Medical Office Administration
Exam Questions
Course Introduction
Medical Office Administration is an essential course designed to equip students with the fundamental knowledge and practical skills necessary for efficient operation within a medical office or healthcare facility. The course covers key topics such as medical terminology, healthcare laws and ethics, patient scheduling, billing and insurance processing, electronic health records management, and effective communication with both patients and healthcare professionals. Through a blend of theoretical learning and hands-on activities, students develop competencies in managing patient files, handling confidential information, and supporting the overall workflow in various medical settings, preparing them for administrative roles in clinics, hospitals, and other healthcare environments.
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) The earliest written code of ethical principles of medicine is called the
Answer: Code of Hammurabi
Q2) What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980?
A) The Modern Standards of Conduct Code
B) The Principles of Medical Ethics
C) The Oath of Hippocrates
D) The American Medical Association Code of Ethics
Answer: B
Q3) Physicians are legally responsible for any actions of their employees performed within the context of their employment; therefore, an employee cannot be sued or brought to trial.
A)True
B)False
Answer: False
Q4) Standards of conduct by which an insurance billing specialist determines the propriety of his or her behavior in a relationship are known as medical
Answer: ethics
Page 3
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Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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Sample Questions
Q1) Health care organizations are encouraged to have a(n) ________________ policy to allow effective lines of communication whereby staff feel secure to report questionable or suspicious activities relating to fraud and abuse.
Answer: open door
Q2) Identify which of the following would NOT typically be considered as a form of discipline for situations that involve fraudulent and malicious misconduct.
A) Verbal warning
B) Termination of employment
C) Restitution of any damages
D) Referral to federal agencies for criminal prosecution
Answer: A
Q3) Forgiving the deductible or copayment for a Medicare patient.
A)Abuse
B)Fraud
Answer: B
Q4) Stealing money that has been entrusted to one's care is known as
Answer: embezzlement
4
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Chapter 3: Basics of Health Insurance
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Sample Questions
Q1) In cases of divorce, the decision as to which parent should be responsible for payment of the child's services should be made by
A) the parents.
B) the provider.
C) the court system.
D) the claims adjudicator.
Answer: C
Q2) A contract that insures a person against on-the-job injury or illness.
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: E
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Page 5
Chapter 4: Medical Documentation and the Electronic Health Record
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Sample Questions
Q1) An established patient is one who
A) has received professional services from a physician who belongs to a group practice within the past 2 years.
B) has previously received professional services from a physician or another physician of the same specialty who belongs to the group practice within the past 3 years.
C) has received professional services from another physician of the same specialty within the past 4 years.
D) has received professional services from a physician within the past 5 years.
Q2) Services rendered by a physician whose opinion is requested by another physician for evaluating a patient's illness.
A)Concurrent care
B)Consultation
C)Continuity of care
D)Counseling
E)Critical care
F)Emergency
G)Referral
Q3) Explain the methods for disposing of both paper and electronic records.
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Chapter 5: Diagnostic Coding
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115 Verified Questions
115 Flashcards
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Sample Questions
Q1) Computer software that predicts the code for a word or phrase based on usage from the past is referred to as
A) retroactive-based method.
B) statistics-based method.
C) rules-based method.
D) prediction-based method.
Q2) When reporting obstetrical care, the trimester of pregnancy is indicated by A) a combination code.
B) the sixth character of the Chapter 15 code.
C) the seventh character of the Chapter 15 code.
D) an additional code.
Q3) Routine outpatient prenatal care is reported with a code from category ___.
Q4) The International Classification of Diseases (ICD) had its beginnings in England during the seventeenth century.
A)True
B)False
Q5) Certain codes that should never be reported at the same time are indicated by the convention ___.
Q6) Provide the appropriate ICD-10-CM code for eczematous dermatitis.
Q7) Always code to the highest level of ____.
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Chapter 6: Procedural Coding
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Sample Questions
Q1) CPT uses a basic ____________________-digit system for coding services rendered by physicians, plus ____________________-digit add-on modifiers.
Q2) UCR (usual, customary, reasonable) is used mostly in reference to managed care services.
A)True
B)False
Q3) Coding and billing numerous CPT codes to identify procedures that are usually described by a single code is called ____________________.
