Medical billing Quiz # 1

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

Medigap

HMO extension

EOB

Co-pay

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

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

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

UB-92

W-4

UB-04

HCFA1500

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

Pending

Denied

Paid

Transition

What does COB commonly refer to?

Coordination of Benefits

Course of Body

Cost of Billing

Cost on Bottom

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

COBRA

HEDIS

Medicare

HIPAA

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

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

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

Carrier

Co-insurance

Code

Co-pay

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

What is Dx refer to?

Bill cancellation

Post-mortem diagnosis

Cancelled diagnosis

Diagnosis code

What organ is measured in an EKG/ECG?

Lung

Brain

Kidney

Heart

What is a premium?

Name-brand medication

The amount paid for an insurance policy

Paying extra for a private hospital room

The copay

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

False

True

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

prescription

validation

clearance

referral

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

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

Premium

OOP

Co-pay

Deductible

Is a co-payment an out of pocket expense?

Yes

No

Sometimes

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

CDI programs are best applied in which situations?

Inpatient Facility

Outpatient facility

All outpatient and inpatient settings, for all payers

Only for Medicare claims

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

False

True

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

HIPAA stands for:

Health Insurance Portability Accountability Act

Health Insurance Protected Act of America

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

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

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

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

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

No

Yes

The exact abbreviation of RA in medical billing terminology?

Right Atrium

Remittance Advice

Regular Appointment

Rheumatoid Arthritis

Remote Agent