2.Examining the procedures performed and the 'medical necessity' on these procedures
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36. Which of the following information is needed to complete the CMS 1500 form?
Patient Information
Insurance/Payment Information
Guarantor Information
Diagnostic Information (ICD-9 Codes)
All of the above
Answer
Correct Answer:
All of the above
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37. What does the bottom of the CMS 1500 Form report?
Provider
Procedure
Diagnostic and Charge Information
All of the above
None of the above
Answer
Correct Answer:
All of the above
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38. What is an accident rider?
A 100% coverage that is not subject to co-payment or deductible in the event that the patient seeks emergency treatment
The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%
The remaining deductible amount not yet incurred by the insured party or family
A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
Answer
Correct Answer:
A 100% coverage that is not subject to co-payment or deductible in the event that the patient seeks emergency treatment
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39. Which of these is not a kind of third-party reimbursement?
Fee-for-service
Capitation
Episode of Care
Managed care plans
Answer
Correct Answer:
Managed care plans
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40. Which of the following is the first phase of the insurance claim life cycle?
Entering the data about claim information
Entering patient demographics in the claim form
Collecting claim data
Stating the name of the guarantor in the claim form
Answer
Correct Answer:
Collecting claim data
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41. Which date format is used on the CMS 1500 Form?
mm/dd/ccyy
mm/dd/yy
yy/mm/dd
The date is not required
Answer
Correct Answer:
mm/dd/ccyy
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42. What is a covered entity?
Any private organization or a government agency
The organizations which maintain and upgrade ICD-9-CM codes
The healthcare providers which are linked to PPOs
The healthcare bodies covered by HIPAA
Answer
Correct Answer:
The healthcare bodies covered by HIPAA
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43. What are the main benefits of electronic claims?
They provide a quicker means of reimbursement
They facilitate quicker submission of claims
They involve more paper work
They lessen the interaction with the consulting physician
Answer
Correct Answer:
They provide a quicker means of reimbursement They facilitate quicker submission of claims
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44. What is a deductible?
A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
The percentage that the policy will pay for a covered procedure
The percentage that the policy will pay for diagnostic, lab and x-ray procedures
The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%
Answer
Correct Answer:
A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
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45. Why were security standards created in HIPAA?
To provide easy accessibility to electronically transmitted health information to all users
To provide a platform to safeguard only the electronic equipment and processes holding the health information
To prevent unauthorized access of electronically stored and transmitted health information
To safeguard electronically stored health information
Answer
Correct Answer:
To prevent unauthorized access of electronically stored and transmitted health information To safeguard electronically stored health information
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46. Why was the accountability component added to HIPAA?
To increase health care costs so that health care professionals earn more profits
To prevent health care fraud and abuse
To deny coverage to an individual who moves from one plan to another
o ensure that individuals get renewed coverage if he moves from one plan to another
Answer
Correct Answer:
To prevent health care fraud and abuse
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47. Which of the following is not a feature of Managed Care Plans?
Charging a nominal fee from the members
Eradicating unwanted services
Charging a standard fee for healthcare provider and hospital services
Itemizing each service and charging to the patient's account
Answer
Correct Answer:
Itemizing each service and charging to the patient's account
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48. If the patient deductible is $600, and the deductible met is $400, the coverage is 60/40 and the physician's charge is $95, how much should the patient pay?
$200
$95
$360
$240
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49. It is necessary to attach a document called _________ when submitting a secondary claim.
Benefits of Explanation
Certificate of Medical Necessity
Explanation of Medical Necessity
Explanation of Benefits
Answer
Correct Answer:
Explanation of Benefits
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50. Which of the following aspects does administrative safeguards focus on?
Administrative functions that ought to be applied to meet security standards
Methods that should be applied to meet physical standards
Administrative functions that prevent access to technical data
All of the above
Answer
Correct Answer:
Administrative functions that ought to be applied to meet security standards
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51. What is a benefit?
It is the function that a product performs
It is what a feature does for a product
It is the additional profits earned by a company
It is the discount that a customer gets on a product
Answer
Correct Answer:
It is what a feature does for a product
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52. Which of the following is not a part of Patient Condition Information?
Name and UPIN of the physician that was referred
Patient date of birth
Diagnosis information
Insured ID Number
Answer
Correct Answer:
Patient date of birth Insured ID Number
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53. Which of the following are required to organize your office as a medical biller?
Computer
CMS- 1500 forms
Printed/ online coding resources
Patient statement forms
All of the above
Answer
Correct Answer:
All of the above
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54. What is not a part of the diagnosis information?
