Medical Insurance and Billing Question
Bank
Course Introduction
This course provides an in-depth overview of the principles and practices of medical insurance and billing within healthcare settings. Students will learn about various types of insurance plans, including private, government, and managed care programs, and understand the roles of healthcare providers, patients, and insurance companies in the reimbursement process. Emphasis is placed on accurately completing insurance claim forms, applying current coding systems (ICD, CPT, HCPCS), navigating the claims submission process, and resolving claim denials or rejections. Legal and ethical considerations, confidentiality, and compliance regulations such as HIPAA are also discussed, equipping students with the knowledge and skills needed for entry-level positions in medical billing and insurance.
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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Chapter 1: Role of an Insurance Billing Specialist
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Sample Questions
Q1) Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring
A) specialized health care practitioners.
B) health care workers with college degrees.
C) multiskilled health care practitioners.
D) untrained health care practitioners.
Answer: C
Q2) A billing specialist is entrusted with
A) holding patients' medical information in confidence.
B) collecting monies.
C) being a reliable resource for co-workers.
D) all of the above.
Answer: D
Q3) The title used for medical billing personnel may depend on the region of the United States where they work.
A)True
B)False
Answer: True
Q4) An NPP is a ______________________________.
Answer: non-physician practitioner
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Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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Sample Questions
Q1) Disclosing PHI as authorized by the laws relating to workers' compensation does not require a signed authorization.
A)True
B)False
Answer: True
Q2) Stark laws prohibit the submission of claims for "designated services" if the referring physician has a __________________ with the entity that provides the service.
Answer: financial relationship
Q3) What is the correct response when a relative calls asking about a patient?
A) Document the name of the relative and his or her relationship to the patient before disclosing any information.
B) Ask the relative to put the request in writing and include the patient's signed authorization.
C) Have the physician return the telephone call.
D) None of the above.
Answer: C
Q4) What is the goal of the Medicare Integrity Program (MIP)?
Answer: Identify and reduce Medicare overpayments.
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Chapter 3: Basics of Health Insurance
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93 Verified Questions
93 Flashcards
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Sample Questions
Q1) The insured is always
A) the patient.
B) the person at risk.
C) the individual enrollee or organization protected.
D) the employer.
Answer: C
Q2) When a contract is not manifested by direct words but is deduced from the circumstance, the general language, or the conduct of the patient, it is referred to as a/an ____________________ contract.
Answer: implied
Q3) Medicare is a program jointly sponsored by federal and state governments for those eligible for public assistance.
A)True
B)False
Answer: False
Q4) In a managed care plan, the participating provider is also referred to as:
Answer: A preferred provider
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Page 5
Chapter 4: Medical Documentation and the Electronic Health Record
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94 Flashcards
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Sample Questions
Q1) When a patient fails to return for needed treatment, documentation should be made
A) in the patient's medical record.
B) in the appointment book.
C) on the financial record or ledger card.
D) all of the above.
Q2) Review of medical events in the patient's family, including diseases that may be hereditary, is known as a/an ____________________.
Q3) An internal review known as a ______________________________ is done after billing insurance carriers.
Q4) The abbreviation HPI stands for ______________________________.
Q5) Area of the body in which the symptom is occurring.
A)Location
B)Quality
C)Severity
D)Duration
E)Timing
F)Context
G)Modifying factors
H)Associated signs and symptoms
Page 6
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Chapter 5: Diagnostic Coding
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115 Verified Questions
115 Flashcards
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Sample Questions
Q1) What is the consequence when a medical practice does not use diagnostic codes?
A) It affects the physician's level of reimbursement for inpatient claims.
B) Claims can be denied.
C) Fines or penalties can be levied.
D) All of the above.
Q2) Certain codes that should never be reported at the same time are indicated by the convention ___.
Q3) ICD-10-PCS replaces the CPT code book used in outpatient billing.
A)True
B)False
Q4) Provide the appropriate ICD-10-CM code for a cellulitis of the anus.
Q5) Terms enclosed in parentheses following the main term are referred to as A) nonessential modifiers.
B) essential modifiers.
C) exclusions.
D) fifth digits.
Q6) In the computer-assisted coding technology known as ___, the physician uses pull-down menus.
Q7) ICD-10-CM codes have from ____ to ___ characters.
Q8) Always code to the highest level of ____.
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Chapter 6: Procedural Coding
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40 Flashcards
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Sample Questions
Q1) 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.
