Medical Billing and Coding Chapter Exam Questions - 1231 Verified Questions
Medical Billing and Coding Chapter Exam Questions
Course Introduction
Medical Billing and Coding is a comprehensive course designed to introduce students to the fundamental concepts and practices involved in processing patient data for billing and insurance purposes within healthcare facilities. The course covers essential topics such as medical terminology, the structure of healthcare delivery systems, the use of coding manuals (ICD, CPT, and HCPCS), and federal regulations affecting healthcare documentation. Students will learn how to accurately translate medical records into standardized codes used for insurance claims, reimbursement, and statistical analysis. Additionally, the course emphasizes the importance of confidentiality, ethical standards, and compliance with regulatory agencies, preparing students for roles in medical billing, coding, and healthcare administration.
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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Sample Questions
Q1) A self-employed medical insurance biller who does independent contracting is responsible for
A) advertising.
B) billing.
C) accounting.
D) all of the above.
Answer: D
Q2) Insurance specialist certificate programs include
A) anatomy.
B) diagnostic coding.
C) computer technology.
D) all of the above.
Answer: D
Q3) What is "cash flow" in a medical practice?
A) The actual money available to a medical practice
B) The amount of money received by a medical practice in 1 day
C) The amount of money received by a medical practice in 1 month
D) The amount of outstanding money on the accounts receivable
Answer: A
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Page 3
Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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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) Failure to make a refund when services are not reasonable or necessary.
A)Abuse
B)Fraud
Answer: A
Q3) Employees should be aware of what is expected from them and the consequences of misconduct through well-publicized ____________ guidelines.
Answer: disciplinary standards
Q4) A well-designed compliance program should show a ______________ effort to submit claims appropriately.
Answer: good faith
Q5) Nonprivileged information consists of ordinary ____________________ unrelated to the treatment of the patient.
Answer: facts
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Chapter 3: Basics of Health Insurance
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Sample Questions
Q1) A form of health insurance that provides periodic payments to replace income when the insured is unable to work is: __________________________
Answer: Disability income insurance
Q2) Provides coverage for spouses and children of veterans with total, permanent, service-connected disabilities or for the surviving spouses and children of veterans who died as a result of service-connected disabilities.
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: F
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Page 5
Chapter 4: Medical Documentation and the Electronic Health Record
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Sample Questions
Q1) The key to substantiating procedure and diagnostic code selections for appropriate reimbursement is a supporting electronic health record.
A)True
B)False
Q2) Levels of evaluation and management services are based on type(s) of physical examination that may be
A) limited.
B) complete.
C) problem focused.
D) both a and b
Q3) An expanded problem-focused examination is a/an
A) expanded examination of a single organ system.
B) extended examination of the affected body area.
C) limited examination of the affected body area.
D) general examination of a single organ system.
Q4) A reference list of all staff members' names, job titles, signatures, and initials is known as a/an ____________________.
Q5) If a professional liability claim is filed by a patient, good ____________________ helps establish a strong defense.
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Chapter 5: Diagnostic Coding
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Sample Questions
Q1) Routine outpatient prenatal care is reported with a code from category ___.
Q2) In the outpatient setting, conditions that are listed as "rule out" can be reported as if the patient has the condition.
A)True
B)False
Q3) When performing a routine physical and an abnormality is found, the abnormality should be reported and sequenced _____.
Q4) Assistance in coding hypertension-related diseases can be located in Chapter ___ of the Chapter Specific Coding Guidelines.
Q5) List the ICD-10-CM code(s) for a patient seen in the medical facility with diabetic retinopathy (insulin-dependent, not stated as uncontrolled) with retinal detachment.
Q6) Which of the following are examples of diagnosis-related procedures?
A) New patient and established patient visits
B) Imaging services and cardiovascular services
C) Local and general anesthesia
D) Histology and pathology procedures
Q7) _____ codes are only reported by the provider who is initially treating a patient for an injury.
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Chapter 6: Procedural Coding
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Sample Questions
Q1) When multiple lacerations of the same classification are repaired in the same body area
A) report only the largest wound.
B) add the lengths of all lacerations and report them with a single code.
C) list the codes for all lacerations separately in descending order of value.
D) be sure to add a code for the anesthesia and chemical or electrocauterization if needed.
Q2) The CPT publication is updated and revised
A) annually.
B) biannually.
C) every 3 years.
D) every 5 years.
