.
B. It requires extensive training to perform correctly.
C. It is not commonly used, so it is unfamiliar to most people.
D. There is no method to crosscheck for accuracy of recording and calculations.
D. There is no method to crosscheck for accuracy of recording and calculations.
What type of record is used to keep track of all the charges and payments for each individual patient?

A. Daily journal
B. Transaction entry record
C. Patient ledger
D. Patient statement
C. Patient ledger
At what interval are charges and payments usually posted to patient accounts?

A. Hourly
B. Monthly
C. Weekly
D. Daily
D. Daily
Which codes are necessary in order to submit insurance claims?

A. Codes are optional when submitting insurance claims
B. Procedure codes only
C. Both diagnosis and procedure codes
D. Diagnosis codes only
C. Both diagnosis and procedure codes
What precaution should be taken when accepting a credit card for payment by a patient?

A. The patient should sign a signature card that will be kept on file.
B. The patient must show a second credit card issued in the same name.
C. The patient should verbally verify the last four numbers of the credit card.
D. The name on the card should be the name of the individual presenting the card.
D. The name on the card should be the name of the individual presenting the card.
If there is a question about the amount of money that has been drawn on a check, what determines the legal amount?

A. The amount shown in figures
B. The amount written in words
C. Neither A nor B—the check is not valid if the amount in figures is not the same as the amount in words
D. None of the above
B. The amount written in words
Which statement best describes the petty cash account?

A. It does not require records to be kept.
B. It is used to purchase items that are not ordered regularly.
C. It is used for incidental items that are usually not very expensive.
D. It is replenished by taking $25 from patient receipts every week.
E. All of the above.
C. It is used for incidental items that are usually not very expensive.
Bookkeeping refers to the process of recording financial transactions, but accounting is a more general term used for the systematic recording and reporting of financial transactions.

A. True
B. False
A. True
When a patient charge is entered into a computerized medical billing system, the posting is reflected both in the patient ledger as well as the daily record of charges.

A. True
B. False
A. True
Charges, payments and adjustments can be posted using a manual system or practice management software.

A. True
B. False
A. True
Which organization compiled the first disease classification system in the United States?

A. American Medical Association
B. Department of Health and Human Services
C. American College of Surgeons
D. American Board of Internists
A. American Medical Association
For which reason(s) are procedure codes used?

A. To classify the type of care given to patients
B. To identify and/or justify medical services a patient received
C. To collect statistics about frequency and effectiveness of procedures
D. To determine how frequently certain diseases occur in the population
E. All of the above
E. All of the above
How often should the medical office purchase new code books or computer code sets?

A. Every time there is a new edition of the CPT manual
B. Annually
C. Every 6 months
D. Every 2 years
B. Annually
Who publishes the CPT manual for procedure codes?

A. The U.S. Department of Health
B. American Medical Association
C. Various publishers
D. World Health Organization
B. American Medical Association
What coding system is used by the Centers for Medicare and Medicaid Services for services and equipment that are not usually covered by ordinary health insurance?

A. DRG
B. ICD-9-CM
C. HCPCS Level II
D. CPT
C. HCPCS Level II
What is the first section of the CPT manual?

A. Anesthesia
B. Evaluation and Management
C. Surgery
D. Radiology
B. Evaluation and Management
Dr. Barry Manning is an internist. In which section of the CPT manual would the codes for his office visits be found?

A. Surgery
B. Radiology
C. Evaluation and Management
D. Medicine
C. Evaluation and Management
Which of the following types of history focuses mainly on the chief complaint?

A. Comprehensive history
B. Expanded problem-focused history
C. Detailed history
D. Problem-focused history
D. Problem-focused history
How is an established patient defined?

A. A patient who has been seen in the past three years
B. A patient who has been seen in consultation
C. A patient who has made a payment to the office
D. A patient who has a medical record in the office
A. A patient who has been seen in the past three years
What is a panel?

A. A set of five codes that are used together for certain diagnostic tests
B. A radiologic test that is done with the patient lying on the back
C. A group of individuals who review insurance claims
D. A group of laboratory tests that are done together
D. A group of laboratory tests that are done together
When procedure codes are used to bill an insurance company, which of the following is an example of upcoding?

A. A medical office charges for venipuncture performed in the office
B. A physician sends a patient to an outside laboratory and the laboratory bills the insurance company
C. A medical office bills for performing a urinalysis in the office
D. A medical office uses a separate code for each lab test in a panel when all tests in the panel were performed
B. A physician sends a patient to an outside laboratory and the laboratory bills the insurance company
What problems with CPT codes may cause insurance claims to be rejected?

A. Modifiers are used to describe special circumstances.
B. The code has been selected from the list of codes in the manual.
C. The service is not backed up with documentation in the patient record.
D. All of the above.
E. None of the above.
C. The service is not backed up with documentation in the patient record.
If the medical assistant is coding for the removal of a lesion, what might influence selection of the proper code?

A. Type of lesion
B. Size of the lesion
C. Location of the lesion
D. Method of removal of the lesion
E. All of the above
E. All of the above
Which of the following abbreviations or punctuation indicates that a more specific ICD-9 or ICD-10 code cannot be identified?

A. NEC
B. [ ] (brackets)
C. ( ) (parentheses)
D. NOS
D. NOS
Why is it important for a medical assistant to be aware of guidelines for medical necessity?

