If an insured patient signs an Assignment of Benefits form, the insurance carrier will send payment directly to the:
bank.
guarantor.
patient.
physician.
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Q. 2) Services covered under the Ambulatory Payment Classification (APC) system include all of the following EXCEPT:
outpatient surgical procedures.
inpatient surgical procedures.
emergency department visits.
diagnostic services.
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Q. 3) The CMS-1500 claim form is mandatory for all Medicare claims.
Indicate whether this statement is true or false.
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Q. 4) The type of care that provides palliative services for terminally ill patients is known as:
hospice care.
home health care.
critical care.
terminal care.
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Q. 5) If an individual is covered under Plan A through her employment and is covered under Plan B through her spouse's employment:
Plan A is primary, and Plan B is secondary.
Plan B is primary, and Plan A is secondary.
only Plan A will pay for her benefits.
Plan B will pay all of the benefits.
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Q. 6) A company that receives claims from providers, audits them, and forwards them on to insurance carriers is a(n):
billing service.
independent auditing firm.
clearinghouse.
third-party administrator.
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Q. 7) The computerized comprehensive list of codes for all services and items provided to hospital patients is known as the __________ .
Fill in the blank with correct word.
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Q. 8) The method of reimbursement that establishes the rate of payment to a hospital before services are rendered is:
capitation.
fee for service.
per diem.
prospective payment system.
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Q. 9) The CMS-1500 claim form used by physician offices was developed by:
the American Medical Association (AMA).
the Blue Cross/Blue Shield Association.
the Centers for Medicare and Medicaid Services (CMS).
representatives from all insurance carriers.
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Q. 10) Audits performed on a regular basis will confirm that documentation and coding were appropriate for the level of service provided or will identify problems.
Indicate whether this statement is true or false.
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