Q4) What does bundling mean?
A) When the code system used on a claim submitted to an insurance carrier does not match the code system used by the company receiving the claim.
B) Deliberate manipulation of CPT codes for increased payment.
C) Coding and billing numerous CPT codes to identify procedures that are usually described by a single code.
D) Grouping codes that are related to a procedure.
Q5) A patient required arthroplasty of the tibial plateaus of both knees. Code this procedure for the surgeon.
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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) OCR is the acronym for A) open code resource.
B) optical character recognition.
C) optical code recognition.
D) online claim recall.
Q2) When completing a claim form for a patient who has group insurance coverage, it is important to complete all information regarding the patient's ___.
Q3) ASCA provides exceptions to the Medicare electronic claims submission requirement to ____ providers.
Q4) The AMA was named in the administrative simplification of the HIPAA of 1996 as the authoritative voice regarding national standard content for submission of claims.
A)True
B)False
Q5) An insurance claim submitted with errors is referred to as A) a dingy claim.
B) a dirty claim.
C) a rejected claim.
D) an incomplete claim.
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Chapter 8: The Electronic Claim
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Sample Questions
Q1) Electronic remittance advices are sent to physicians following electronic funds transfer. However, the staff must still manually post payments to each individual patient's account.
A)True
B)False
Q2) A transmission report which identifies the most common reasons for claim denial is the
A) send and receive file reports.
B) scrubber report.
C) transaction transmission summary.
D) rejection analysis report.
Q3) The implementation of standard formats, procedures, and data content into the electronic data interchange process is the result of ______ regulations.
Q4) Clearinghouses always charge a flat fee for claim processing.
A)True
B)False
Q5) For assignment of benefits, each patient's ___ must be obtained.
Q6) Medicaid, Medicare, and TRICARE use which system to eliminate the need for a clearinghouse?
Page 10
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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Sample Questions
Q1) A Level 1 Medicare redetermination (appeal) may be made by telephone, in writing, or by submitting a CMS-20027 form.
A)True
B)False
Q2) If you have a denied insurance claim, you should change the information and resubmit the claim.
A)True
B)False
Q3) For Medicare patients whose secondary insurance is Medicaid:
A) Medicaid is billed separately.
B) Medicare reimburses both the primary and secondary payments.
C) The balance is adjusted because the Medicaid fee schedule is less than Medicare.
D) The patient is sent a statement for the secondary insurance balance.
Q4) An insurance claims register provides a
A) file containing the name and address of all insurance companies.
B) follow-up report that is sent to the insurance commissioner.
C) follow-up procedure for insurance claims.
D) practice analysis.
Q5) FTC stands for _________________________.
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Chapter 10: Office and Insurance Collection Strategies
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Sample Questions
Q1) If an insurance company seems to be ignoring all efforts to trace a claim, send a copy of the
A) history and physical.
B) operative report.
C) claim.
D) history of the account.
Q2) A/An ________________ is a patient payment option in which the check is deposited into the physician's account at the time of service.
Q3) What should be done to inform a new patient of office fees and payment policies?
A) Send a patient information brochure.
B) Send a confirmation letter.
C) Discuss fees and policies at the time of the initial contact.
D) All of the above.
Q4) Cash flow is
A) the amount of money available in the cash drawer.
B) the amount of money taken into the office in a given period of time.
C) the ongoing availability of cash in the medical practice.
D) the amount of money in accounts receivable.
Q5) The collection abbreviation OOT means ____________________.
Q6) All discounted fees need to be noted on the patient's ____________________.
Page 12
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Chapter 11: The Blue Plans, Private Insurance, and Managed Care Plans
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41 Flashcards
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Sample Questions
Q1) 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
Q2) A primary care physician who controls patient access to specialists is called a/an ____________________.
Q3) In certain managed care plans there is an incentive for the gatekeeper to limit patient referrals to specialists.
A)True
B)False
Q4) Managed care plans never require a CMS-1500 claim form to be completed and submitted.
A)True
B)False
Q5) The term turfing means to transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer.
A)True
B)False
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Chapter 12: Medicare
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Sample Questions
Q1) A patient classified with ESRD may be provided benefits from Medicare. What does ESRD stand for?
