Allied Health Office Procedures
Practice Questions
Course Introduction
Allied Health Office Procedures introduces students to the essential administrative and clerical functions found within healthcare settings. The course covers topics such as patient scheduling, medical records management, insurance processing, billing, coding, and office communication. Emphasis is placed on maintaining patient confidentiality, understanding legal and ethical standards, utilizing electronic health records (EHR), and fostering professional interactions with patients and staff. By the end of the course, students will be equipped with the foundational skills needed to efficiently support healthcare teams and ensure smooth office operations in various allied health environments.
Recommended Textbook
Health Insurance Today A Practical Approach 5th Edition by Janet I. Beik AA BA Med
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18 Chapters
1335 Verified Questions
1335 Flashcards
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Chapter 1: The Origins of Health Insurance
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45 Verified Questions
45 Flashcards
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Sample Questions
Q1) Individuals who are employed by a business are always covered by a group healthcare plan.
A)True
B)False
Answer: False
Q2) The federal act that allows employees who quit their jobs or get laid off to extend their group coverage is known by the acronym ___________________.
Answer: COBRA
Q3) The out-of-pocket expense that patients must pay before insurers begin paying benefits is called a/an ____________________.
Answer: deductible
Q4) The business of protecting,through legal means,a person or property against loss or harm is referred to as:
A) prevention.
B) insurance.
C) a contract.
D) preclusion.
Answer: B
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Page 3
Chapter 2: Tools of the Trade: A Career as a Health
(Medical)Insurance Professional
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40 Verified Questions
40 Flashcards
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Sample Questions
Q1) Career opportunities for a health insurance professional include:
A) physician's offices.
B) healthcare organizations.
C) nursing homes.
D) all of the above.
Answer: D
Q2) The compliance date for all covered entities to convert to the new ICD-10 diagnostic coding system is no sooner than:
A) 2012.
B) 2013.
C) 2015.
D) 2020.
Answer: C
Q3) HIPAA has created an opportunity for the healthcare industry to move from paper claims transactions to electronic transactions using one national standard format.
A)True
B)False
Answer: True
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Chapter 3: The Legal and Ethical Side of Medical Insurance
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67 Verified Questions
67 Flashcards
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Sample Questions
Q1) Elements of a legal contract include all of the following,except:
A) an attorney.
B) consideration.
C) competent parties.
D) offer and acceptance.
Answer: A
Q2) A medical record is not a legal document.
A)True
B)False
Answer: False
Q3) The primary goal of the health insurance professional is to accurately complete and submit insurance claims in a timely manner.
A)True
B)False
Answer: True
Q4) Medical law and liability is the same in all 50 states.
A)True
B)False Answer: False
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Chapter 4: Types and Sources of Health Insurance
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48 Verified Questions
48 Flashcards
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Sample Questions
Q1) SSDI is an insurance program that only individuals older than 65 can qualify for.
A)True
B)False
Q2) A special tax shelter set up for the purpose of paying medical bills.
Q3) Medicare supplement policies are frequently called Medigap policies.
A)True
B)False
Q4) The level of health plan which is most like the former "basic" coverage is called the:
A) bronze plan.
B) silver plan.
C) gold plan.
D) platinum plan.
Q5) Under a health reimbursement arrangement (HRA),employees must provide the funds for all medical expenses incurred.
A)True
B)False
Q6) A periodic fee that is paid to an insurer for healthcare coverage.
Q7) The flexible spending account (FSA)is an IRS Section 125 _____________.
Page 6
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Chapter 5: Claim Submission Methods
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70 Flashcards
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Sample Questions
Q1) The two main sections of the CMS-1500 are ____________ and ____________.
Q2) Documents needed to generate an insurance claim include all of the following,except a:
A) patient information form.
B) patient insurance ID card.
C) patient's driver's license.
D) patient's health record.
Q3) Failure to confirm a patient's insurance coverage can create a delay in payment or result in no payment at all.
A)True
B)False
Q4) Guidelines for claim attachments are the same if the medical facility uses electronic claim submission.
A)True
B)False
Q5) Explain how claim attachments can be sent electronically using such software as FastAttach .
Q6) Documents that are sometimes necessary to support the services and procedures reported on the claim are called ________________.
Page 7
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Chapter 6: Traditional Fee For Service/Private Plans
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74 Verified Questions
74 Flashcards
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Sample Questions
Q1) What is "self-insurance?"
Q2) The legislation that includes a mandate that insurance companies must cover certain preventive services for those who purchased or joined a new plan on or after September 23,2010,without charging out-of-pocket costs,is:
A) ERISA.
B) COBRA.
C) Health Insurance Privacy and Portability Act.
D) Patient Protection and Affordable Care Act.
Q3) A document prepared by the carrier that gives details of how a claim was adjudicated is called a/an:
A) secondary claim.
