H08V EXAM 6 ANSWERS - ASHWORTH

H08V EXAM 6 ANSWERS - ASHWORTH

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H08V Medical Coding II Exam 6 Answers (Ashworth)

Question 1

0 / 2.5 points

Which of the following is sent to the medical office after an insurance claim has been processed by the insurance company?

Question options:

	a)  COB
	b)  UCR
	c)  MFS
	d)  EOB
Question 2		2.5 / 2.5 points

A patient was seen in the physician office and paid a $10 copay on a $160 bill. The insurance company reimbursed the office for $100. In balance billing, what would happen?

Question options:

	a)  The physician office would bill the patient $50.
	b)  The physician office would write off $50.
	c)  The physician office would appeal the $50 difference.
	d)  The physician office would bill the secondary insurance the $50.
Question 3		0 / 2.5 points

With nationally uniform relative values, the practice expense is based on

Question options:

	a)  premiums.
	b)  cost elements.
	c)  overhead.
	d)  geography.
Question 4		2.5 / 2.5 points

Which of the following is used to control accounts receivable?

Question options:

	a)  Lockbox
	b)  Conversion factor
	c)  Write-offs
	d)  Pending claim
Question 5		2.5 / 2.5 points

You need to write off the remaining balance for a patient’s account. This is called

Question options:

	a)  adjudication.
	b)  adjustment.
	c)  a charge-based fee.
	d)  capitation.
Question 6		0 / 2.5 points

When a claim is submitted electronically, the explanation of benefits may be called a(n)

Question options:

	a)  EOB.
	b)  ERA.
	c)  COB.
	d)  MCF.
Question 7		2.5 / 2.5 points

When a doctor’s office enters into an agreement to treat a specific number of patients in a plan, this is known as

Question options:

	a)  a nonavailability statement.
	b)  preauthorization.
	c)  a beneficiary.
	d)  capitation.
Question 8		2.5 / 2.5 points

Dr. Jones is a non-PAR provider. He sent a claim to the insurance company for $200. The insurance company’s allowable amount is $150. What happens to the remaining $50?

Question options:

	a)  The physician should write it off.
	b)  The physician should bill the patient.
	c)  The physician should appeal the amount.
	d)  The physician should change the claim.
Question 9		2.5 / 2.5 points

Which of the following helps determine the Medicare fee?

Question options:

	a)  RVU × CPT
	b)  RBRVS × RVU
	c)  UCR × RVU
	d)  RVU × GPCI
Question 10		2.5 / 2.5 points

A patient has a copay of $10, and the insurance company paid $90. Which of the following is the most likely allowed amount?

Question options:

	a)  $10
	b)  $90
	c)  $100
	d)  $80
Question 11		2.5 / 2.5 points

Which one of the following choices is based on federal and state laws for how long patient records should be kept in a healthcare facility?

Question options:

	a)  Retention schedule
	b)  EOB
	c)  COB
	d)  Adjudication
Question 12		2.5 / 2.5 points

Which one of the following choices is considered the strength and stability of a growing medical practice?

Question options:

	a)  EOBs
	b)  ERAs
	c)  Accounts receivable
	d)  Balance billing
Question 13		2.5 / 2.5 points

A physician bases the fees for her service on what other physicians charge. She is using

Question options:

	a)  charge-based fees.
	b)  resource-based fees.
	c)  allowed charges.
	d)  withholding.
Question 14		2.5 / 2.5 points

An office sees a patient covered by Medicare. After the deductible is met, Medicare pays the doctor’s office 80% of the MFS and the patient is responsible for 20%. The 20% patient’s portion is known as the

Question options:

	a)  deductible.
	b)  copayment.
	c)  coinsurance.
	d)  charges.
Question 15		2.5 / 2.5 points

Dr. Jones is a PMPM provider. She gets $25 for each patient. There are 150 patients in the plan. What is her monthly reimbursement?

Question options:

	a)  $6
	b)  $25
	c)  $175
	d)  $3,750
Question 16		2.5 / 2.5 points

Dr. Smith charged $150 for a procedure, but the insurance company’s allowed charges are $200. How much will the insurance reimburse the physician?

Question options:

	a)  $150
	b)  $200
	c)  $350
	d)  $50
Question 17		2.5 / 2.5 points

When an insurance company receives a claim form, which one of the following choices is probably one of the first things to be checked?

Question options:

	a)  Patient’s insurance policy identification number
	b)  Diagnosis and procedure codes
	c)  Charges due
	d)  Physician’s name
Question 18		2.5 / 2.5 points

A medical insurance plan lists the following information:
OV $15
SP $35
ER $100
 
What is the patient’s copay for a visit to her physician for fever and sore throat lasting four days?

Question options:

	a)  $15
	b)  $35
	c)  $100
	d)  $150
Question 19		2.5 / 2.5 points

Primary Insurance A sends an ERA and a copy of the claim to Insurance B so that Insurance B knows what it’s responsible for paying. This process is known as

Question options:

	a)  EOB.
	b)  COB.
	c)  MCF.
	d)  UCR.
Question 20		0 / 2.5 points

Once an allowed charge has been set,

Question options:

	a)  physicians can appeal if they don’t agree.
	b)  patients can appeal if they don’t agree.
	c)  physicians are never paid more than that amount.
	d)  physicians are never paid less than that amount.