Macro Code
Description
Insurance Information
Gender Specific Indication
ICD9
Answer
Correct Answer:
Insurance Information
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55. What is contained in the release of information (ROI) form?
Name and signature of the patient
he details of the information being transmitted
The name of the medical biller
None of the above
Answer
Correct Answer:
Name and signature of the patient he details of the information being transmitted
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56. What does the UB-04 form include?
National Provider Identifier
Taxonomy
Guarantor Information
Additional Codes
Answer
Correct Answer:
National Provider Identifier Taxonomy Additional Codes
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57. CPT Codes are updated ________.
once every 2 years
annually
whenever changes are necessary
None of the above
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58. The 'Group' in the 'Group Health Insurance Card' refers to the _________.
employer
the name of the insured
the name of the insurance company
third party administrator
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59. Electronic Medical Claims (EMC) help to ___________.
get the carrier more quickly than the paper claims
pay more quickly than the paper claims
notify more quickly in case the claim is rejected
All of the above
Answer
Correct Answer:
All of the above
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60. What are modifiers?
They are used to add more information about a ICD-9 CM code
They help in establishing
They are used to add more information about a CPT code
They are an indicator to show that a procedure is linked to more than one diagnosis
Answer
Correct Answer:
They are used to add more information about a CPT code
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61. In DME claims which of the following is necessary: Referring physician or Ordering physician?
Both
Referring Physician
Neither
Ordering Physician
Answer
Correct Answer:
Referring Physician
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62. If a provider is non-par, any allowed claim amount that is ______ billed charges should be unacceptable.
more than
less than
equal to
Answer
Correct Answer:
less than
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63. A ________ limits the amount of out-of-pocket expenses a patient will have to pay for TRICARE-covered medical services.
TRICARE cap
HMO cap
catastrophic cap
Care ceiling
Answer
Correct Answer:
catastrophic cap
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64. This type of workers compensation would be described as: abnormal conditions or disorders caused by exposure to enviromental factors. Examples of these could be exposure to a chemical, inhalation, ingestion or direct exposure.
Industrial accident
Occupational illness
Federal Employment Liability Act
State Workers Compensation
Occupational Safety and Health Administration
Answer
Correct Answer:
Occupational illness
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65. Which one of the following is the largest Blue Cross Blue Shield member?
WellPoint
CareFirst
Highmark
Premera
Answer
Correct Answer:
WellPoint
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66. Medicare Advantages Plans cover consultation codes?
No
Yes
Partially
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67. According to the MBAA, up to _____ % of US medical bills contain errors.
5%
35%
80%
50%
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68. True or false? An individual on an HMO plan would need a referral to get a yearly mammogram.
TRUE
False
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69. What is the abbrevation for SSI?
Social Security Income
Supplemental Security Information
None of the above
Social Security Information
Supplemental Security Income
Answer
Correct Answer:
Supplemental Security Income
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70. Your office has discovered a breach of a patient’s PHI. How long do you have to notify the patient?
No more than 45 days from the time you discover the breach.
No more than 60 days from the time you discover the breach.
No more than 90 days from the time you discover the breach.
No more than 30 days from the time you discover the breach.
Answer
Correct Answer:
No more than 60 days from the time you discover the breach.
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71. You must notify the local media if a breach of PHI involves ___ or more patients.
100
250
50
500
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72. The form which is specifically used to bill dental services is called?
HCFA 1500 form
ADA form
UB-04 form
Dental Claim form
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73. The federal law that was originally created to safeguard an employees retirement benefits is abbreviated as:
ERISA
TRICARE
COBRA
NOSSCR
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74. True or False? Med pay is a form of no-fault insurance.
True
False
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75. Will Medicare accept a UB-92 form?
Yes
Sometimes
No
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76. The incident-to rule:
Is applicable only to commercial (third-party) payers
Applies specifically to CMS payers
Applies only to inpatient services
Answer
Correct Answer:
Applies specifically to CMS payers
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77. The difference between the summarized income rate and the summarized cost rate over a given valuation period is the:
MediGap
Administrative discrepancy
Cost restraints
Actuarial Balance
Answer
Correct Answer:
Actuarial Balance
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78. A health benefit plan allowing the patient to choose to receive a service from a group of contracted providers is a:
OOP
PPT
PCP
POS
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79. What is a challenge of processing medical bills off site?
None of these
Governmental regulations
It is illegal to process medical bills off site
The biller may not be able to contact the physician
Answer
Correct Answer:
The biller may not be able to contact the physician
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80. Submitting several CPT treatment codes when only one code is necessary is called:
Facility charges
Fraud
Unbundling
Abuse
Answer
Correct Answer:
Unbundling
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81. After the claim is paid, the payer requests documentation to support coding. What type of audit is this?
