Insurance MCQ

Offering stock as an incentive to purchase an illegal practice known as Answer: Rebating

Every producer must complete continuing education courses every Answer: 2 years

A producer with a property and casualty license must complete Answer: 16 hours of continuing education every 2 years

Insurers must keep record of all policies for Answer: 2 years

What is a reason you cannot Denny coverage Answer: The applicant has been denied by another insurance company

A producer must inform the director of a change of address within Answer: 30 days

If a producer fails to comply with a suponea issued by the director, the director may revoke/suspend the license and take further legal action in the office of a Answer: County circuit court

If a worker died due to a work-related injury; survivor benefits will be paid to a surviving spouse for Answer: 2 years

Terry is an insurance producer. She received an application for coverage on a single family home. Her client has submitted an application with a premium Answer: Terry has the authority to issue a blinder to provide temp coverage

Which of the following are required to be covered by workman's comp. Answer: Restaurants

If a cash premium is paid to the producer the producer must Answer: Give the customer a written receipt, signed by the producer

If an insurer denies coverage, it must notify the prospective insured within Answer: 30 days

After a policy is terminated, the producer or insurer must keep the policy records for Answer: 3 years

A producers license must contain the following except Answer: Past insurance experience

The guaranty fund provides coverage for unpaid health insurance claims up to Answer: $100,000

To show continued eligibility under the mature defense driver law, one must repeat the approved highway traffic safety course every Answer: 24 months

Paying a person an inducement to purchase insurance is called Answer: Rebating

If an insured inquires about submitting claim the insurer must do each of the following within 10 days...But CANNOT Answer: Pay the claim

A producer most notify the directory if any felony prosecution within Answer: 30 days

A car dealer may self-insure for its own liability if it has more than how many vehicles Answer: 25

A producer may receive commission from Answer: Another licensed producer having the same type of license

Director may issue temporary license for Answer: 90 days

Inland Marine Insurance covers a lot but they do not cover Answer: Warehouses

Auto policies in Missouri have a minimal duration of Answer: 3 months

Any company or individual being examined must provide records within Answer: 10 days

Workers comp must cover Answer: Members unless they reject it in writing

Single limit policy must provide how much auto liability coverage Answer: $60,000

FAIR plan policy are always issued for a duration of 1 Year.TRUE or FALSE Answer: True

Director must approve or reject am insurers form/rate within Answer: 60 days

Missouri certificate of auto self-insurance may be obtained from Answer: Director of revenue

Director must give 15 days of hearings with changes.TRUE or FALSE Answer: True

After appointing a producer the appointment must be registered in the insurer's registered appointed producers within Answer: 30 days

Tempo license can go to Answer: Surviving spouse

If a license of a producer of a financial planner Answer: He or she is also a sales person

Purpose of sr-22 filing is to Answer: Notify the department of revenue that an auto policy has been canceled

Discriminatory to charge different rates based on Answer: Marital status

Property or casualty policy claim is covered under Missouris prop + casualty guaranty fund up to how much Answer: $300,000

Guaranty fund provides coverage death benefit Answer: $300,000

Business entity's may obtain producers license unless its a Answer: Sole proprietorship

A producers license may be revoked by the Answer: Director of insurance

A producer may split commissions with Answer: Any producer w/ the same line of insurance

A construction industry must have workers comp if it has Answer: One employee

A Missouri producer cannot use a binder to provide Answer: A rate advantage over competitors

When canceling a sr-22 filing the director must notify within Answer: 10 days

The purpose of the Missouri FAIR plan is to Answer: Provide property insurance to persons unable to obtain insurance

If an insurer terminates a producer, the insurer must notify the commissioner within how many days? Answer: 30 days

If the director revokes a producers license, the producer may appeal to the decision within Answer: 30 days

The director may grant a waiver from the continuing education requirement for a lot, but NOT Answer: When the producer met more than a mandatory hours in the prior 2 year period

Making a false statement under oath in any insurance director investigation Answer: Is a class D felony which would take the offenders license or certificate of authority will be revoked

Insurers must keep all claim records for Answer: 3 years

FAIR plan polices Answer: Are issued by the plan, not the private insurers

What is allowed as an underwriting factor if the actuaries can show it's justified Answer: Sex

A Medicare patient signature on an advanced beneficiary notice must be obtained Answer: For all services Medicare does not deem "medically necessary"

What is the statement called that is sent to Medicare patient summarizing the disposition of a claim in layman's terms? Answer: Medicare summary notice

The "birthday rule" helps determine the primary insurance plan Answer: When a child is covered by both parents

