Court decisions that establish a standard use legal decisions to serve as authoritative rules or
patterns in future similar cases. The legal term for standard is ______.
a. decision
b. example
c. precedent
d. statute - answer✔precedent
Which is established in advance and based on reported health care charges from which a
predetermined per diem rate is determined?
a. prospective cost-based rate
b. retrospective reasonable cost system
c. prospective price-based rate
d. site-of-service differential - answer✔prospective cost-based rate
Which is a legal action that can be used to recover a debt and is usually a last resort for a medical
practice?
a. litigation
b. mediation
c. adjudication
d. subrogation - answer✔litigation
When a child lives with both parents, and each parent subscribes to a different health insurance
plan, the primary and secondary policies are determined by applying the birthday rule. The
individual who holds the primary policy for dependent children is the spouse whose birth
______.
a. month and day occur earlier in the calendar year
b. year occurs earlier
c. day occurs earlier in the month
d. month, day, and year occur earlier - answer✔month and day occur earlier in the calendar year
TRICARE deductibles are applied to the government's ______ year, which runs from October 1
of one year to September 30 of the next.
a. fiscal
b. calendar
c. consecutive
d. sequential - answer✔fiscal
The Resource Based Relative Value Scale (RBRVS) system reimburses physicians' practice
expenses using a ______.
a. usual and reasonable payment basis
b. prospective payment system
c. guaranteed issue method
d. fee schedule - answer✔fee schedule
OSHA has special significance for those employed in health care because employers are required
to obtain and retain manufacturers' Material Safety Data Sheets (MSDS), which contain
information about ______ used on site. Training employees in the safe handling of these
substances is also required.
a. vaccinations and drugs
b. possibly harmful agents only
c. oral, IM, and IV medications
d. chemical and hazardous substances - answer✔chemical and hazardous substances
The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS
substitutes the term subscriber or ______ for policyholder.
d. member - answer✔member
Which type of automobile insurance pays for damage to a covered vehicle caused by hitting an
object or being hit during an automobile accident?
a. liability
b. collision
c. personal injury protection
d. comprehensive - answer✔collision
BlueShield plans were created as the result of a resolution passed by the House of Delegates at
an American Medical Association meeting in 1938. This resolution supported the concept of
______ health insurance that would encourage physicians to cooperate with prepaid health care
plans.
a. voluntary
b. mandatory
c. commercial
d. profit - answer✔voluntary
Which of the following is an example of abuse?
a. submitting claims for services and procedures knowingly not provided
b. misrepresenting ICD-10-CM and CPT/HCPCS codes to justify payment
c. billing noncovered services/procedures as covered services/procedures
d. falsifying health care certificates of medical necessity plans of treatment - answer✔billing
noncovered services/procedures as covered services/procedures
Which code represents a new patient exam in which the physician documents a detailed history,
detailed examination, and medical decision making of low complexity?
a. 99203
b. 99204
d. 99213 - answer✔99203
Which punctuation is used in the ICD-10-CM index to identify manifestation codes and in the
ICD-10-CM index and tabular list to enclose abbreviations, synonyms, alternative wording, or
explanatory phrases?
a. braces
b. parentheses
c. colons
d. slanted brackets - answer✔slanted brackets
Which code represents foot, abduction rotation bar, without shoes?
a. L3170
b. L3150
c. L3140
d. L3160 - answer✔L3150
The Medicare durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) fee
schedule reimburses DMEPOS either ______ percent of the actual charge for the item or the fee
schedule amount, whichever is lower.
a. 80
b. 20
c. 50
d. 100 - answer✔80
Which claims are organized by year and are generated for providers who do not accept
assignment?
a. clean claims
b. unassigned claims
c. open claims
d. closed claims - answer✔unassigned claims
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