Pre-payment
Post-payment
Comprehensive review
Claim-focused audit
Answer
Correct Answer:
Post-payment
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82. Coding for a name-brand medication when a generic brand was used is called __________.
Swapping
Value-coding
Upcoding
Upgrading
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83. Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called:
Focused care
All of these are correct
Extraneous services
Ancillary care
Answer
Correct Answer:
Ancillary care
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84. Tricare was formerly known as
United States Department of Defense Military Health System
None of the above
Civilian Health and Medical Program of the United States(CHAMPUS)
Civilian Health and Medical Program of the Uniformed Services(CHAMPUS)
Humana Military Healthcare Services
Answer
Correct Answer:
Civilian Health and Medical Program of the Uniformed Services(CHAMPUS)
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85. A 3-digit number used on hospital bills to tell the insurer where the patient was when they received treatment, or what type of item a patient received, is the:
SMI code
Policy identification number
Revenue Code
Medical Code
Answer
Correct Answer:
Revenue Code
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86. True or False: A Heralding Notice from a payer is a notice that your office has been targeted for an audit.
False
True
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87. Which one of the following was known as Medicare + Choice?
Part C
Part A
Part D
Part B
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88. HEAT is an effort of which federal agency(ies)?
HHS and DOJ
OIG
OIG and CMS
Answer
Correct Answer:
HHS and DOJ
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89. The average amount Medicare will pay a provider or hospital for a procedure is the:
RVU
CCRC
PTAN
SNF
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90. How many digits are in a National Provider Identifier?
8
11
4
10
9
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91. Level II HCPCS codes are formatted as a single letter followed by _________.
Two numeric digits and three letters
Four numeric digits
five numeric digits and one letter
Two numeric digits and 2 letters
Answer
Correct Answer:
Four numeric digits
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92. True or false? The coder should NOT correct any errors in a bill.
TRUE
False
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93. What are modifiers used for?
They are used to add more information about a ICD-9 CM code
They are used to add more information about a ICD10 CM code
They are used to add more information about a CPT code
They are an indicator to show that a procedure is linked to more than one diagnosis
They help in establishing "medical necessity"
Answer
Correct Answer:
They are used to add more information about a CPT code
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94. The claim form for billing for facility fees which replaces the UB92 form is the _______ form.
CMS 1450
SNF20
UB04
UB100A
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95. In March 2013, Noridian (Medicare Part B contractor in jurisdictions E and F) issued what type of review in Arizona?
Service Specific Review
Probe Review
Provider on Review
Service on Review
Answer
Correct Answer:
Service Specific Review
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96. What could POS exactly stand for in Medical Billing?
Polycystic Ovary Syndorme
Point of Service
Place of Service
Answer
Correct Answer:
Place of Service
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97. What is the minimum number of patients affected by a breach of PHI that requires you to personally notify the patient(s) of a breach?
5
1
100
25
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98. When is it acceptable for a physician to accept a gift from a patient?
Always
If the gift is of minimal value, and/ or can be displayed or shared with staff (e.g., chocolates, flowers, baked goods, etc.)
If the gift is highly personal and/or expensive
Never
Answer
Correct Answer:
If the gift is of minimal value, and/ or can be displayed or shared with staff (e.g., chocolates, flowers, baked goods, etc.)
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99. True or False? The difference between the Medicare and Medicaid allowable is that Medicaid does NOT pay a percentage of the allowed amount.
False
True
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100. Health insurance coverage which is contracted to supplement Medicare coverage is called:
HMO extension
Medicaid
Medigap
SSDI
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101. Which of the following is an agreement made between the insurance company and the insured to send payments directly to the physician?
Referral
Assignment of Benefits
Preauthorization
Pre-Existing Conditions
Coordination of Benefits
Answer
Correct Answer:
Assignment of Benefits
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102. The HIPAA approved standard paper claim form submitted to insurance companies to have the outpatient health benefit or the contracted provider visit paid is the:
HIPAA 1450
HIPAA 1500
CMS 1450
CMS 1500
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103. Charging for services that are not medically necessary are included under:
Abuse
Custodial care
Low cost alternatives
Information models
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104. The form the provider uses to document the treatment and diagnosis for a patient visit which typically includes ICD-9 diagnosis and CPT procedural codes is the:
Advanced payment form
IPC-450 form
Focused item bill
Superbill
Answer
Correct Answer:
Superbill
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105. The ICD-9-CM coding classification to identify health care for reasons other than injury or illness is
H-code
V-code
A-code
T-code
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106. An illegal practice of assigning an ICD-9 diagnosis code that does not agree with the patient records for the purpose of increasing the reimbursement from the insurance payor is called:
ICD skimming
Code banking
Upcoding
Pocketlining
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107. What does UCR stand for?