B) claim explanation.
C) explanation of benefits.
D) adjudication notice.
Q4) Providers who do not contract with a particular insurance carrier are called nonPARs. A)True
B)False
Q5) Name the two basic categories of health insurance.
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Chapter 7: Unraveling the Mysteries of Managed Care
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50 Flashcards
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Sample Questions
Q1) One primary function of a managed care organization (MCO)is to establish a list of covered benefits tied to managed care rules.
A)True
B)False
Q2) A complex healthcare system in which hospitals and healthcare professionals organize an interrelated system of people and facilities that works together as a unit describes:
A) commercial insurance.
B) managed care.
C) systemized healthcare.
D) preventive care.
Q3) The purpose of a consultation usually is to obtain an expert opinion only,and care of the patient is not relinquished to the consulting provider.
A)True
B)False
Q4) When a patient is sent to another provider (often a specialist)with the intent of rendering an expert opinion only,this is a/an ____________________.(Hint: Total care is not transferred.)
Q5) HMOs normally do not have ____________________ or plan limits.
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Chapter 8: Understanding Medicaid
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87 Verified Questions
87 Flashcards
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Sample Questions
Q1) Provisions of the Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income was at or below 133% of the federal poverty level (FPL)beginning the year
A) 2010.
B) 2012.
C) 2013.
D) 2014.
Q2) The Affordable Care Act provides Americans with opportunities for better healthcare by:
A) expanding coverage.
B) lowering healthcare costs.
C) guaranteeing more choices in healthcare coverage.
D) all of the above
Q3) In order to be eligible for SSI,the individual must meet all of the following criteria,except:
A) be at least 65 years old or blind.
B) have limited resources.
C) be disabled.
D) be single.
Q4) List four possible methods for verifying Medicaid eligibility.
Page 10
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Chapter 9: Conquering Medicares Challenges
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105 Verified Questions
105 Flashcards
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Sample Questions
Q1) Neither (original)Medicare Part A nor Part B covers any preventive care services.
A)True
B)False
Q2) Medicare HMO member/enrollees must receive care only from the providers in the network except in emergencies.
A)True
B)False
Q3) The program that provides community-based,long-term care services to eligible recipients is:
A) PACE.
B) Medicare Part A.
C) Medicare Part D.
D) SHIIP.
Q4) Medicare Part C was previously called ___________;it was renamed by The Medicare Prescription,Improvement,and Modernization Act of 2003 (MMA)and is now called ___________.
Q5) All Medicare Advantage plans offer the exact same coverage as original Medicare.
A)True
B)False
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Chapter 10: Military Carriers
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80 Verified Questions
80 Flashcards
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Sample Questions
Q1) All CHAMPVA claims,whether electronic or paper,should be sent to the VA Health Administration Center in:
A) Washington, D.C.
B) Sacramento, Calif..
C) Denver, Colo..
D) Philadelphia, Pa.
Q2) The spouse or dependent child of a veteran who is rated as having a permanent and total service-connected disability is eligible for CHAMPVA.
A)True
B)False
Q3) By law,CHAMPVA is always a secondary payer,except for CHAMPVA supplemental policies and:
A) Medicare.
B) Medicaid.
C) TRICARE.
D) TRICARE for Life.
Q4) Active duty,retired,or deceased service members are called
Q5) What procedure should the health insurance professional use to confirm eligibility for benefits under one of the military's healthcare programs?
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Chapter 11: Miscellaneous Carriers: Workers Compensation and Disability Insurance
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55 Verified Questions
55 Flashcards
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Sample Questions
Q1) Name the major benefit components to workers' compensation.
Q2) List and explain the two major classifications of disability coverage.
Q3) List at least four of the health insurance professional's responsibilities for facilitating disability claims processing.
Q4) Most short-term disability policies have a maximum benefit amount that is paid each month.
A)True
B)False
Q5) HIPAA permits covered entities to disclose PHI to workers' compensation insurers and/or employers without the individual's written authorization.
A)True
B)False
Q6) Disability income insurance replaces a portion of earned income when an individual is unable to do his or her work resulting from nonemployment-related injuries.
A)True
B)False
Q7) Name the two distinct roles of the attending physician in workers' compensation claims.
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Chapter 12: Diagnostic Coding
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132 Verified Questions
132 Flashcards
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Sample Questions
Q1) ___________ modifiers must be a part of the diagnosis documented in the patient health record.
Q2) All of the following are contained in Part II of the Alphabetic Index (Vol.2)except the
A) Table of Neoplasms
B) Table of Drugs and Chemicals
C) External Cause Index
D) Tabular List of Diseases and Injuries
Q3) Manifestation is another term for the sign or symptom of a disease.