Assign consent to release medical information for treatment, payment, and healthcare operations Answer: Is no longer mandated by HIPAA

A "taxonomy code" on a claim form is used to designate Answer: The physicians specialty

For TRICARE patients, a nonavailability statement is needed when a patient lives with in the hospital ZIP Code area and Answer: Non-emergency care is not available

To supplement Medicare, the department of defense offers Answer: TRICARE for Life

State disability insurance is offered in Answer: California, Hawaii, New Jersey, New York, Rhode Island, and Puerto Rico

Patient patient having both Medicare and Medicaid is referred to as Answer: Medi/Medi case

What is the acronym used one another pair is primary to Medicare? Answer: MSP

Eligibility for a TRICARE patient is verified by using Answer: the VRU system + the tricare website

Medicare physicians and practitioners Answer: Can "opt out" of the Medicare program for two years

When examining a Medicare card, which has been presented for services in a physicians office, Be sure the patient has Answer: Part B coverage

To contain cost and prosecute cases of Medicare and Medicaid fraud, what law did the government pass? Answer: Civil Monetary Penalties Law

The Medicaid program is generally for A. low income any individuals b. Members of families receiving a dependent children c. The blind and disabled d. All the above Answer: d. All the above

With healthcare reform Medicare patients who now belong to Medicare advantage plans that are higher incomes will soon Answer: No longer qualify for Medicare

Medicaid is a health assistant program sponsored by Answer: Both state and federal governments

Under which type of managed-care plan can physician see capitated managed care patients in private pay patient and maintain their own offices? Answer: IPA

Healthcare reform ushers that they will no longer be a. Limitations on coverage b. limits for lifetime maximum benefits c. Pre-existing condition clauses d. All the above Answer: d. All of the above

With healthcare reform, parents will be able to keep adult children on their policies until age Answer: 26

Dependents of the insured are a. Spouses b. Children c. Domestic partners d. All of the above Answer: d. All of the above

A "HDHP" is a/an Answer: insurance health plan with a high deductible

Select the correct statement about health care premiums and benefits a. The more coverage the lower the premium in the less out-of-pocket expenses b. The more coverage the higher the premium and the less out-of-pocket expenses c. The less coverage the lower the premium and the less out-of-pocket expenses d. I love the ridge the less coverage the higher premium and no out-of-pocket expenses Answer: b. The more coverage the higher the premium and the less out-of-pocket expenses

Which type of claim has been discarded by an insurance company system because of technical errors and may be returned to the provider? Answer: Rejected

According to the patient protection and affordable care act which is designed to ensure an additional 32 million Americans everyone must purchase health insurance or face at $695 annual fine by the year Answer: 2014

Which type of claim contains complete information but its contents is illogical or incorrect Answer: Invalid

When an insurance company determines that a particular service or procedure is appropriate based on standards of prudent care, this is establishing Answer: medical necessity

Under which type of managed care plan will the cost of services be covered only if the patient receives care from a participating physician? Answer: HMO

A compilation of a physician's charges and payments made by an insurance company for specific services over a period of time is the physician's Answer: fee schedule

Which of the following is a procedure used by insurance companies to avoid duplicate payments due to benefits provided by more than one policy? Answer: Coordination of benefits

What information must be copied from a patient's insurance card? Answer: the front and back of the card

If a valid claim has not been paid after multiple inquiries and or a denial has been received, what may be filed with the insurance company? Answer: appeal

Accurate diagnostic and procedural codes must be included as part of Answer: Health insurance claims

A feature of electronic billing systems that reviews claim data and identifies inconsistencies or missing information before the claim is submitted is the Answer: claim scrubber

The National Provider Identifier (NPI) number serves an a unique identifier for physicians who Answer: Submit health insurance claims

Which type of policy is available from private insurance companies and regulated by the federal government to supplement Medicare coverage? Answer: Medigap

Federal legislation that requires employers offer extended group health insurance benefits to employees and dependents affected by job loss or other life events is called? Answer: COBRA

Hospital insurance benefits are provided under which part of the Medicare program? Answer: Part A

The health benefits program that covers dependents of men and women in the military is Answer: TRICARE

A voluntary prescription drug coverage plan falls under which part of the medicare program Answer: Part D

The process of finding out if a service or procedure is covered under a patient's insurance policy is Answer: Precertification

The process of finding out the maximum dollar amount that an insurance company will at for a particular service or procedure is Answer: Predetermination

Which of the following is a method of payment on which the physician is paid a set amount for each patient enrolled regardless of services provided? a. Relative value study b. Usual, customary, and reasonable c. Free-for-service d. Capitation Answer: d. Capitation

