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August 22, 2014

Homework Help: insurance prep

Posted by mia on Thursday, June 2, 2011 at 9:42pm.

1. The information for Blocks 1 9 on the CMS-1500 can be obtained
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1. The information for Blocks 1–9 on the CMS-1500 can be
obtained from the
A. ledger card.
B. medical treatment record.
C. confidential patient information record.
D. fee schedule.
2. If a patient is covered by Medicaid, what should you put in
Block #9a?
A. Nothing
B. The 12-digit Medicaid number
C. The policy number of other coverage, if any
D. The patient’s social security number3. If both nondivorced parents of a dependent child have insurance that will cover the child,
which policy is considered to be the primary carrier for the child?
A. The mother’s insurance
B. The father’s insurance
C. The coverage that has been in effect longer
D. The coverage of the parent whose birthday falls earlier in the year
4. As an employee at Medical & Dental Associates, how much should you charge for comprehensive
service for an established patient?
A. $48 C. $72
B. $55 D. $90
5. A type of insurance that was designed to meet the needs of senior citizens is
A. Medicare. C. CHAMPUS.
B. Medicaid. D. SSI.
6. CHAMPVA would be considered a primary payer for a patient who has _______ coverage.
A. Medicaid C. Medicare
B. fee-for-service D. SSI
7. You should record payments that are received from insurance companies on the
A. confidential patient information record.
B. medical treatment record.
C. routing slip.
D. ledger card.
8. When filling out a CMS-1500 form, where would you place the address of the agency to
which you’re submitting the form?
A. At the very top right of the form C. In Block #5
B. On the EOB D. In Block #9d
9. Suppose that your office has submitted a claim for $800 to Medicare. The amount
approved by Medicare for this claim is $625. How much will your office actually receive
from Medicare?
A. $175 C. $625
B. $500 D. $800
10. When should you submit a claim to a secondary insurance company?
A. When a primary insurance company returns a claim for correction
B. When the patient authorizes you to do so
C. At the same time you submit the claim to the primary carrier
D. After you receive payment from the primary insurance company
6011. If the patient in Question 9 has only Medicare coverage, your office will have to bill the
patient for the amount of
A. $125. C. $300.
B. $175. D. $625.
12. When you’re completing a CMS-1500 form for a fee-for-service insurance company, you
should omit the patient’s telephone number because
A. a patient’s phone number is XXXXXXXXXXXX information.
B. the insurance company will already have the patient’s number.
C. the insurance company shouldn’t contact the patient directly by phone.
D. the phone number creates problems for scanners.
13. Most of the laws that govern Medicaid coverage are set by
A. the CMS. C. state governments.
B. WHO. D. the federal government.
14. The purpose of Coordination of Benefits clauses is to
A. avoid overpayments of insurance claims.
B. make the completion of the CMS-1500 easier.
C. outline the order in which insurance companies are to be billed.
D. make sure that physicians receive 100 percent of what they charge.
15. One of the physicians in your office is treating XXXXX XXXXXXX for a work-related injury.
Karen will be receiving workers’ compensation for her injury. Who should receive the claim
for any treatment Karen receives that’s not related to the work injury?
A. Karen’s employer
B. Workers’ compensation
C. Medicare
D. Karen’s primary insurance company
16. CHAMPUS was created to provide insurance coverage primarily for
A. men and women on active duty in the armed forces.
B. spouses and children of men and women on active duty.
C. disabled veterans.
D. retired veterans.
17. In Block #8 of the CMS-1500 form, the two boxes labeled “full-time student” and “part-time
student” are used for
A. patients who are dependent children of the subscriber.
B. patients under the age of 18.
C. patients who are between 18 and 24 years old that are still covered by their
parents’ insurance.
D. patients who are dependent children with their own insurance covera18. What form should be attached to a CMS-1500 form submitted to a secondary
insurance company?
A. A copy of the CMS-1500 sent to the primary insurance company
B. An Explanation of Benefits
C. A copy of the patient’s medical treatment record
D. A copy of the patient’s ledger card
19. The type of insurance that’s most often prone to abuse is
A. auto liability. C. Medicare.
B. workers’ compensation. D. fee-for-service.
20. Which of the following types of insurance is based on need?
A. Disability insurance C. Fee-for-service insurance
B. SSDI D. SSI
21. Which of the following blocks on the CMS-1500 must be completed for
indemnity insurance?
