General Medical Billing MCQs

1. A Remittance Advice statement is most similar to a(n):

2. Who is eligible for Medicare part C

3. Health Insurance Claim (HICN) is a number assigned by the Social Security Administration to an individual identifying him/her as a _______ beneficiary

4. Which of the following would you likely use if billing Medicare?

5. Which of these are NOT standard statuses of a claim in a typical EOB?

6. What does COB commonly refer to?

7. Which federal law strengthens the privacy of a patient's PHI and allows a patient to review their medical record?

8. What is COBRA insurance?

9. Place of service codes on claims are there to define?

10. The predetermined (flat) fee, a patient usually has to pay on each office visit is a:

11. Which of these would be a valid reasons for a claim to be denied?

12. What is Dx refer to?

13. What organ is measured in an EKG/ECG?

14. What is a premium?

15. True or false? Sometimes multiple treatments will fall under one billing code.

16. A patient on an HMO plan typically needs a _________ to receive care from a specialist.

17. The date the insurance policy is set to begin or when benefits or covered services are allowed is most commonly known as the:

18. The amount paid, often in monthly installments, for an insurance policy by the employer or patient themselves, is the:

19. Is a co-payment an out of pocket expense?

20. Which activities may be indicative of fraudulent coding/billing?

21. CDI programs are best applied in which situations?

22. True or False? Tertiary insurance is intended to cover gaps in coverage the primary and secondary insurance may not cover.

23. To what payer address should you mail an appeal?

24. HIPAA stands for:

25. 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.

26. In medical billing, what is the function of a clearinghouse?

27. What do the CPT codes refer to?

28. 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:

29. If a physician uses an open-panel HMO, can they see non-HMO patients?

30. The exact abbreviation of RA in medical billing terminology?

31. ________ billing is when a patient is charged for the difference between what a doctor bills and what the provider and insurance company agree upon.

32. In which month do commercial insurance and Medicare deductibles start each year?

33. What is capitation?

34. A type of health coverage that typically allows a patient to go to any doctor or provider without permission is known as:

35. 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.

36. True or False: If a payer requests medical records, you have an obligation to comply.

37. What is the purpose of an Advanced Beneficiary Notice?

38. True or False? ERISA includes PPOs, POS, and HMO benefit plans.

39. Hospital beds, wheelchairs and oxygen equipment would be considered examples of:

40. When submitting a secondary claim, what is the name of the document that must be attached?

41. Which part of Medicare is the drug prescription coverage?

42. With the implementation of HIPAA, all the following systems became mandatory EXCEPT:

43. True or False? A Medicaid MCO provides comprehensive services to Medicaid beneficiaries, but not commercial or Medicare enrollees.

44. True or false? Undercoding is illegal.

45. The Employer Identification Number is also known as the:

46. Which best describes how rules for Medicaid are set:

47. What is a clearing house?

48. What does UCR stand for?

49. 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:

50. The ICD-9-CM coding classification to identify health care for reasons other than injury or illness is

51. 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:

52. Charging for services that are not medically necessary are included under:

53. 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:

54. Which of the following is an agreement made between the insurance company and the insured to send payments directly to the physician?

55. Health insurance coverage which is contracted to supplement Medicare coverage is called:

56. True or False? The difference between the Medicare and Medicaid allowable is that Medicaid does NOT pay a percentage of the allowed amount.

57. When is it acceptable for a physician to accept a gift from a patient?

58. 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?

59. What could POS exactly stand for in Medical Billing?

60. In March 2013, Noridian (Medicare Part B contractor in jurisdictions E and F) issued what type of review in Arizona?

61. The claim form for billing for facility fees which replaces the UB92 form is the _______ form.

62. What are modifiers used for?

63. True or false? The coder should NOT correct any errors in a bill.

64. Level II HCPCS codes are formatted as a single letter followed by _________.

65. How many digits are in a National Provider Identifier?

66. The average amount Medicare will pay a provider or hospital for a procedure is the:

67. HEAT is an effort of which federal agency(ies)?

68. Which one of the following was known as Medicare + Choice?

69. True or False: A Heralding Notice from a payer is a notice that your office has been targeted for an audit.

70. 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:

71. Tricare was formerly known as

72. Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called:

