Health Information Management
Mock Exam
Course Introduction
Health Information Management is a comprehensive course that explores the principles and practices involved in the collection, storage, analysis, and protection of patient health information within healthcare organizations. Students will learn about health information systems, data management, privacy and security regulations such as HIPAA, electronic health records (EHRs), coding and classification systems, and quality improvement processes. The course also examines the crucial role health information professionals play in supporting clinical decision-making, ensuring legal compliance, and enabling effective health care delivery in various settings.
Recommended Textbook
Insurance Handbook for the Medical Office 14th Edition by Marilyn Fordney
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18 Chapters
1231 Verified Questions
1231 Flashcards
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Page 2
Chapter 1: Role of an Insurance Billing Specialist
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65 Verified Questions
65 Flashcards
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Sample Questions
Q1) What does the abbreviation MSHP designate?
A) Multiple service health care professional
B) Multiskilled health practitioner
C) Multiskilled health professional
D) Managed care solo health practice
Answer: B
Q2) A claims assistance professional (CAP) acts as an informal representative of patients and helps patients interpret insurance contracts.
A)True
B)False
Answer: False
Q3) Physicians are paid on the basis of _________________________ units. Answer: relative value
Q4) It is illegal to report incorrect information to government-funded programs such as Medicare, Medicaid, and TRICARE.
A)True
B)False
Answer: True
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Page 3
Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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70 Verified Questions
70 Flashcards
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Sample Questions
Q1) Altering fees on an insurance claim form to obtain higher payment.
A)Abuse
B)Fraud
Answer: B
Q2) List three things that can be done to avoid having a patient hear confidential information regarding other patients.
Answer: Any three of the following: privacy glass at the front window; have conversations away from the area where patients are present; move dictation stations away from the patient areas; wait to dictate until no patients are present; avoid telephone conversations in front of patients.
Q3) Explain the difference between use and disclosure under HIPAA Privacy Rules.
Answer: Use is the sharing, application, and examination of analysis of information within an organization that holds it. Disclosure is the release, transfer, provision of access to, or divulging of information outside of the entity holding the information.
Q4) What does "safe harbor" refer to?
Answer: Business and service arrangements that are protected from prosecution under the Anti-Kickback statute.
Page 4
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Chapter 3: Basics of Health Insurance
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Sample Questions
Q1) Government-sponsored program that provides hospital and medical services for dependents of active duty uniform service members, military retirees and their families, and survivors of uniformed services.
A)Independent practice association (IPA)
B)Medicaid
C)State disability or Unemployment Compensation Disability (UCD)
D)TRICARE
E)Workers' compensation insurance
F)CHAMPVA
G)Health maintenance organization (HMO)
H)Disability income insurance
I)Medicare
Answer: D
Q2) Information such as the deductible, copayment, preapproval provisions, and insurance company address and telephone number can usually be found on the insurance card.
A)True
B)False
Answer: True
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Page 5
Chapter 4: Medical Documentation and the Electronic Health Record
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Sample Questions
Q1) An inventory of body systems obtained through a series of questions that are used to identify signs and/or symptoms of the patient is known as a/an
Q2) A consultation may take place in a home, office, hospital, or extended care facility.
A)True
B)False
Q3) At least _______ elements of the HPI or the status of at least three chronic conditions is required for the extended level of HPI.
Q4) The word chronic should be used instead of recurrent for a medical condition that persists over a long period.
A)True
B)False
Q5) The term ____________________ refers to a disease that persists over a long time.
Q6) The upper middle region above the stomach is known as the ____________________ region.
Q7) PFSH is the abbreviation for ___________________________________.
Q8) WNL is the abbreviation for _________________________.
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Chapter 5: Diagnostic Coding
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115 Verified Questions
115 Flashcards
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Sample Questions
Q1) When a neoplasm has been analyzed by the pathologist but has not been confirmed as benign or malignant, it would be coded from the column labeled _____.
Q2) It is possible for the primary diagnosis and the principal diagnosis to be the same.
A)True
B)False
Q3) The presence of essential modifiers or their absence does not affect the code assigned.
A)True
B)False
Q4) In what case should a Z code be used?
A) Sterilization
B) Hysterectomy
C) Antibiotic injection
D) Dermatitis
Q5) All codes should be verified in ICD-10-CM Volume 1.
A)True
B)False
Q6) Provide the appropriate ICD-10-CM code for bursitis of the elbow.
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Chapter 6: Procedural Coding
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Sample Questions
Q1) A patient required arthroplasty of the tibial plateaus of both knees. Code this procedure for the surgeon.