A. Block #19 C. Block #21
B. Block #20 D. Block #23
22. In a workers’ compensation case, who determines the date when the employee is
expected to return to work?
A. The insurance company representative
B. The employer
C. The employee
D. The physician
23. To provide nonemergency treatment to a CHAMPUS patient, the sponsor must obtain
preauthorization if the
A. patient is new to the office.
B. sponsor is within a 40-mile radius of a CHAMPUS treatment facility.
C. patient has secondary insurance coverage.
D. sponsor is treating the patient for an injury caused by an automobile accident.
Questions 24, 25, 26, and 27 are based on the CPIR and the Medical Treatment Record
for Maria Blumquist found on pages 192 and 193 in your textbook.
24. What number should you insert in Block #1a of the CMS-1500 form you prepare for
patient Blumquist?
A. XXXXX-XXXX-2 C. 99-9999999
B. XXX-XX-XXXX D. XXX-XXX-XXXX25. Which of the following amounts will you insert in Block #28?
A. $55 C. $65
B. $75 D. $70
26. Which of the following codes should you include in Block #21?
A. 802.20 C. 99204
B. 802.30 D. J9293
27. Which of the following boxes should you check in Block #6?
A. Self C. Child
B. Spouse D. Other
Questions 28 and 29 are based on the CPIR and the routing slip for Hoyt Styvesant found on
pages 216 and 217 in your textbook.
28. In preparing a CMS-1500 form for Mr. Styvesant, which of the following numbers should
you insert in Block #21, line 1?
A. 295.70 C. 99211
B. 786.50 D. J1631
29. How should you handle Block #9a?
A. Insert XXXXXXXXXX4. C. Insert XXX-XX-XXXX.
B. Leave it blank. D. Insert XXXXXXXXXX
Questions 30, 31, 32, 33, and 34 are based on Record #13, Sheets 1–3, on pages 204–206
in your textbook.
30. Which of the following numbers should you insert in Block #1a on the CMS-1500 form that
you submit to the primary insurance company?
A. XXX-XX-XXXX C. XXX-XX-XXXX
B. XXXXXXXXX D. XXXXXXXXX
31. If you receive $40 from the primary insurance company and $15 from the secondary
insurance carrier, how much should you submit to the third carrier?
A. Nothing C. $48
B. $13 D. $68
32. Which of the following numbers should you place in Block #24-E?
A. 1 C. 99214
B. 2 D. XXXXXXX. According to Medical & Dental Associates’ procedures, who should receive the bill for the
portion of Ritchey’s fee that’s not covered by insurance?
A. Ritchey Bacon C. Cheryl Bacon
B. Melanie Beeker D. Charles Bacon
34. Under how many insurance policies is Ritchey covered?
A. 1 C. 3
B. 2 D. 4
Questions 35, 36, 37, 38, and 39 are based on the CPIR and the routing slip for Philip
Woods found on pages 222 and 223 in your textbook.
35. In preparing a CMS-1500 form for patient Woods, which of the following codes should you
use for the primary diagnosis?
A. 99243 C. 571.5
B. 80059 D. 599.7
36. Which of the following actions should you take for Block #24K?
A. Leave Block #24K blank.
B. Get the correct number for Block #24K from the Medicaid office.
C. Place code number XXXXXXXXX in Block #24K.
D. Place code number XXXXXXXXX in Block #24K.
37. Which of the following is the total amount of the bill you should submit to Medicaid for
Philip Woods?
A. $69 C. $194
B. $81 D. $206
38. When you receive the Medicaid payment for Philip Woods, which of the following actions
should you take regarding the remainder of the bill?
A. Send no more claims—you must accept what Medicaid provides.
B. Send a bill for the remainder to the patient, Philip Woods.
C. Submit a second claim to Medicare.
D. Submit a claim to the referring doctor, Dr. Lukoskie.
39. Philip Woods was charged the amount of $45 for a
A. hepatic function panel. C. hepatitis panel.
B. general health panel. D. quantitative syphilis test.Questions 40, 41, and 42 are based on the CPIR and two routing slips for Keith Konklin
found on pages 240–242 in your textbook.
