All are eligible under Medicare health insurance except:
a) retiree of the Civil Service Retirement System
b) persons of 65 years or older, retired on Social Security benefits
c) those diagnosed with end-stage renal d
...
All are eligible under Medicare health insurance except:
a) retiree of the Civil Service Retirement System
b) persons of 65 years or older, retired on Social Security benefits
c) those diagnosed with end-stage renal disease (ESRD)
d) All kidney donors - ✔✔d) All kidney donors
Which provider/network must accept the payer's allowable amount as 100% payment for procedures or
services provided?
a) Out of Network provider
b) Participating provider
c) Non-participating provider
d) Both a & b - ✔✔b) Participating provider
_____ means the provider agrees to accept what the insurance company approves as payment in full for
the claim.
a) Assignment of benefits
b) Fee schedule
c) accept assignment
d) Capitation - ✔✔c) accept assignment
Charge a higher premium than HMO's in exchange for more flexibility and more options for the
beneficiaries. There is no gatekeeper-physician and beneficiaries choose the provider from whom to
seek services as long as the provider is within the network.
a) PPO
b) HMO
c) Triple Plan Optiond) Prepaid health plan - ✔✔a) PPO
Vaccine codes are found in what section of the CPT?
a) E & M secion
b) Laboratory section
c) Medicine section
d) Appendix C - ✔✔c) Medicine section
Covers some other medical services that Part A doesn't cover, such as outpatient services, some of the
services of physical and occupational therapists, and some home health care.
a) Medicare Part A
b) Medicare Part B
c) Medicare Part C
d) Medicare Part D - ✔✔b) Medicare Part B
Under Medicaid, a low income individual losing employer health insurance coverage can be eligible
under Medicaid. What law provides continuation of group health coverage that otherwise might be
terminated?
a) COBRA
b) Stark Law
c) OIG
d) HIPAA - ✔✔a) COBRA
For work related injuries, is it covered by private insurance even though patient is covered under
Worker's Compensation Insurance?
a) True
b) False - ✔✔b) False
Gate-keeper under managed care plan is also called the:
a) Primary care physicianb) Referring physician
c) Consultant
d) Attending physician - ✔✔a) Primary care physician
Assignment of benefits means that third party payer will:
a) Pay the physician directly
b) Pay the patient directly
c) Pay claim 100%
d) none of the above - ✔✔a) Pay the physician directly
Insurance for active military personnel and their dependents.
a) CHAMPVA
b) Medicare
c) Tricare
d) BCBS - ✔✔c) Tricare
Which of the following is not being paid by insurance because it is not included in the benefits list of
insurance policy contract?
a) preexisting condition
b) medically necessary
c) non-covered benefits
d) not authorized services - ✔✔c) non-covered benefits
Which would be assigned to report DMEPOS on insurance claim?
a) CPT code
b) HCPCS Level I codes
c) HCPCS Level II codes
d) HCPCS Level III codes - ✔✔c) HCPCS Level II codesWhich of the following is the "Payer of Last Resort"?
a) Tricare
b) Medicare
c) Medicaid
d) all of the above - ✔✔c) Medicaid
those who qualify for Medicaid include all of the following except:
a) Low income families with children
b) Persons over 65 who are blind or have a permanent disability
c) Persons who earn enough money to pay basic living expenses, but cannot afford high medical bills
d) High income earners - ✔✔d) High income earners
To avoid interfering with an individual's access to quality health care or the efficient payment for such
health care, the Privacy Rule permits a covered entity to use and disclose protected health information,
with certain limits and protections without individual's authorizations for the following purposes:
a) Treatment, Payment, and Healthcare Operations
b) Treatment, Pathology, and Outpatient Visits
c) Trading, Payment, and Research
d) None of the above. All disclosure need patient's authorization. - ✔✔a) Treatment, Payment, and
Healthcare Operations
Anti Self-referral law is also called:
a) HIPAA
b) False Claims act
c) Stark Law
d) CMS -
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