1. Officer Browner is an active member of the Air Force. He visited the emergency room for treatment of a wrist fracture. The coder is billing for the emergency room visit and the treatment of the fracture. The coder will most likely submit the claim to
A. TRICARE.
B. CHAMPUS.
C. CHAMPVA.
D. SCHIP.
2. Medicare Part B is classified as
A. supplemental medical insurance because people don't automatically receive it.
B. an optional supplement for Medicare Part D.
C. a mandatory component of Medicare Part A.
D. an amendment to Medicare Part C.
3. Which one of the following statements is true according to the "gatekeeper" concept?
A. The physician chooses the cases that generate higher reimbursement.
B. The medical coder chooses the charts that will be coded.
C. The primary care physician or another health care worker is the case manager for the patient.
D. The insurance underwriter chooses the patient who receives coverage.
4. What is the purpose of the National Committee for Quality Assurance (NCQA)?
A. Monitors the quality of patient care in long-term care facilities
B. Reviews complaints filed by patients regarding the quality of physician care
C. Monitors the quality of patient care in nursing homes
D. Assesses and reports on the quality of managed care plans
5. An insurer's responsibilities include
A. clarifying policy questions for OASIS dependents.
B. organizing medical records.
C. writing the terms of union contracts.
D. fixing the terms of coverage.
6. The term active duty would apply to
A. physicians who perform duties on 24-hour rotation.
B. patients covered under TRICARE.
C. nurses who perform duties while active in a specific radius.
D. patients covered under Medicare Part D.
7. Medicare Part D covers
A. hospital inpatient stays.
B. prescription drugs.
C. occupational therapy visits.
D. physician surgeries.
8. What does Medicaid provide?
A. Health care coverage for low-income families that meet certain eligibility requirements
B. Dental insurance coverage
C. Supplemental insurance for veterans
D. Additional coverage for dependents under age 18
9. Healthcare providers who organize to treat Medicare patients are called _______ organizations.
A. accountable care
B. independent care
C. managed care
D. geriatric care
10. If you have 80-20 policy coverage, it means
A. you pay 80% of the expenses and the insured pays 20%.
B. you pay 80% of the expenses and the insurer pays 20%.
C. the insurer pays 80% of the expenses and you pay 20%.
D. the insured pays 80% of the expenses and you pay 20%