40. On the ADA for Keith Konklin, the number XXX-XXXX should be placed in Block
A. #7. C. #19.
B. #18. D. #31.
41. Which of the following is the total amount of the claim to be submitted for patient Konklin?
A. $475 C. $579
B. $554 D. $683
42. Which of the following codes should include an indication of tooth 14 on the ADA?
A. 02330 C. 00220
B. 00120 D. 01110
Question 43 is based on the CPIR and routing slip for Terrence James found on pages 245
and 246 in your textbook.
43. Which of the following types of insurance form should you complete for Terence James?
A. An ADA form
B. A CMS-1500 form
C. A form provided by the patient
D. A Medicaid Dental form
Questions 44 and 45 are based on the CPIR and routing slip for Bill Williams found on
pages 247 and 248 in your textbook.
44. How many separate items should you list in Block #31?
A. 1 C. 4
B. 2 D. 5
45. For Blocks #24–#30, which one should be marked “yes” for Bill Williams?
A. Block #24 C. Block #27
B. Block #25 D. Block #281. Which of the following documents would provide information on
a patient’s diagnosis?
A. Confidential patient information record
B. Ledger sheet
C. Medical treatment record
D. CPT-4
2. By signing an “Assignment of Benefits” statement, a patient is
A. authorizing a doctor to provide information to an insurance
carrier about his or her condition.
B. verifying that all information on the CPIR is accurate.
C. giving permission to the insurance carrier to pay the
physician or dentist directly.
D. accepting responsibility for payment of all medical bill3. In which of the following would you look to find the code for a diagnosis of emphysema?
A. ICD-9-CM manual C. CMS-1500
B. CPT-4 manual D. CPIR
4. Which of the following is the code for congestive heart failure?
A. 428 C. 428.1
B. 428.0 D. 428.9
5. The first thing you must do to code a patient’s diagnosis is
A. look up the diagnosis in the Tabular List.
B. find the main term in the Index to Diseases.
C. determine whether it’s a V-code or E-code.
D. look under neoplasm in the ICD-9-CM manual.
6. Which of the following is the correct code for chronic apical periodontitis?
A. 522.4 C. 523.4
B. 522.6 D. 523.3
7. The CPIR is used to
A. gather new patient information.
B. keep track of payments made to a physician’s office.
C. submit insurance claims.
D. record each patient’s visit to a physician’s office.
8. The code for a condition resulting from an auto accident is a/an
A. E-code. C. late-effect code.
B. V-code. D. hypertension code.
9. Which of the following is the correct code for candidal otitis externa?
A. 112.82 C. 380.10
B. 112.9 D. 382.9
10. The term malignant, when used in reference to hypertension, is a
A. treatable cancer.
B. cancer that has metastasized.
C. serious, life-threatening disease.
D. condition related to high blood pressure.11. The term neoplasm refers to a/an
A. invasive carcinoma. C. encapsulated tumor.
B. malignant growth. D. growth of tissue.
12. The term used to describe why medical treatment is necessary is
A. morphology. C. adverse effect.
B. procedure. D. diagnosis.
13. The physician you work for performed a bilateral epididymectomy with reduced services.
Which of the following codes would you include on the CMS-1500 for this procedure?
A. 54860 C. 54861
B. 54860-52 D. 54861-52
14. An adverse effect is a condition that develops as a result of
A. a recent illness.
B. a long-standing illness.
C. the improper use of medication or drugs.
D. the proper use of medication or drugs.
15. Which of the following terms has the same meaning as subscriber?
A. Gatekeeper C. Practitioner
B. Insured D. Established patient
16. How many codes are needed to correctly code accidental poisoning by consuming
noxious mushrooms?
A. 1 C. 3
B. 2 D. 4
17. What does it mean when you find a three-digit code highlighted in the Tabular List?
A. You must confirm the code in the Index to Diseases.
B. You must add a decimal point to the code and at least one more digit.
C. You must include a separate code from the CDT-2 manual.
D. You must include a modifier, such as -50, with the code.
18. Which of the following is the code for traumatic thumb amputation?
A. 886.0 C. 885.0
B. 886.1 D. 885.119. Which of the following is the correct code for secondary malignant hypertension due to
renal embolism?
A. 405.01 C. 405.09
B. 405.11 D. 405.19
20. A patient is suffering from a severe rash that’s a reaction to a medication prescribed by a
physician. To find the correct E-code for this situation, what column should you use in the
Table of Drugs and Chemicals?
A. Poisoning C. Therapeutic Use
B. Accident D. Undetermined

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