Q2) In coding a surgical procedure, postoperative care and follow-up visits may not be coded separately if they fall within the global period for the procedure.
A)True B)False
Q3) When there is a choice of two or three somewhat similar codes, the insurance claims examiner will choose the highest-paying code.
A)True
B)False
Q4) If a procedure requires more than one modifier code, use the multiple two-digit code ____________________ after the usual five-digit code number.
Q5) Coding and billing numerous CPT codes to identify procedures that are usually described by a single code is called ____________________.
Q6) CPT uses a basic ____________________-digit system for coding services rendered by physicians, plus ____________________-digit add-on modifiers.
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Page 8
Chapter 7: The Paper Claim: Cms-1500 02-12
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78 Verified Questions
78 Flashcards
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Sample Questions
Q1) According to OCR guidelines, information may be handwritten on the claim form if necessary.
A)True
B)False
Q2) A Medicare claim that is missing required information.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim
Q3) A clean claim has no ___ and passes all electronic edits.
Q4) The objective of the Administrative Simplification Compliance Act was to improve the administration of the Medicare program by increased efficiencies resulting from
Q5) The diagnosis field of the CMS-1500 claim form is referred to as Block ___.
Q6) All paper claims that are generated should be ___ for misspelling of patient names.
Page 9
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Chapter 8: The Electronic Claim
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80 Verified Questions
80 Flashcards
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Sample Questions
Q1) Review clearinghouse/payer transmission reports.
A)Daily
B)Weekly
C)End of month
D)Daily or weekly
Q2) Why was the HIPAA Transaction Code Set developed?
Q3) The employer's identification number is assigned by
A) the state.
B) the insurance company.
C) the Internal Revenue Service.
D) none of the above.
Q4) The objective of HIPAA Transaction and Code Set regulations was to standardize code sets, claim forms, and processes used in health care facilities which would reduce administrative costs.
A)True
B)False
Q5) The exchange of data in a standardized format through computer systems is known as electronic data interchange.
A)True
B)False
Page 10
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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Sample Questions
Q1) TRICARE appeals are normally resolved within A) 2 weeks.
B) 30 days.
C) 60 days.
D) 90 days.
Q2) Appeal decisions on Medicare unassigned insurance claims are sent to the patient.
A)True
B)False
Q3) All requests of the insurance commissioner must be submitted in writing and include the ____________________ signature.
Q4) Routine use of too many nonspecific diagnostic codes may result in downcoding.
A)True
B)False
Q5) If you have a denied insurance claim, you should change the information and resubmit the claim.
A)True
B)False
Q6) FTC stands for _________________________.
11
Q7) Requests to the insurance commissioner must be submitted _______________.
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Chapter 10: Office and Insurance Collection Strategies
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Sample Questions
Q1) When writing a collection letter
A) do not try to be friendly; just get to the point.
B) use a friendly tone and ask why payment has not been made.
C) do not suggest that the patient has overlooked a previous statement.
D) do not imply that the patient has good intentions to pay.
Q2) The part of the legal system that allows laypeople to settle a legal matter without use of an attorney is the
A) people's court.
B) justice court.
C) small claims court.
D) all of the above.
Q3) When collecting fees, your goal should always be to
A) leave the impression that you are a nice person.
B) collect at least one half the fee.
C) collect the full amount.
D) collect as much as possible.
Q4) In a telephone collection call, if a patient does not respond, it probably means "no."
A)True
B)False
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Chapter
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41 Verified Questions
41 Flashcards
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Sample Questions
Q1) Practitioners in an HMO program may come under peer review by a professional group called a
A) peer review group.
B) quality control group.
C) Quality Improvement Organization.
D) utilization management corporation.
Q2) The abbreviation MCO stands for ______________________________.
Q3) When a physician sees a patient more than is medically necessary, it is called
A) buffing.
B) turfing.
C) churning.
D) stirring.
Q4) A primary care physician who controls patient access to specialists is called a/an
Q5) A program that offers a combination of HMO-style cost management and PPO-style freedom of choice is a/an
A) point-of-service (POS) plan.
B) exclusive provider organization (EPO).
C) managed care organization (MCO).
D) physician provider group (PPG).
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Chapter 12: Medicare
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Sample Questions
Q1) What is the courtesy adjustment?
Q2) Nonparticipating physicians have an option regarding accepting assignment on the Medicare patient.
A)True
B)False
Q3) An explanation of benefits document for a patient under the Medicare program is referred to as the
A) Medicare remittance advice document.
B) reimbursement report.
C) summary payment report.
