IC36 Mock Test Sample 8
IC36 Health Insurance Claims Management emphasizes provider network optimization, medical coding standards, quality audits, and fraud prevention. ICD-10 coding provides greater specificity, laterality, and flexibility compared to ICD-9. Healthcare providers act as gatekeepers to ensure appropriate utilization of services and control costs. Clinical indicators such as mortality rates, medication errors, and length of stay help assess hospital performance. Credentialing ensures that healthcare professionals meet competency standards. Effective claim management involves verification, investigation when necessary, and adherence to policy terms. Understanding medical conditions, healthcare technology, and ethical practices supports accurate and efficient health insurance claim administration.
1. An optimum provider network should have the ability to:
a) Attract competent healthcare providers
b) Ensure adequate patient volume for providers
c) Enlist cost-conscious providers
d) All of the above
2. Which statement regarding ICD-9 and ICD-10 coding systems is incorrect?
a) ICD-10 codes provide greater specificity
b) ICD-10 includes laterality features
c) ICD-9 offers more flexibility for adding new codes
d) ICD-9 codes are generally shorter than ICD-10 codes
3. ICD-10 codes for diagnosis are predominantly used in:
a) The United States only
b) Most countries outside the United States
c) India alone
d) Australia alone
4. Deposition of cholesterol in coronary artery walls is known as:
a) Cardiac arrest
b) Heart failure
c) Atherosclerosis
d) Cardiomyopathy
5. Which activity forms an integral part of verifying whether claims are processed according to company guidelines?
a) Claim closure
b) Auditing
c) Premium calculation
d) Policy issuance
6. Primary care physicians are often called gatekeepers because they:
a) Help reduce unnecessary hospital admissions
b) Guide patients to appropriate levels of care
c) Control healthcare utilization
d) All of the above
7. ICD-9-CM primarily refers to:
a) Procedural coding methodology
b) Mortality coding system
c) Pharmacy coding system
d) Financial coding standards
8. The cerebellum is mainly responsible for:
a) Vision and hearing
b) Coordination and balance
c) Speech production
d) Memory formation
9. Which classification system is used in India for mortality and morbidity statistics?
a) CPT
b) ICD
c) ACHI
d) CCSD
10. Public sector insurers maintain control over claims handled by TPAs through:
a) Periodic audits of claim files
b) Premium revisions
c) Agent supervision
d) Direct hospital management
11. Credentialing of doctors may consider:
a) Professional qualifications
b) Institutional affiliations
c) Research and teaching contributions
d) All of the above
12. Meningitis affects the membranes covering the:
a) Heart and lungs
b) Brain and spinal cord
c) Kidneys and bladder
d) Liver and pancreas
13. ICD has been translated into numerous languages to facilitate:
a) Standardized international reporting
b) Insurance marketing
c) Hospital licensing
d) Premium computation
14. A scrutiny or process sheet in claims management is generally used to:
a) Record processing notes during claim evaluation
b) Calculate policy premiums
c) Issue health cards
d) Register hospitals
15. Improper use of technology in healthcare may result in:
a) Patient dissatisfaction
b) Increased treatment costs
c) Delays in care delivery
d) All of the above
16. Inflammation of liver cells leading to liver injury is called:
a) Cellulitis
b) Folliculitis
c) Hepatitis
d) Gastroenteritis
17. Effective claim management includes:
a) Verification of policy details
b) Review of medical information
c) Scrutiny of final hospital bills
d) All of the above
18. Clinical indicators used to assess hospital quality include:
a) Mortality rates
b) Medication errors
c) Length of hospital stay
d) All of the above
19. Which body system primarily regulates growth, metabolism, and sexual development?
a) Digestive system
b) Endocrine system
c) Respiratory system
d) Circulatory system
20. Which of the following would generally NOT fall under fraudulent conduct?
a) Intentional concealment of material facts
b) Deliberate misrepresentation of information
c) Honest statements made without intent to deceive
d) Acts designed to mislead others