Q3) The key components that determine an evaluation and management code are documented by
A) the medical assistant.
B) the physician.
C) the insurance billing specialist.
D) none of the above.
Q4) Insurance companies go by the rule: "If it is not documented, then it was not ____________________."
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Chapter 7: The Paper Claim: Cms-1500 02-12
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Sample Questions
Q1) The CMS-1500 is known as the
A) COMB-1.
B) basic paper claim.
C) attending physician's statement.
D) electronic claim.
Q2) What is the procedural code that was submitted on this claim form, describing the services provided to this patient?
Q3) 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
Q4) Most insurance companies accept the CMS-1500 claim form except TRICARE and the Blue Plans.
A)True
B)False
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Chapter 8: The Electronic Claim
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Sample Questions
Q1) A provider is not considered a covered entity under HIPAA under which of the following circumstances?
A) The provider has fewer than 10 employees and submits claims only on paper to Medicare.
B) If the provider submits electronic transactions to any payer.
C) If the provider submits paper claims to Medicare and has more than 10 employees.
D) None of the above.
Q2) Medicaid, Medicare, and TRICARE use which system to eliminate the need for a clearinghouse?
Q3) A status report of claims is usually received ___.
Q4) What is an encoder?
Q5) Update practice management system with payer information.
A)Daily
B)Weekly
C)End of month
D)Daily or weekly
Q6) Practice management systems can be "rented" over the Internet.
A)True
B)False
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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Sample Questions
Q1) The correct method to send documents for a Medicare reconsideration (Level 2) is by
A) certified mail with return receipt requested.
B) certified mail.
C) standard mail.
D) overnight mail.
Q2) The following are examples of problem claim filing EXCEPT:
A) payment paid to patient.
B) payment lost in the mail.
C) denied for no preauthorization.
D) all are examples of problem claim filing.
Q3) The insurance payment poster is responsible for submitting appeals for denied claims.
A)True
B)False
Q4) The management of health insurance claims by paper and electronically are the same.
A)True
B)False
Q5) FTC stands for _________________________.
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Chapter 10: Office and Insurance Collection Strategies
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Sample Questions
Q1) In a telephone collection call, the first 2 minutes will set the scene for your relationship with the patient.
A)True
B)False
Q2) In dealing with an estate claim, a call to the ____________________ can be made periodically to check on the status of the estate.
Q3) The amount due listed on the patient's financial accounting record is also referred to as the account ____________________.
Q4) If the endorsement on the back of the payment check does not match the name on the front, there may be a case of ____________________.
Q5) What is the name of the act designed to address the collection practices of third-party debt collectors and attorneys who regularly collect debts for others?
A) Equal Credit Opportunity Act
B) Fair Credit Billing Act
C) Truth in Lending Act
D) Fair Debt Collection Practices Act
Q6) The collection abbreviation OOT means ____________________.
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Page 12
Chapter 11: The Blue Plans, Private Insurance, and Managed Care Plans
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Sample Questions
Q1) America's oldest privately owned, prepaid medical group is the
A) Ross-Loos Medical Group.
B) INA Healthplan, Inc.
C) Kaiser Permanente Medical Care Program.
D) Health Net HMO, Inc.
Q2) Kaiser Permanente's medical plan is a closed panel program, which means A) only certain illnesses are covered.
B) it limits the patient's choice of personal physicians.
C) it limits the patient's choice of a hospital for emergency care.
D) services are provided on a fee-for-service basis.
Q3) When a managed care plan requires the primary care physician to seek approval before referring a patient to a specialist, it is called obtaining
Q4) How does an HMO receive payment for the services its physicians provide?
A) Fee-for-service
B) Usual, customary, and reasonable charges
C) Allowable charges
D) Prepaid health plan
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Q5) A primary care physician who controls patient access to specialists is called a/an
Chapter 12: Medicare
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Sample Questions
Q1) Under the prospective payment system (PPS), hospitals treating Medicare patients are reimbursed according to
A) a new fee schedule established in 1983.
B) preestablished rates for each type of illness treated based on diagnosis.
C) preestablished rates for each type of hospital stay based on services.
D) a hospital capitation plan.
Q2) A patient classified with ESRD may be provided benefits from Medicare. What does ESRD stand for?
Q3) The Medicare HCPCS coding system has ____________________ levels.
Q4) What is the amount of the check that Medicare sends to the physician?
Q5) The 1987 Omnibus Budget Reconciliation Act (OBRA) established the A) MAAC.