Usual, customary, or reasonable
Unusual Chronic Illness
Ultra Conservative Response
Unique Client Referral
Answer
Correct Answer:
Usual, customary, or reasonable
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108. What is a clearing house?
Intermediary between provider and insurance
Hygienic Place
Payment clearing authority
None of these
All of these
Answer
Correct Answer:
Intermediary between provider and insurance
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109. Which best describes how rules for Medicaid are set:
Medicaid is administered by a non-governmental regulatory body created under the federal Social Security Act.
Medicaid is administered through a combination of federal and state regulation.
Medicaid is administered by the individual state governments.
Medicaid is administered by the federal government.
Answer
Correct Answer:
Medicaid is administered through a combination of federal and state regulation.
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110. The Employer Identification Number is also known as the:
Social Security Identification Number
Health Department Identification Number
Federal Tax Identification Number
Employer Group Health Plan
Answer
Correct Answer:
Federal Tax Identification Number
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111. True or false? Undercoding is illegal.
True
FALSE
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112. True or False? A Medicaid MCO provides comprehensive services to Medicaid beneficiaries, but not commercial or Medicare enrollees.
True
False
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113. With the implementation of HIPAA, all the following systems became mandatory EXCEPT:
ICD
HCPCS
CPT
ADT
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114. Which part of Medicare is the drug prescription coverage?
Part D
Part C
Part B
Part A
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115. When submitting a secondary claim, what is the name of the document that must be attached?
Explanation of Medical Necessity
Certificate of Medical Necessity
Benefits of Explanation
Explanation of Benefits
Certificate of codding
Answer
Correct Answer:
Explanation of Benefits
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116. Hospital beds, wheelchairs and oxygen equipment would be considered examples of:
EBSA
DOS
DME
COBRA
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117. True or False? ERISA includes PPOs, POS, and HMO benefit plans.
True
False
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118. What is the purpose of an Advanced Beneficiary Notice?
To confirm receipt of a patient's payment
To alert the hospital to changes in Medicare's coverage policies
To alert a patient to a change in their premium payments
To alert a patient that Medicare may deny payment for a specific procedure or treatment
Answer
Correct Answer:
To alert a patient that Medicare may deny payment for a specific procedure or treatment
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119. True or False: If a payer requests medical records, you have an obligation to comply.
True
False
True
False
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120. This health insurance coverage is available to an individual and their dependents after becoming unemployed - either due to voluntary or involuntary termination of employment for reasons other than gross misconduct.
GovCare
Medicare Insurance
Co - Insurance
USICA
COBRA Insurance
Answer
Correct Answer:
COBRA Insurance
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121. A type of health coverage that typically allows a patient to go to any doctor or provider without permission is known as:
Contractor insurance
Fee-for-Service
On-call fees
Descriptor insurance
Answer
Correct Answer:
Fee-for-Service
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122. What is capitation?
The process of cutting down the price of a medical bill
The hierarchy of payments
A payment scheduling method
A system that pays physicians and nurses a set amount per enrolled patient assigned to them
Answer
Correct Answer:
A system that pays physicians and nurses a set amount per enrolled patient assigned to them
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123. In which month do commercial insurance and Medicare deductibles start each year?
March
June
October
January
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124. ________ billing is when a patient is charged for the difference between what a doctor bills and what the provider and insurance company agree upon.
Fair
Balanced
Upcoding
Downcoding
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125. The exact abbreviation of RA in medical billing terminology?
Right Atrium
Remittance Advice
Regular Appointment
Rheumatoid Arthritis
Remote Agent
Answer
Correct Answer:
Remittance Advice
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126. If a physician uses an open-panel HMO, can they see non-HMO patients?
No
Yes
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127. The federal law that allows a worker to continue to purchase employer paid health insurance for up to 18 months if they lose their job or your coverage is otherwise terminated is known as:
NOSSCR
Medicaid
HMO
COBRA
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128. What do the CPT codes refer to?
The disease that the patient is suffering from
The names of the medicines prescribed by the practitioner
The procedures performed by a physician or a practitioner
The procedures performed by Medical biller
The diagnoses performed on the patient
Answer
Correct Answer:
The procedures performed by a physician or a practitioner
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129. In medical billing, what is the function of a clearinghouse?