An injury or illness that occurred before the issuance of a health insurance policy is a(n) a. Preexisting benefit b. Permanent condition c. Preexisting condition d. Exclusion Answer: c. Preexisting condition

Claims may be received, edited, and distributed electronically to insurance companies through a central a. Clearinghouse b. Insurance carrier c. benefits administrator d. physician network Answer: a. Clearinghouse

Terms in a group insurance policy that allow the insured to continue the same or lesser coverage under an individual policy is a a. Routine provision b. Conversion privilege c. Reinstatement clause d. Group benefit Answer: b. Conversion privilege

An insurance policy is a legally enforceable a. regulation b. authorization c. contract d. benefit Answer: c. contract

Periodic payments made to keep an insurance policy in force are a. Deductibles b. Copayments c. Annual limits d. Premiums Answer: d. Premiums

An illness or injury that prevents an individual from performing all major duties of his or her occupation or from engaging in any other type of work is a a. Partial disability b. Total disability c. Preexisting condition d. Temporary disability Answer: b. Total disability

ICD-10-CM uses a disease index to initially locate codes for conditions and a ______ to verify codes. Answer: Tabular List

Which document is sent by private insurance carriers to detail amounts paid or denied on an insurance claim? a. Coverage outline b. Remittance advice c. explanation of benefits d. summary notice Answer: c. explanation of benefits

What legislation requires adherence the coding guidelines when assigning ICD-10_CM codes? Answer: HIPAA

Codes that have an applicable seventh character are considered ______ w/out the seventh character. Answer: Invalid

Select the first-listed dx: The physician treated the pt's chronic asthma during an OV, and she also received a renewed prescription for hypertention. Answer: Chronic Asthma

Select the first-listed dx: The pt was treated in the office for nausea and vomiting. The physician dx gastroenteritis. The pt also requested a refill for her hypertension medication. Answer: Gastroenteritis

Which of the following coding conventions indicates mutually exclusive codes, two conditions that cannot be reported together? Answer: Excludes 1 note

_______ is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. Answer: Screening

_____ qualify (help define) the mainterm by listing alternative sites, etiology, or clinical status. Answer: Essential Modifiers

General rules that are incorporated into the index and tabular list instructional notes. (format, abbreviations, punctuation and symbols, includes and excludes notes, inclusion terms, other and unspecified codes, etiology and manifestation rules, and, with, see, and see also) Answer: Coding Conventions

This testing is routinely completed prior to an inpatient admission or outpatient surgery to facilitate the patient's treatment and reduce the length of stay. Some payers provide reimbursement this, making it important to assign codes properly. Answer: PAT

Translation dictionaries or crosswalks of codes that can be used to roughly identify ICD-10-CM codes for their ICD-9-CM equivalent codes (and vice versa) Answer: GEMs

For carcinoma of breast to spread to the lungs, the primary site is Answer: breast

Major topic headings in the Tabular List of ICD-10-CM are known as Answer: code blocks

The chapter ______ is used as a placeholder in ICD-10-CM. Answer: X

ICD-10-PCS will be used to report services and procedures in Answer: hospitals

Which best describes how many characters ICD-10 Codes contain? Answer: Three, four, five, six, or seven characters

If the primary site of malignancy is no longer present, assign a code for Answer: personal hx of malignant neoplasm

______ identify codes to be assigned when information needed to assign a more specific code cannot be located in the ICD-10_CM coding manual. Answer: NECs

Intestinal Infectious Diseases [A00-A09] is an example of a ________ which is printed in bold uppercase letters and followed by groups of three-character disease categories w/in a chapter. Answer: Major Topic Heading

Which index would be used to locate main terms such as accident, injury, injured, or misadventure to pt during surgical or medical care? Answer: Index to External Causes

The ICD-10-CM Alphabetical Listing of Main Terms or Conditions printed in boldface type that may be expressed as nouns, adjectives, or eponyms is called the Answer: Index to Diseases and Injuries

What is the term for a malignant tumor that is localized, circumscribed, encapsulated, and noninvasive? Answer: Carcinoma in situ (CA in situ)

Eponyms are diseases or syndromes that are named for ppl. Answer: True

The ICD-10-CM is published as a singe volume coding manual that include the Index to Diseases and Injury and the Tabular List of Diseases and Injuries. Answer: True

Supplementary words located in parentheses after a main term on the ICD Index to Diseases are nonessential modifiers that may be present in or absent from the physician's statement w/out affecting the code number to which it is assigned. Answer: True