Q2) For all elective surgeries for which the actual charge will be ____________________ or more, a Medicare nonparticipating physician who does not accept assignment must provide the beneficiary in writing with the estimated fee for any elective surgery, the estimated Medicare-approved allowance for the surgery, and the cost difference between the approved allowance and the Medicare limiting charge.
Q3) The frequency of Pap tests that may be billed for a Medicare patient who is low risk is A) once every 12 months.
B) every other year.
C) once every 24 months.
D) once every 5 years.
Q4) In the Medicare program, there is mandatory assignment for A) clinical laboratory tests.
B) surgery performed in the physician's office.
C) ECGs.
D) E/M services.
Q5) What is the patient's financial responsibility?
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Chapter 13: Medicaid and Other State Programs
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Sample Questions
Q1) It is not possible for a person to be eligible for Medicaid benefits and also have additional group health insurance coverage.
A)True
B)False
Q2) Family planning is a Medicaid basic benefit.
A)True
B)False
Q3) The patient's Medicaid card must be checked each time the patient visits the physician's office to verify eligibility for month of service.
A)True
B)False
Q4) Medicaid is an established program of medical assistance in 46 states.
A)True
B)False
Q5) Some Medicaid recipients in the medically needy category must pay a coinsurance payment and/or deductible, also known as a/an ____________________, within the eligibility month before state benefits may be received.
Q6) The abbreviation for the Deficit Reduction Act of 1984 is ____________________.
Page 15
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Chapter 14: Tricare and Veterans Health Care
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Sample Questions
Q1) TRICARE/CHAMPVA is usually the second payer when a beneficiary is enrolled in other health insurance plans.
A)True
B)False
Q2) A certified nurse midwife is an authorized provider of health care for TRICARE beneficiaries.
A)True B)False
Q3) The active duty service member whose family members are covered under TRICARE is called the ____________________.
Q4) A person retired from a career in the armed forces is eligible for TRICARE until 65 years of age.
A)True B)False
Q5) In the TRICARE Extra plan, the individual enrolls yearly and pays an annual fee. A)True B)False
Q6) What does the acronym CHAMPVA stand for?
Q7) Where are claims for patients on active duty sent?
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Chapter 15: Workers Compensation
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Sample Questions
Q1) Authorization to treat a patient with an industrial injury may be obtained over the telephone.
A)True
B)False
Q2) All state workers' compensation laws are compulsory.
A)True
B)False
Q3) A narrative industrial medical report should include only objective findings and not subjective factors.
A)True
B)False
Q4) The three types of disability claims are ____________, ________________, and _____________.
Q5) In an industrial case, if the patient is experiencing pain that can be tolerated but will cause some handicap in the performance of the activity precipitating the pain, it is classified as
A) severe pain.
B) moderate pain.
C) slight pain.
D) minimal or mild pain.
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Sample Questions
Q1) Funding for State Disability Insurance is usually a small percentage of the employee's wage that
A) is deducted from employees' paychecks each month.
B) the employer may elect to pay a portion of.
C) the employer may elect to pay as a fringe benefit.
D) all of the above.
Q2) Which two programs managed by the Social Security Administration pay monthly disability benefits to people younger than age 65 who cannot work for at least a year because of a severe disability?
A) CCRS and FERS
B) Armed Services Disability and Veterans Affairs (VA) disability program
C) SSDI and SSI
D) SSI and FERS
Q3) Provisions written into the insurance contract denying coverage or limiting the scope of coverage are called
A) exceptions.
B) exclusions.
C) preexisting conditions.
D) denied benefits.
Q4) What are six major government disability programs?
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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 ____________________ is the clinical résumé for final progress notes.
Q3) The MS-DRG-based system is a complex _________________-tiered system.
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) 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.
Q2) A résumé that provides recent experiences first, with dates and descriptive data for each job, is ____________________.
Q3) The procedures and format for preparing an electronic résumé are the same as those for preparing a manual résumé.
A)True
B)False
Q4) An employer may evaluate the application itself to determine whether the applicant can follow ____________________.
Q5) It is discriminatory for an employer to ask if an applicant smokes. A)True
B)False
Q6) A résumé that summarizes the applicant's job skills, as well as educational and employment history, is of the ____________________.
Page 20
Q7) List five ways to search for a job.
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