B) DRG.
C) CPT.
D) RBRVS.
Q6) It is possible for an alien to be eligible for Medicare Part A and Part B.
A)True
B)False
Q7) When Medicare payments are posted to a separate daysheet, what should the daysheet payment total agree with?
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Chapter 13: Medicaid and Other State Programs
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Sample Questions
Q1) The two Medicaid eligibility classifications are the ____________________ needy group and the ____________________ needy class.
Q2) The time limit to appeal a claim varies from state to state, but it is usually
A) 30-60 days.
B) 90-120 days.
C) 6 months.
D) 1 year.
Q3) All state Medicaid programs operate with a fee-for-service reimbursement system.
A)True
B)False
Q4) The federal aspects of Medicaid are the responsibility of the A) AMA.
B) AHA.
C) HIAA.
D) CMS.
Q5) Medicaid patients in managed care plans must go to hospitals participating in their assigned plan.
A)True
B)False
Q6) The ____________________ form accompanies all Medicaid payment checks.
Page 15
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Chapter 14: Tricare and Veterans Health Care
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Sample Questions
Q1) All dependents ____________________ years of age or older are required to have a Uniformed Services (military) identification card.
Q2) For a CHAMPVA beneficiary, if the physician is nonparticipating and does not accept assignment, the patient completes the top portion of the CMS-1500 claim form, attaches an itemized statement from the physician, and submits the claim.
A)True
B)False
Q3) What payment does a participating provider agree to accept when assignment is accepted in a TRICARE case?
Q4) TRICARE Prime and TRICARE Extra claims are
A) filed by the beneficiary to a TRICARE subcontractor.
B) filed by the provider to a TRICARE subcontractor.
C) paid by capitation, so no claim needs to be filed.
D) filed the same as for TRICARE Standard and CHAMPVA claims.
Q5) Enrollment in TRICARE Prime is for
A) 1 month at a time.
B) 1 year at a time.
C) as long as the beneficiary would like to remain in the plan.
D) none of the above.
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Chapter 15: Workers Compensation
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Sample Questions
Q1) An abnormal condition caused by exposure to environmental factors associated with employment is termed a/an
A) physical injury.
B) occupational illness.
C) temporary disability.
D) permanent disability.
Q2) A proceeding in which an attorney asks a witness questions regarding a case and the witness answers under oath but not in open court is known as a/an
A) arbitration.
B) negotiation.
C) deposition.
D) hearing.
Q3) 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
Q4) An individualized program of therapy using simulated or real work tasks to build up strength and improve a worker's endurance toward a full day's work is called
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Sample Questions
Q1) Which two programs managed by the Social Security Administration pay disability benefits to people younger than 65?
Q2) Benefits for medical expenses are provided through disability income insurance. A)True
B)False
Q3) What are six major government disability programs?
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) The Supplemental Security Income (SSI) program under Title XVI of the Social Security Act provides
A) monthly income benefits to workers and those self-employed who meet certain conditions.
B) disability payments to needy people with limited income and few resources.
C) for those who have worked for Civil Service and who become totally disabled.
D) income for those injured on the job.
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Chapter 17: Hospital Billing
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Sample Questions
Q1) Medicare provides stop-loss called _____________________ in its regulations.
Q2) On the CMS 1450 (UB-04) claim form, code 6 (transfer from another health care facility) in Field 15 is used to indicate A) type of admission.
B) source of admission.
C) occurrence span.
D) treatment authorization.
Q3) The Administrative Simplification provisions of the Health Information Portability and Accountability Act of 1996 prohibit the submission of most _____________________.
Q4) 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?
Q5) ______________________ is a preexisting condition that will, because of its effect on the specific principal diagnosis, require more intensive therapy or cause an increase in length of stay by at least 1 day in approximately 75% of cases.
Q6) Elective surgeries are deferrable.
A)True
B)False
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) Accounts receivable bookkeeping experience would be listed on a résumé under the heading
A) skills.
B) education.
C) professional experience.
D) references.
Q2) A functional résumé
A) lists the most recent work experiences first with dates and descriptive data for each job.
B) states the applicant's qualifications or skills the individual is able to perform.
C) lists the applicant's job skills, education, and employment history.
D) introduces the applicant and summarizes all important data.
Q3) 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.
Q4) A résumé that summarizes the applicant's job skills, as well as educational and employment history, is of the ____________________.
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