It processes all of the payments
It calculates total patient bills
It runs background checks on patient credit history
It checks bills for errors then transmits them to the insurance company
Answer
Correct Answer:
It checks bills for errors then transmits them to the insurance company
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130. True or False? AWP laws are state laws that require health insurance companies to accept into their PPO and HMO networks any provider willing to agree to the insurance company's terms and conditions.
False
True
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131. HIPAA stands for:
Health Insurance Portability Accountability Act
Health Insurance Protected Act of America
Answer
Correct Answer:
Health Insurance Portability Accountability Act
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132. To what payer address should you mail an appeal?
The address on the back of the patient’s insurance card
None of the above
The address that has been verified with the payer for appealed claims
The corporate office of the payer
Answer
Correct Answer:
The address that has been verified with the payer for appealed claims
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133. True or False? Tertiary insurance is intended to cover gaps in coverage the primary and secondary insurance may not cover.
False
True
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134. CDI programs are best applied in which situations?
Inpatient Facility
Outpatient facility
All outpatient and inpatient settings, for all payers
Only for Medicare claims
Answer
Correct Answer:
All outpatient and inpatient settings, for all payers
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135. Which activities may be indicative of fraudulent coding/billing?
The application of modifiers, such as 25 and 59, to the majority of services
All of the above
A high percentage of highest-level E/M coding
A high number of re-billings with claim modifications
Answer
Correct Answer:
All of the above
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136. Is a co-payment an out of pocket expense?
Yes
No
Sometimes
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137. The amount paid, often in monthly installments, for an insurance policy by the employer or patient themselves, is the:
Premium
OOP
Co-pay
Deductible
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138. The date the insurance policy is set to begin or when benefits or covered services are allowed is most commonly known as the:
Startup date
Effective date
Float date
Coverage blanket date
Answer
Correct Answer:
Effective date
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139. A patient on an HMO plan typically needs a _________ to receive care from a specialist.
prescription
validation
clearance
referral
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140. True or false? Sometimes multiple treatments will fall under one billing code.
False
True
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141. What is a premium?
Name-brand medication
The amount paid for an insurance policy
Paying extra for a private hospital room
The copay
Answer
Correct Answer:
The amount paid for an insurance policy
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142. What organ is measured in an EKG/ECG?
Lung
Brain
Kidney
Heart
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143. What is Dx refer to?
Bill cancellation
Post-mortem diagnosis
Cancelled diagnosis
Diagnosis code
Answer
Correct Answer:
Diagnosis code
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144. Which of these would be a valid reasons for a claim to be denied?
The service was not covered under the patient’s health insurance contract.
The medical condition was deemed by the insurance company as being preexisting
The service was considered as not being medically necessary
All are valid reasons
Answer
Correct Answer:
All are valid reasons
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145. The predetermined (flat) fee, a patient usually has to pay on each office visit is a:
Carrier
Co-insurance
Code
Co-pay
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146. Place of service codes on claims are there to define?
The payment qualifier
The place of service where services were rendered
The time of service
The type of service
Answer
Correct Answer:
The place of service where services were rendered
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147. What is COBRA insurance?
Insurance available to individuals after they become unemployed
It is a slang term used to describe uninsured emergency room patients
It is an insurance plan specific to the military
Insurance for exotic injuries
Answer
Correct Answer:
Insurance available to individuals after they become unemployed
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148. Which federal law strengthens the privacy of a patient's PHI and allows a patient to review their medical record?
COBRA
HEDIS
Medicare
HIPAA
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149. What does COB commonly refer to?
Coordination of Benefits
Course of Body
Cost of Billing
Cost on Bottom
Answer
Correct Answer:
Coordination of Benefits
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150. Which of these are NOT standard statuses of a claim in a typical EOB?
Pending
Denied
Paid
Transition
Answer
Correct Answer:
Transition
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151. Which of the following would you likely use if billing Medicare?
UB-92
W-4
UB-04
HCFA1500
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152. Health Insurance Claim (HICN) is a number assigned by the Social Security Administration to an individual identifying him/her as a _______ beneficiary
CHIP
Medicare
COBRA
Medicaid
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153. Who is eligible for Medicare part C
An individual who has an HMO plan
An individual who pays all premiums
An individual who has a supplemental Plan
An individual who is covered under Parts A and B
Answer
Correct Answer:
An individual who is covered under Parts A and B
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154. A Remittance Advice statement is most similar to a(n):
Medigap
HMO extension
EOB
Co-pay
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Medical Billing MCQs | Topic-wise
