Test Your Billing Definitions and Terms Knowledge

Multiple Choice

1. What is the difference between co-pay and coinsurance?

a. They mean the same thing and used by insurance companies interchangebly

b. Coinsurance is a percentage and copay is a set amount

c. Copay is a percentage and coinsurance is a set amount

d. Coinsurance is the term used only for Medicare patients

2. What does EDI stand for?

a. Employer Designated Insurer

b. External Data Integrity

c. Error on Data Insurance

d. Electronic Data Interchange

3. What is capitation?

a. Pre-established payments to providers for enrollees over a period of time, whether the patient is seen or not by the provider

b. Payment for services rendered by providers and based many times on Medicare fee schedules

c. Services that all inclusive for a procedure, typically 10, 30 or 90 days

d. Health insurance plans that include preventive services

4. What is the definition of "deductible"?

a. The amount the insurance company will pay before patient co-insurance benefits are calculated

b. A specific dollar amount set by the insurance company for each visit or medical service that is rendered

c. The amount the patient is financially responsible before an insurance policy provides payment

d. The amount the insurance company is financially responsible before before other benefits are paid

5. What is the name of the standard claim form used to submit physician office services to Medicare and other insurance payors?

a. UB04

b. CMS1250

c. CMS1500

d. HSA


What is RBRVS?

a. Program with the federal govenemnt to help pay Medicare premiums, deductibles and coinsurance and coinsurance for low monthly
          individuals who have Medicare Part A

b. A fixed fee to physicians for participating and contracting with an insurance payor for services provided to their subscribers

c. A managed care fee-for-service plan that includes prescription drugs

d. Payment system for reimbursement of physician practice expenses base on the physician work, practice expense and malpractice
          insurance expense


 What is PIP insurance?

a. PIP insurance helps cover medical bills, lost wages and other costs after a car accident,. It also known as no-fault insurance.

b. PIP insurance is personal property insurance to help cover injuries on your property such as falls or other injuries.

c. PIP insurance is a long term insurance you can add to a HMO insurance program to cover lost wages and long term healthcare

d. PIP insurance a disability insurance. There are strict regulations for coverage and determine by age and status of current health conditions.


What is the correct definition of a "Guarantor".

a. This is the person who received the services

b. This is the name of the insurance company

c. This is the person responsible for the bill and not always the patient who receive the services.

d. This is the name of the employer


What is FECA and who is covered under this program?

a. Federal Employees Compensation Act for all federal employees of the government

b. Federal Expenses Coverage for Alzheimer's is a federal program recently established for persons over the age of 50 for clinical trials and payment of expenses for this disease

c. Federal Employees of Coal Mine Association. Benefits for respiratory conditions related to former employment in national's coal mines.

d. Federal Employees Compensation Act for federal and postal workers for employment related injuries and occupational diseases


What is the difference between copay and coinsurance?

a. Coinsurance is a set amount owed by the patient, copay is a percentage of the allowed amount

b. Coinsurance is a percentage of the allowable amount, copay is a set amount such as $10.00, $30.00 etc.

c. Coinsurance is the dollar amount owed before insurance will pay. Copay is the percentage of the allowable amount

d. Coinsurance and copay are terms used interchangeably


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