D) explanation of Medicare benefits.
Q4) In the Medicare program, a physical examination is a covered benefit when performed within 12 months of enrollment.
A)True
B)False
Q5) Funds for Medicare Part B come equally from those who sign up for it and the federal government.
A)True
B)False
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Chapter 13: Medicaid and Other State Programs
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Sample Questions
Q1) Medicaid is administered by the
A) federal government.
B) federal government with partial state funding.
C) state government with partial federal funding.
D) state government.
Q2) TEFRA stands for Tax Equity and Financial Reimbursement Act.
A)True
B)False
Q3) The medically needy aged
A) require help in meeting costs of medical care.
B) qualify for cash assistance.
C) are classified as those with extremely low income.
D) qualify for housing assistance.
Q4) Family planning is a Medicaid basic benefit.
A)True B)False
Q5) The group of Medicaid recipients referred to as ____________________ includes all cash recipients of the Aid to Families with Dependent Children, certain other AFDC-related groups, most cash recipients of the Supplemental Security Income program, and other SSI-related groups.
Page 15
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Chapter 14: Tricare and Veterans Health Care
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Sample Questions
Q1) An NAS is a
A) certification of the status of a military hospital.
B) certification of the status of a civilian hospital.
C) certification from a civilian hospital stating specific treatment that was denied.
D) certification from a military hospital stating that it cannot provide the necessary care.
Q2) A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries.
A)True
B)False
Q3) An NAS certification is required for all TRICARE Standard, TRICARE Extra, and CHAMPVA beneficiaries who wish to receive treatment as inpatients at a civilian hospital and who live within a catchment area surrounding a Uniformed Services medical treatment facility.
A)True
B)False
Q4) A certification from a military hospital stating that it cannot provide the care needed is called a ______________________________.
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16
Chapter 15: Workers Compensation
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57 Verified Questions
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Sample Questions
Q1) Under health reform legislation of 2010, what is the fee per employee for employers with more than 50 employees when the government subsidizes their workers' insurance coverage?
Q2) A narrative industrial medical report should include only objective findings and not subjective factors.
A)True
B)False
Q3) If a worker has a work-related injury or illness and is unable to perform the duties of his or her occupation for 2 months and then returns to modified work for 1 month before returning to full work, the claim is referred to as a
A) nondisability claim.
B) temporary disability claim.
C) permanent disability claim.
D) permanent and stationary claim.
Q4) The injured worker does not have the right to be evaluated by a physician who is not assigned by the employer.
A)True
B)False
Q5) Which types of employees fall under federal workers' compensation statutes?
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Sample Questions
Q1) If a state has State Disability Insurance, all types of workers are covered.
A)True
B)False
Q2) The definition of total disability varies from policy to policy because there is no standard definition.
A)True
B)False
Q3) For people trying to qualify for SSDI or SSI, determination is made by the physician.
A)True
B)False
Q4) The maximum amount of time for which benefits will be paid to the injured or ill person for a disability is called the
A) waiting period.
B) elimination period.
C) benefit period.
D) payment period.
Q5) Who are the eight types of workers not covered by state disability?
Page 18
Q6) What are six major government disability programs?
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Chapter 17: Hospital Billing
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Sample Questions
Q1) ______________________ are DRG cases that cannot be assigned properly because of an atypical situation.
Q2) The __________________________________________________ is used to list procedural codes for Medicare patients on hospital insurance claims that are not in the CPT book.
Q3) What is the document that needs to be completed and signed by the physician after a patient leaves the hospital, before the hospital can receive reimbursement?
Q4) Confidential information about patients should never be discussed with A) news media. B) family.
C) friends.
D) any of the above.
Q5) MS-DRGs are weighted to reflect the average costs for inpatient care. A)True B)False
Q6) ____________________ are used for CPT and HCPCS codes to modify or provide more detailed information on the procedure and/or medical supply.
Q7) The ____________________ is the clinical résumé for final progress notes.
Page 19
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) Most of the certifications offered for individuals who bill for physicians are obtained through state organizations.
A)True
B)False
Q2) The procedures and format for preparing an electronic résumé are the same as those for preparing a manual résumé.
A)True
B)False
Q3) What should a cover letter end with?
Q4) A medical insurance billing specialist prices his or her services by A) percentage of reimbursement.
B) an annual or hourly fee.
C) a set fee per claim.
D) all of the above.
Q5) Internet access for a job search is available through A) America Online.
B) Online service.
C) the World Wide Web.
D) all of the above.
Q6) List five ways to search for a job. Page 20
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Page 21