73. Coding for a name-brand medication when a generic brand was used is called __________.

74. After the claim is paid, the payer requests documentation to support coding. What type of audit is this?

75. Submitting several CPT treatment codes when only one code is necessary is called:

76. What is a challenge of processing medical bills off site?

77. A health benefit plan allowing the patient to choose to receive a service from a group of contracted providers is a:

78. The difference between the summarized income rate and the summarized cost rate over a given valuation period is the:

79. The incident-to rule:

80. Will Medicare accept a UB-92 form?

81. True or False? Med pay is a form of no-fault insurance.

82. The federal law that was originally created to safeguard an employees retirement benefits is abbreviated as:

83. The form which is specifically used to bill dental services is called?

84. You must notify the local media if a breach of PHI involves ___ or more patients.

85. Your office has discovered a breach of a patient’s PHI. How long do you have to notify the patient?

86. What is the abbrevation for SSI?

87. True or false? An individual on an HMO plan would need a referral to get a yearly mammogram.

88. According to the MBAA, up to _____ % of US medical bills contain errors.

89. Medicare Advantages Plans cover consultation codes?

90. Which one of the following is the largest Blue Cross Blue Shield member?

91. 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.

92. A ________ limits the amount of out-of-pocket expenses a patient will have to pay for TRICARE-covered medical services.

93. If a provider is non-par, any allowed claim amount that is ______ billed charges should be unacceptable.

94. In DME claims which of the following is necessary: Referring physician or Ordering physician?

95. What are modifiers?

96. Electronic Medical Claims (EMC) help to ___________.

97. The 'Group' in the 'Group Health Insurance Card' refers to the _________.

98. CPT Codes are updated ________.

99. What does the UB-04 form include?

100. What is contained in the release of information (ROI) form?

101. What is not a part of the diagnosis information?

102. Which is required to organize your office as a medical biller?

103. Which is not a part of Patient Condition Information?

104. What is a benefit?

105. Which aspects does administrative safeguards focus on?

106. It is necessary to attach a document called _________ when submitting a secondary claim.

107. 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?

108. Which is not a feature of Managed Care Plans?

109. Why was the accountability component added to HIPAA?

110. Why were security standards created in HIPAA?

111. What is a deductible?

112. What are the main benefits of electronic claims?

113. What is a covered entity?

114. Which date format is used on the CMS 1500 Form?

115. Which is the first phase of the insurance claim life cycle?

116. Which is not a kind of third-party reimbursement?

117. What is an accident rider?

118. What does the bottom of the CMS 1500 Form report?

119. Which information is needed to complete the CMS 1500 form?

120. Identify the order of events after a claim reaches the insurance carrier: 1.Application of leftover deductible 2.Examining the procedures performed and the 'medical necessity' on these procedures 3.Application of 'allowable payments options' for every procedure performed 4.Review of the claim for proper formatting and information

121. What is the length of the standard CPT codes?

122. What is the need for insurance verification?

123. What is not one of the eligibility criteria for Medicare?

124. Which does the acronym HIPAA stand for?

125. How is the patient identified in case of Champva?

126. What is needed to file Worker's Compensation and Auto Insurance Claims?

127. Which are the disclosures exempted from minimum necessary?

128. Which is not one of the co-operating parties which maintains and upgrades ICD-9-CM codes?

129. The component 'National Identifier Standards' fall under which component of HIPAA?

130. In which method will you bill your clients for giving your services as a medical biller?

131. What do the CPT codes refer to?

132. Which is a more efficient and less time consuming method to submit your claims?

133. National Provider Identifier is a _____ digit number.

134. What is the way to determine the primary and secondary policy if a child is covered under both parent's policies?

135. What is a write off?

136. Which correctly defines the Encounter Document?

137. Which is not a type of insurance coverage?

138. What things should you emphasize on while selecting an attorney when starting your own medical billing business?

139. If the patient deductible is $700, and the deductible met is $685, the coverage is 80/20 and the physician's charge is $75, how much should the patient pay?

140. Which is not necessarily a function performed by a medical biller?

141. What is the role of a clearing house while submitting claims electronically?

142. Which body is responsible for implementing the Privacy Rules

143. Which does not cover preventive care services?

144. Why was HIPAA enacted into a law?

145. Who can also be a guarantor?

146. Which is not a coding convention?

147. _____is an agreement made between the insurance company and the insured to send payments directly to the physician.

148. What is the full form of AIDA?

149. Which is not a suitable marketing strategy for medical billing business?

150. HIPAA provides protections for both Group Health Plans and Individual Coverage.

151. Which component of HIPAA have been put into effect?

152. Ideal practice management software should have good reporting and multi-tasking capabilities.

153. In which box are the CPT codes entered on the CMS-1500 Form?

154. Which is the code for anesthesia (type of service code)?