IC36 Mock Test Sample 6
IC36 Health Insurance Claims Management highlights the importance of medical coding, provider classification, claims auditing, and cost control. Co-morbidity coding assists policymakers in understanding disease severity, risk assessment, and patient outcomes. ICD and E-codes support accurate classification of diseases and external causes of injuries. Healthcare providers are categorized based on the level of care offered, while benchmarking and package pricing improve efficiency in healthcare delivery. Claims reserves ensure adequate financial provisioning by insurers. Knowledge of anatomy, medical conditions, and claim verification processes helps professionals maintain accuracy, detect fraud, and facilitate effective claims management.
1. Identification of co-morbidity codes helps policymakers to:
a) Recognize severity of illness
b) Measure patient outcomes
c) Assess healthcare risks
d) All of the above
2. Which of the following compensation methods is generally considered unacceptable for primary care providers?
a) Fee for Service
b) Salary-based payment
c) Fixed Fee Case arrangement
d) Per Patient Episode payment
3. Which coding system is used to describe the cause and circumstances of injuries?
a) V-Codes
b) E-Codes
c) CPT Codes
d) ICD-9-CM Procedure Codes
4. Diseases such as diabetes and leukemia are often associated with:
a) Cell dysfunction
b) Tissue regeneration
c) Bone disorders
d) Nerve compression
5. Claim processing may be kept on hold if there is:
a) Incomplete treatment details
b) Mismatch in claimant information
c) Improper discharge documentation
d) Any of the above
6. Which of the following is an example of a facility-based provider?
a) Specialist physician
b) Nurse practitioner
c) Alternative birthing center
d) Mid-level practitioner
7. Identifying unusual billing patterns helps insurers with:
a) Marketing strategies
b) Cost control measures
c) Hospital expansion plans
d) Agent recruitment
8. The most important classification of healthcare providers is based on:
a) Number of beds
b) Hygiene standards
c) Level of care offered
d) Hospital ownership
9. ICD codes are commonly used by:
a) Health insurers
b) Medical coders
c) TPAs
d) All of the above
10. The spinal cord forms part of the:
a) Peripheral Nervous System
b) Central Nervous System
c) Digestive System
d) Respiratory System
11. Medical inflation primarily results from:
a) Increased treatment costs
b) Lower hospitalization rates
c) Reduced use of technology
d) Fewer medical consultations
12. Gastroenteritis generally refers to inflammation involving the:
a) Stomach and intestines
b) Liver and pancreas
c) Kidneys and bladder
d) Brain and spinal cord
13. If there is a discrepancy in claim documents, the insurer may:
a) Request clarification or additional information
b) Automatically reject the claim
c) Approve the claim without review
d) Cancel the policy immediately
14. Auditors in health insurance claims may:
a) Review all claims
b) Focus on selected samples
c) Examine high-value claims
d) Any of the above
15. In the absence of pricing benchmarks, hospital charges may depend on:
a) Location of the hospital
b) Reputation of consultants
c) Facilities and amenities offered
d) All of the above
16. The human skull is primarily composed of:
a) Cartilage
b) Tissues
c) Bones
d) Muscles
17. Financial provisions created by insurers for outstanding claims are known as:
a) Solvency margins
b) Claim reserves
c) Premium allocations
d) Expense ratios
18. Package pricing in healthcare can:
a) Encourage provider participation in risk management
b) Promote efficient resource utilization
c) Improve cost predictability
d) All of the above
19. In ICD-9-CM, the abbreviation "CM" stands for:
a) Clinical Modification
b) Case Management
c) Cost Measurement
d) Coding Methodology
20. Appendicitis may affect structures associated with the:
a) Large intestine region
b) Peritoneal cavity
c) Cecal area
d) All of the above
