The most commonly used health care claim form is the:
a. CMS-1500.
b. HCFA-1450.
c. CMS-1450.
d. HCFA-1500.
(
Q. 2) Use of a conversion factor allows the insurance company to:
a. increase the deductible at regular intervals.
b. vary the copayment for services.
c. pay a small portion of services at 100 percent and others at varying amounts.
d. confuse the physician's office.
(
Q. 3) If an insurance plan includes an actively-at-work provision and the employee is off work due to a non-work injury on the effective date, the insurance becomes effective on:
a. the date of hire.
b. the date of the injury.
c. the date of return to work.
d. the date the injury heals.
(
Q. 4) Which of the following items is not required to obtain preauthorization for surgery?
a. Insurance policy number
b. Diagnosis related to reason for surgery
c. List of potential complications
d. Name of the surgeon
(
Q. 5) Which type of benefit is usually paid at 100 percent?
a. Preventative services
b. Comprehensive
c. Major medical
d. Basic
(
Q. 6) A form or phone call presented to the insurance company prior to a procedure being completed is called a(n):
a. predetermination.
b. authorization.
c. treatment authorization.
d. preauthorization.
(
Q. 7) The greater the insurance coverage, the greater the:
a. payment.
b. copayment.
c. coinsurance.
d. premium.
(
Q. 8) When insurance benefits stop and the insurance company will no longer pay for claims, the policy has been:
a. inactivated.
b. terminated.
c. shut down.
d. invalidated.
(
Q. 9) When an insurance policy requires preauthorizations for procedures, it is a good idea for the medical biller to keep a:
a. list of scheduled procedures.
b. log of authorized procedures.
c. list of codes related to procedures.
d. list of authorized procedure codes.
(
Q. 10) Predetermination requires the physician's office to provide:
a. a proposed treatment plan.
b. a statement of the treatment provided.
c. an invoice for the treatment provided.
d. a request for authorization of a procedure.
Quick Reply