Q2) Some managed care plans develop "internal codes" for use by the plan only to code specific procedures.
A)True
B)False
Q3) CPT uses a basic ____________________-digit system for coding services rendered by physicians, plus ____________________-digit add-on modifiers.
Q4) Deliberate manipulation of CPT codes for increased payment is called ____________________.
Q5) The CPT code for office services provided on an emergency basis is A) 99302.
B) 99312.
C) 99282.
D) 99058.
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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) The diagnosis field of the CMS-1500 claim form is referred to as Block ___.
Q2) Medicare providers who charge patients a fee for supplies and equipment such as crutches, urinary catheters, and walkers must send the claims to
A) their regional fiscal intermediary.
B) a specific DME fiscal intermediary.
C) TRICARE.
D) the patient.
Q3) The CMS-1500 paper claim can be purchased through a medical office supply company or through the ____.
Q4) A dirty claim is one that had coffee spilled on it before it was sent to the insurance carrier.
A)True
B)False
Q5) Who is the physician who treated this patient?
Q6) A clean claim has no ___ and passes all electronic edits.
Q7) A claim that is submitted to the insurance carrier via Internet connection is referred to as ___.
Q8) Does the patient have another health insurance plan that would provide secondary coverage?
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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) List common electronic claim submission errors that have resulted from the upgrade to Version 5010 of the electronic claims submission standards.
Q2) When a medical practice has its own computer and transmits claims electronically directly to the insurance carrier, this system is known as
A) carrier-direct.
B) immediate response.
C) clearinghouse.
D) straight-line submission.
Q3) Name three advantages of using a clearinghouse to bill insurance companies.
Q4) What does an electronic remittance advice (RA) do?
Q5) 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.
Q6) The establishment of standard unique patient identifiers is currently stalled due to protest that universal identifiers could be a ____ threat.
Q7) Why was the HIPAA Transaction Code Set developed?
Page 10
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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Sample Questions
Q1) A peer review is usually done before the appeal process.
A)True
B)False
Q2) Routine use of too many nonspecific diagnostic codes may result in downcoding.
A)True
B)False
Q3) If the medical practice receives payment from an insurance company that is more than the contract rate, it is called a/an ____________________.
Q4) The status of electronic insurance claims may be accessed quickly through online health insurance physician web portals.
A)True
B)False
Q5) If an insured is in disagreement with the insurer for settlement of a claim, a suit must begin within
A) 1 year.
B) 2 years.
C) 3 years.
D) 5 years.
11
Q6) Overdue payment on an insurance claim is referred to as
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Chapter 10: Office and Insurance Collection Strategies
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87 Verified Questions
87 Flashcards
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Sample Questions
Q1) What does the insurance billing specialist need to monitor to be able to evaluate the effectiveness of the collection process?
A) Number of statements sent
B) Number of claims processed
C) Accounts payable
D) Accounts receivable
Q2) In a telephone collection call, if a patient does not respond, it probably means "no."
A)True
B)False
Q3) What is the name of the federal act that prohibits discrimination in all areas of granting credit?
A) Equal Credit Opportunity Act
B) Fair Credit Reporting Act
C) Fair Credit Billing Act
D) Truth in Lending Act
Q4) The truth in lending consumer credit cost disclosure requires businesses to disclose all ____________________ and ____________________ costs related to granting credit.
Q5) The collection abbreviation TTA means ____________________.
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Chapter 11: The Blue Plans, Private Insurance, and Managed Care Plans
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Sample Questions
Q1) The Health Maintenance Organization Act of 1973 required most employers to offer HMO coverage to their employees as an alternative to traditional health insurance.
A)True
B)False
Q2) How are physicians who work for a prepaid group practice model paid?
A) Salary paid by independent group
B) Salary paid by a health plan
C) Fee-for-service
D) Usual, customary, and reasonable charges
Q3) When a physician sees a patient more than is medically necessary, it is called A) buffing.
B) turfing.
C) churning.
D) stirring.
Q4) Exclusive provider organizations (EPOs) are regulated by the federal government.
A)True
B)False
Q5) Benefits under the HMO Act fall under two categories: ____________________ health services and supplemental health services.
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Chapter 12: Medicare
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Sample Questions
Q1) The Medicare HCPCS coding system has ____________________ levels.
Q2) The time limit for sending in Medicare claims is the end of the calendar year in which professional services were performed.
A)True
B)False
Q3) Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called A) local intermediaries.
