Reference no: EM132803823
TEST 1 THEORY
Instruction: True or False and Multiple choice T/F
1. There is no timeline for submission of medical claims to the MOHLTC.
2. Interim Federal Health is a program that provides health care coverage for refugees.
T/F
3. Each province or territory has a list of insured health services that must be adhered to by physicians and medical billers in order to receive payment.
T/F
4. The MOHLTC may send verification letters to patients of physicians who are under review or suspected of inappropriate or fraudulent billing.
T/F
5. A physician who refers a patient to another physician can bill for the referral.
T/F
6. A physician cannot bill for a service that is unrelated to the physician's area of specialty as referred to in the physician's code.
T/F
7. OBEC is a method of real-time health card validation in Ontario through the MOHTLC.
T/F
8. In Ontario, all health cards have an expiry date.
T/F
9. It is the physician's office's responsibility to advise patients of the costs involved in noninsured services as well as the method of payments accepted prior to the encounter.
T/F
10. UHIP and WSIB are examples of insured billing through MOHLTC.
T/F
11. A physician must have a valid CPSO number in order to receive an authorized billing number.
T/F
12. Deregulated services are those that OHIP has suspended.
T/F
13. Form 6 is the WSIB form that is completed by health care professionals after an injury has occurred.
T/F
14. All provinces and territories participate in a reciprocal billing program.
T/F
15. The Schedule of Benefits is a negotiated contract between the OMA and the
Government of Ontario; it is a legal document that includes a list of uninsured services.
T/F
16. An individual can travel anywhere in Canada, show his or her health card, and not be expected to pay for the service.
T/F
17. The Ontario Drug Benefit, the Ontario Trillium Drug Program, and the Northern Travel Grant are all subsidy plans.
T/F
18. Stale dated claims are those not submitted within eight months.
T/F
19. Medically necessary services are insured services and are also known as fee services.
T/F
20. Procedures codes are also commonly referred to as service codes.
T/F
21. If a patient arrives with a health card that is reported stolen, confirm with photo identification, and if there is no match, contact the fraud line, ask the patient to pay directly for the service, and ask the patient to contact ServiceOntario.
T/F
22. Associations by specialty provide information to its members and participate in changes to current insured services.
T/F
23. The Suffix Code for a Procedure Code is not keyed with the Procedure Code in an EMR system when creating a bill.
T/F
24. A prefix generally refers to the location of where the health care provider performed the service.
T/F
25. Which of the following does not relate to the MOHLTC:
a) Processes medical claims
b) Establishes fee scheduled for insured services
c) Provides billing numbers for physicians
d) is a federal Ministry
26. OHIP provides the following:
a) Coverage for insured services
b) Subsidies for uninsured services
c) Physician's billing number
27. The College of Physicians and Surgeons:
a) Provides the billing numbers for physicians
b) Provides a list of uninsured services
c) Regulates practising physicians
28. Which of the following is not a responsibility of the Ontario Medical Association:
a) Negotiate with government for insured services
b) Publish a list of uninsured services
c) Provide educational opportunities for physicians
d) Issue physician billing numbers
29. The Resource Manual for Physicians:
a) Provides diagnosis codes
b) Provides procedure codes
c) Provides premium codes
d) Provides specialty codes
30. The Schedule of Benefits:
a) Provides diagnosis codes
b) Provides procedure codes
c) Provides a list of uninsured services
31. A procedure code relates to:
a) The type of service performed by the physician
b) The reason the patient came to see the physician
c) A chronic illness
32. A diagnosis code relates to:
a) The type of service performed by the physician
b) The reason why the patient came to see the physician
c) A chronic illness
33. A facility number relates to:
a) An institution
b) The service areas within an institution
c) A team of physicians
34. A mast number relates to:
a) An institution
b) The service areas within an institution
c) A team of physicians
35. The monitoring body responsible for medical claim submissions and payments in Ontario is:
a) OMA
b) OHIP
c) MOHTLC
d) CMA
36. If a patient came into the office without a health card, you would complete this form:
a) Interactive voice response form
b) Health number release form
c) Health card renewal form
d) UHIP form
37. Diagnosis codes are normally represented by:
a) 5 numbers
b) 3 numbers
c) 3 numbers and 1 letter
d) 1 letter and 3 numbers
38. In the Schedule of Benefits, the time definition for a 12-month period is:
a) January 1 to March 31
b) April 1 to March 31
c) Any period of 12 consecutive months
39. Which of the following is an example of an uninsured service:
a) Psychiatric therapy
b) Retinal eye surgery
c) Laser eye surgery
d) Heart surgery
40. A patient arrives with a health card that has an invalid version code. You would do the following:
a) Check for keying errors to confirm the version code and confirm cardholder identity
b) Check for keying errors to confirm the health number and version code and confirm cardholder identity
c) Ask cardholder if he or she has another health card
d) Request the surrender of the health card