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Flashcards in Part 7 Deck (10)
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1

Which is the special group that requires states to pay Medicare Premiums, deductibles and coinsurance amounts for individuals whose income is at or below 100 percent of the federal poverty level and whose resources are at or below twice the standard allowed under SSI?

A. QUALIFIED MEDICARE BENEFICIARIES
B. QUALIFIED WORKING DISABLED INDIVIDUALS
C. QUALIFYING INDIVIDUALS
D. SPECIFIED LOW INCOME MEDICARE BENEFICIARIES

QUALIFIED MEDICARE BENEFICIARIES

2

To qualify for Worker's Compensation benefits, an employee must be injured while working within the scope of the job description, be injured while performing a service required by the employer, or develop a disorder that can be directly linked to employment, such as abetosis or mercury poisoning. The worker does not have to be physically on company property to qualify for Worker's Compensation benefits?

A. Employee is injured in an accident during a trip to the bank to deposit personal checks
B. Employee develops pneumonia after working at the medical office all week
C. Employee faints at the grocery store and believes it is due to stress at work
D. Employee is injured when picking up reports for the office at the local hospital

Employee is injured when picking up reports for the office at the local hospital

3

The amount charged for medical insurance policy is called the __________.

A. Claim
B. Deductible
C. Fee schedule
D. Premium

Premium

4

What is the current program that makes cash assistance available, for a limited time, for children deprived of support because of a patient's absence, death, incapacity, or unemployment?

A. Qualified working disabled individuals
B. Federal medicaid assistance percentage
C. Temporary assistance for needy families
D. Aid to families with dependent children

Temporary assistance for needy families

5

Which program pays for inpatient hospital critical care access, skilled nursing facility stays, hospice care, and some home health care?

A. Medicare Part D
B. Medicare Part A
C. Medicare Part C
D. Medicare Part B

Medicare Part A

6

The term used to refer to the statement sent to the provider and the patient to clarify the services provided, billed amounts, and payments made by the payer

A. Claims transactions
B. Electronic data interchange
C. Explanation of benefits

Explanation of benefits

7

The health plan reimburses Dr. Tan $15 per patient per month. In January, Dr. Tan saw 300 patients so he received $4,500 from the health plan. What method is the health plan using to reimburse Dr. Tan?

A. Discounted fee schedule
B. Capitation rate
C. Traditional Retrospective
D. Relative rate

Capitation rate

8

Ensures uniformity of electronically transmitted data in healthcare billing in an physician practice setting.

A. 835 data set
B. 837P data set
C. 834 data set
D. 837I data set

837P data set

9

The regulatory repeating set of events the produces the financial income in a healthcare facility.

A. Utilization review
B. Revenue cycle
C. Case management
D. Revenue

Revenue cycle

10

The patient must pay $500 out of her own pocket before her insurance company will begin to reimburse for medical expenses. She is also responsible for 20% of the bill for medical services. The 20% is the

A. Coinsurance
B. Deductible
C. Charge
D. Premium

Coinsurance