A)True
B)False
Q4) The first thing that the coder must do in the coding process is:
A) determine if a modifier is required
B) identify the main (lead) term
C) locate the diagnosis in the patient's health record
D) look up the applicable anatomic site
Q5) The purpose of the ICD system was to promote a way of comparing the collection,classification,processing,and presentation of _________________.
Q6) What is contained in the ICD-10-CM Tabular List?
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Chapter 13: Procedural, Evaluation and Management, and HCPCS Coding
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122 Verified Questions
122 Flashcards
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Sample Questions
Q1) The E/M codes are found at the end of the CPT manual.
A)True
B)False
Q2) A CPT code can be displayed one of three ways: as ____________,____________,or ______________.
Q3) E/M documentation guidelines first became effective in 1995.In what year did the second set become effective?
A) 1995
B) 1996
C) 1997
D) 1998
Q4) A ____________ is a procedure by which codes used for data in one database are translated into the codes of another database,making it possible to relate information between or among databases.
Q5) Level I of the HPCS codes contains:
A) HCPCS national codes.
B) codes used to report medical services and supplies. C) codes used for generating physicians' charges.
D) the AMA Physicians' CPT codes.
Q6) The CPT index is organized by ____________ listed alphabetically. Page 15
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Page 16
Chapter 14: The Patient
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Sample Questions
Q1) To use the small claims process,the practice must retain an attorney.
A)True
B)False
Q2) Recent Congressional legislation established a program that provides incentives to physicians and hospitals that use certified EMR technology in a meaningful manner,referred to as _______________.
Q3) Match the term with its definition
The "core" of a practice's financial records
A) accounts receivable
B) general ledger and salaries
C) patient ledger
D) payroll ledger
E) accounts payable
F) general journal
G) disbursements journal
H) chronologic journal
I) core journal
J) activities journal
K) daily journal
Q4) The entire group of patient ledgers is referred to as the
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Chapter 15: Keys to Successful Claims Management
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Sample Questions
Q1) What is the first key to successful claims processing?
A) Obtaining necessary preauthorization
B) Collecting and verifying patient information
C) Following payer guidelines
D) Proofreading to avoid errors
Q2) The book outlines 12 keys to successful claims processing.
A)True
B)False
Q3) An alternative to the suspension file is to record claims information on a columnar form called a/an:
A) explanation of benefits.
B) payment receiving form.
C) insurance claims register.
D) computerized claim form.
Q4) If a patient is incapacitated in any way,the health insurance professional is not allowed (by law)to contact the patient's insurer to obtain preauthorization.
A)True
B)False
Q5) List the six keys to successful claims processing.
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Chapter 16: The Role of Computers in Health Insurance
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Sample Questions
Q1) In order to qualify for Medicare/Medicaid's monetary incentives to put EMRs into operation,providers must demonstrate _________________ EMRs.
A) a significant need for B) meaningful use of C) adequate patient load for D) they can afford
Q2) Effective October 2003,HIPAA made it mandatory (with few exceptions)that all Medicare claims be submitted electronically.
A)True
B)False
Q3) A physician,practitioner,facility,or supplier with fewer than 10 full-time equivalent (FTE)employees is called a/an _______________.
Q4) A(n)_____ acts as an intermediary between the medical facility and the insurance carrier.
A) EFT
B) EDI
C) EMR
D) clearinghouse
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Chapter 17: Reimbursement Procedures: Getting Paid
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Sample Questions
Q1) Under Medicare's PPS,long-term care hospitals (LTCHs)generally treat patients who require hospital-level care for an average length of stay greater than _____ days.
A) 10
B) 15
C) 25
D) 60
Q2) Organizations that have the ability to force hospitals to comply with HHS admission and quality standards are called ____________________.
Q3) Medicare and Medicaid's patient classification system,consisting of distinct groupings that provide a means for relating the type of patients a hospital treats with the costs incurred for treating them is called:
A) PPS.
B) DRG.
C) RVS.
D) APC.
Q4) List the three types of firms that fall under the umbrella of a "covered entity," as named by HIPAA.
Q5) Name the factors on which the DRG inpatient classification system is based.
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Chapter 18: Hospital Billing and the UB-04
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Sample Questions
Q1) Modern hospital construction is regulated by:
A) federal and state laws.
B) state health department policies.
C) city ordinances.
D) all of the above
Q2) The same prospective payment system used for TRICARE and CHAMPVA payments is used in calculating Medicare payments.
A)True
B)False
Q3) In 2000 a specific payment system was implemented for use by CMS for hospital outpatient services reimbursement called the:
A) ambulatory payment classification system.
B) hospital outpatient prospective payment system (HOPPS).
C) registered health payment system.
D) vertically integrated payment system.
Q4) ICD-9-CM Volume 3 is used to assign codes to inpatient hospital procedures.
A)True
B)False
Q5) List at least four elements that informed consent is typically based on:
Q6) Discuss the purpose of the new HIPAA edit.
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