IC36 Mock Test Sample 10
IC36 Health Insurance Claims Management focuses on accurate documentation, medical coding, fraud prevention, and efficient claims processing. Investigation reports and standardized medical records help correlate diagnosis with treatment and determine claim admissibility. Coding systems support disease classification, risk assessment, underwriting, reimbursement, and fraud detection. Accreditation bodies such as NABH assess healthcare quality and compliance with established protocols. Understanding medical investigations, informed consent, provider roles, and healthcare terminology improves claim evaluation. Insurers and TPAs work together to manage claims effectively, while strong internal controls and vigilance mechanisms help minimize fraudulent activities within the insurance ecosystem.
1. Which document assists in correlating diagnosis and treatment to understand the patient's condition?
a) Hospitalization record
b) Discharge summary
c) Investigation report
d) Consolidated report
2. A fee charged within the range normally charged by physicians with similar expertise is known as:
a) Provider fee
b) Service fee
c) Customary fee
d) Registration fee
3. Which coding system helps identify the medical status of a patient with a known condition requiring specific treatment?
a) ICD-10
b) ICD-9
c) V-Code
d) E-Code
4. Treatment provided at home because the patient cannot be moved to a hospital is called:
a) Primary care
b) Day care treatment
c) Domiciliary treatment
d) Emergency care
5. Which document serves as evidence of the amount payable under an insurance policy?
a) Investigation report
b) ICU charges statement
c) Consolidated bill
d) Prescription slip
6. NABH evaluates healthcare institutions on aspects such as:
a) Healthcare processes
b) Clinical protocols
c) Non-physician specialist services
d) All of the above
7. Medical coding can be used for:
a) Fraud detection
b) Assessing disease burden
c) Measuring readmission rates
d) All of the above
8. Cystoscopy is a diagnostic investigation related to the:
a) Respiratory system
b) Circulatory system
c) Urinary system
d) Endocrine system
9. Coded healthcare data is commonly used for all of the following except:
a) Underwriting
b) Product pricing
c) Claims management
d) Personal investment planning
10. Which of the following may indicate gastrointestinal disorders?
a) Reflux esophagitis
b) Hiatus hernia
c) Blood in stools
d) All of the above
11. A claim form generally contains:
a) Patient and policy details
b) Cause of illness
c) Period of hospitalization
d) All of the above
12. Informed consent is:
a) A formal document
b) An explanation of treatment risks and benefits
c) A record of patient understanding
d) All of the above
13. Under an Overseas Mediclaim Policy, a new hospital admission is generally notified to the:
a) Relative
b) Assistance company
c) Travel manager
d) Employer
14. Medical professionals and institutions delivering healthcare services promised under an insurance policy are called:
a) TPAs
b) Providers
c) Auditors
d) Investigators
15. Which measure helps reduce fraud risk within insurance companies?
a) Effective vigilance mechanisms
b) Strong internal audits
c) Special investigation units
d) All of the above
16. Which of the following is considered a vestigial structure in the human body?
a) Coccyx
b) Fingers
c) Feet
d) Hair follicles
17. Medical management objectives include:
a) Treating illness
b) Providing appropriate nursing care
c) Rehabilitation of disabled individuals
d) All of the above
18. Filing a claim for a non-covered person using a false identity is known as:
a) Claim inflation
b) Impersonation
c) Misrepresentation
d) Claim duplication
19. Insurers provide advance funds to TPAs primarily to:
a) Settle approved claims efficiently
b) Increase policy sales
c) Improve underwriting results
d) Reduce premium rates
20. The digestive system is responsible for ingestion, absorption, and ________ of food for energy and bodily functions.
a) Collection
b) Assimilation
c) Multiplication
d) Distribution