A. To determine what diagnostic tests should be ordered for patients
B. To link procedure codes to correct diagnosis codes
C. To use a variety of codes instead of overusing certain codes
D. To be sure that codes reflect a high enough level of service
B. To link procedure codes to correct diagnosis codes
If an office has a pattern of downcoding, what is the effect on insurance payments?

A. Insurance payments will tend to be higher than average for the services
B. Insurance payments will tend to be lower than average for the services
C. The insurance company will reject a large number of claims
D. The insurance payments will be delayed because of requests for documentation
B. Insurance payments will tend to be lower than average for the services
When coding the diagnosis "tachycardia, R/O angina pectoris," the medical assistant should look up the code in the index under "angina."

A. True
B. False
B. False
Which federal insurance plan provides for services for the elderly and disabled?

A. CHAMPVA
B. Medicaid
C. TRICARE
D. Medicare
D. Medicare
What insurance plan provides for care for patients who are suffering from end-stage kidney disease?

A. TRICARE
B. CHAMPUS
C. Medicaid
D. Medicare
D. Medicare
What insurance plan provides care for low-income individuals and children?

A. CHAMPVA
B. TRICARE
C. Medicare
D. Medicaid
D. Medicaid
Tom Bloom is a disabled serviceman whose disability is caused by service-related injuries. What insurance plan covers his wife and children?

A. Medicare
B. TRICARE
C. CHAMPVA
D. Medicaid
C. CHAMPVA
What is the term for the amount of money that must be paid each year for services before the insurance company begins to pick up the payments?

A. Premium
B. Deductible
C. Benefit
D. Assignment
B. Deductible
When the insurance company pays 80% of the charge, and the patient pays the remaining 20%, what is the patient's portion called?

A. Deductible
B. Benefit
C. Copayment
D. Coinsurance
D. Coinsurance
Mary and Tom Weatherly are both covered by a family health insurance plan. Whose plan is the primary plan for their children?

A. Whoever's birthday falls the closest to the child's
B. Whoever's birthday comes first in the year
C. Whoever has worked the longest
D. Whoever earns the highest annual income
B. Whoever's birthday comes first in the year
Mary and Tom divorced after a few years. However, they both continued to work and share custody of their children (joint custody). The children reside with Mary. Neither parent has remarried. Tom is the "responsible party" for the children. Whose insurance is the primary insurance for the children?

A. Both
B. Tom's
C. Mary's
D. The birthday rule applies
B. Tom's
What type of payments do patients with HMO insurance usually make?

A. Deductible
B. Copayment
C. Both deductible and coinsurance
D. Coinsurance
B. Copayment
Under Medicare Part A, which of the following goods/services would be covered?

A. Medications administered in the medical office
B. Canes and walkers purchased in a pharmacy
C. Homemaker/health aide services
D. Hospital stay
D. Hospital stay
If a patient with Medicare is admitted to a hospital for three days, what portion of the hospital costs must the patient pay?

A. Nothing
B. A fixed amount that is adjusted annually
C. 20% of the amount charged by the hospital
D. A deductible of $135.00
B. A fixed amount that is adjusted annually
How does Medicare set allowable charges for services under Part B using resource-based relative value systems (RBRVS)?

A. Based on the amount of work for each procedure with adjustments for overhead and malpractice insurance
B. Based on the usual, customary and reasonable charge in the geographic area
C. Based on the education of the practitioner who performs the procedure with a geographic adjustment
D. Using base units multiplied by time units and a factor to adjust for geographic location
A. Based on the amount of work for each procedure with adjustments for overhead and malpractice insurance
How much is the copayment or coinsurance that a patient with Medicaid must pay?

A. $10 copayment
B. The patient with Medicaid does not pay anything
C. 20% and a $100 deductible
D. 20% coinsurance
B. The patient with Medicaid does not pay anything
What type of insurance covers long-term nursing home costs for eligible patients?

A. Medicaid
B. Medicare
C. CHIP plans
D. None of the above
A. Medicaid
What program provides benefits for the dependent spouses and children of veterans who suffered total, permanent service disabilities or who died as a result of those service-connected disabilities?

A. CHAMPVA
B. CHAMPUS
C. Medicaid
D. TRICARE
A. CHAMPVA
Which of the following is NOT required for each charge on an insurance claim form?

A. Procedure code
B. Date(s) of service
C. Place of service
D. Time of service
D. Time of service
What can the medical assistant use to determine the patient's identification or policy group number?

A. The patient's Social Security number
B. The patient's driver's license
C. The patient's insurance card
D. A telephone call to the patient's insurance company
C. The patient's insurance card
What is a frequent reason for an insurance claim to be rejected?

A. A two-digit modifier was used with the procedure code.
B. The secondary insurance company is billed after the primary insurance has paid on the claim.
C. The claim was not filed in a timely manner.
D. The procedures are not medically justified by the diagnosis.
D. The procedures are not medically justified by the diagnosis.
If a claim is rejected by an insurance company, what should the medical assistant do first?

A. Prepare a bill for the patient, since he or she is now completely responsible.
B. Mark in the insurance claims register that the claim will not be paid.
C. Resubmit the claim with corrections and/or additional information.
D. Immediately resubmit the claim exactly as it before.
C. Resubmit the claim with corrections and/or additional information.