B) regional intermediaries.
C) fiscal intermediaries.
D) fiscal agents.
Q4) Because Medicare is a federal program providing uniform benefits, payment of each medical service rendered to Medicare patients is consistent across the United States. A)True
B)False
Q5) Medicare Part A is called supplementary medical insurance (SMI).
A)True
B)False
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Chapter 13: Medicaid and Other State Programs
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Sample Questions
Q1) The federal government designs the Medicaid program for each state on the basis of the needs of the state.
A)True
B)False
Q2) Time limits for Medicaid claim submission can vary from ____________________ months to 1 year from the date of service depending on the state in which service was provided.
Q3) The abbreviation for the Deficit Reduction Act of 1984 is ____________________.
Q4) 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.
Q5) Medicaid was legally established by Title ____________________ of the Social Security Act.
Q6) The Medicaid patient may be responsible for a copayment. A)True B)False
Q7) The ____________________ form accompanies all Medicaid payment checks.
Q8) Medicaid identification cards are usually issued every ____________________. Page 16
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Page 17
Chapter 14: Tricare and Veterans Health Care
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53 Flashcards
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Sample Questions
Q1) CHAMPVA is a/an
A) insurance program.
B) service benefit program.
C) both a and b.
D) neither a nor b.
Q2) The Privacy Act of 1974 establishes an individual's right to review his or her medical records maintained by
A) a federal medical care facility.
B) a VA hospital.
C) a U.S. Public Health Service facility.
D) all of the above.
Q3) A partnership program permits TRICARE-eligible people to receive inpatient treatment from civilian providers of care in a military hospital.
A)True
B)False
Q4) A person who has served in the Armed Forces of the United States, especially in a time of war, who is no longer in the service and has received an honorable discharge is called a/an ____________________.
Q5) What does the acronym CHAMPVA stand for?
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Chapter 15: Workers Compensation
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57 Verified Questions
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Sample Questions
Q1) In many states, workers' compensation laws have exemptions for certain occupations such as
A) file clerks, telephone operators, and typists.
B) administrative secretaries, receptionists, and bookkeepers.
C) domestic employees, babysitters, and gardeners.
D) all of the above.
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) A/An ____________________ is an unplanned and unexpected happening traceable to a definite time and place, causing injury (damage or loss) not due to any fault on the part of the person injured.
Q4) 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?
Q5) Name the five types of workers' compensation benefits.
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Sample Questions
Q1) A policy that offers an insured person protection when loss of sight or loss of limb(s) occurs is called
A) double indemnity.
B) residual benefits.
C) dismemberment benefit.
D) amputee protection.
Q2) Temporary disability exists when an illness or injury prevents a person from performing one or more of the functions of his or her regular job.
A)True
B)False
Q3) Medical requirements are the same for both the SSDI and SSI programs.
A)True
B)False
Q4) What are six major government disability programs?
Q5) One of the most important items on a state disability claim form is the claimant's Social Security number.
A)True
B)False
Q6) Who are the eight types of workers not covered by state disability?
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Chapter 17: Hospital Billing
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Sample Questions
Q1) Dollar amount owed to a participating provider for health care services rendered to a plan member according to a fee schedule set by the managed care plan.
A)Ambulatory payment
B)Bed leasing
C)Capitation or percentage of revenue
D)Case rate
E)Diagnosis-related groups (DRGs)
F)Differential by day in hospital
G)Differential by service type
H)Fee schedule
I)Flat rate
J)Per diem
K)Periodic interim payments (PIPs) and cash advances
L)Withhold
M)Reinsurance stop-loss
N)Charges
O)Discounts in the form of sliding scale
P)Sliding scales for discounts and per diems
Q2) The Uniform Bill claim form is considered a ____________________ statement.
Q3) Medicare provides stop-loss called _____________________ in its regulations.
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) List five ways to search for a job.
Q2) According to the IRS, payroll records and summaries should be retained
A) for 3 years.
B) for 5 years.
C) for 7 years.
D) permanently.
Q3) An insurance billing specialist may be employed by a physician, hospital, or other medical facility or may choose to be self-employed.
A)True
B)False
Q4) When an individual wishes to start his or her own medical billing service, he or she should have sufficient funds to run the business for a period of A) 2-4 months.
B) 3-6 months.
C) 1 year or more.
D) 1-3 years.
Q5) Never use a post office box for a home-based business.
A)True
B)False
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