Medical Office Administration
Exam Solutions
Course Introduction
Medical Office Administration is an essential course that introduces students to the administrative functions and organizational skills required to efficiently manage a medical office. The course covers topics such as medical terminology, patient scheduling, records management, billing and coding, insurance processing, and effective communication within healthcare settings. Emphasis is placed on professionalism, confidentiality, and compliance with regulatory requirements. Through practical exercises and real-world scenarios, students develop the competencies needed to support healthcare professionals and enhance the patient experience in a medical office environment.
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
Source URL: https://quizplus.com/study-set/638
Page 2
Chapter 1: The Origins of Health Insurance
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45 Verified Questions
45 Flashcards
Source URL: https://quizplus.com/quiz/12084
Sample Questions
Q1) One of the new healthcare laws enacted in 2010 that brought major changes to how Americans can get access to healthcare more easily is the:
A) Health Insurance Portability and Accountability Act (HIPAA).
B) Health Maintenance Organization (HMO) Act.
C) Patient Protection and Affordable Care Act (PPACA).
D) Consolidated Omnibus Budget Reconciliation Act (COBRA).
Answer: C
Q2) The program that provides insurance for qualifying children who are ineligible for Medicaid but cannot afford private insurance is called:
A) CHIP.
B) COBRA.
C) ARRA.
D) HIPAA.
Answer: A
Q3) The amount of money an individual pays in return for health insurance coverage is called a/an ____________________.
Answer: premium
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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) Healthcare providers in this country rely heavily on health insurance professionals. A)True
B)False Answer: True
Q2) The change to the new HIPAA transaction standards was made to better accommodate the ICD-9-CM codes. A)True
B)False Answer: False
Q3) Health insurance professionals can enhance their career by becoming certified. A)True B)False Answer: True
Q4) Health insurance professionals are currently in high demand in the United States. 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
Source URL: https://quizplus.com/quiz/12086
Sample Questions
Q1) A patient can terminate the doctor/patient contract simply by paying the bill and not returning to the practice.
A)True
B)False
Answer: True
Q2) The federal act that states that Medicare is the secondary payer in the case of automobile or liability coverage is the:
A) Federal Privacy Act of 1974.
B) Federal Omnibus Budget Reconciliation Act of 1980.
C) Tax Equity and Fiscal Responsibility Act of 1982.
D) Consolidated Omnibus Budget Reconciliation Act of 1986.
Answer: B
Q3) Before medical information can be divulged to a third party,the patient should sign a/an:
A) written consent form.
B) assignment of benefits form.
C) release of medical information form.
D) either a or c
Answer: D
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Page 5
Chapter 4: Types and Sources of Health Insurance
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48 Verified Questions
48 Flashcards
Source URL: https://quizplus.com/quiz/12087
Sample Questions
Q1) Individuals who prefer not to enroll in original Medicare can purchase supplemental policies called Medigap or Medicare Supplement plans.
A)True
B)False
Q2) The amount the insured must pay before insurance coverage begins is referred to as the ________________.
Q3) The "birthday rule" is an informal procedure used to determine which plan is "primary" when individuals are listed as dependents on more than one policy.
A)True
B)False
Q4) The dollar amount that a patient must pay each year before his or her insurance benefits begin is called a/an:
A) dividend.
B) copayment.
C) deductible.
D) reimbursement.
Q5) A provider who is under no contractual agreement with the insurer to accept reimbursement as payment in full.
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Chapter 5: Claim Submission Methods
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70 Verified Questions
70 Flashcards
Source URL: https://quizplus.com/quiz/12088
Sample Questions
Q1) Name the two entities that have the responsibility of updating and revising the CMS-1500 universal form?
Q2) Roster billing of Medicare-covered vaccinations for multiple beneficiaries must be submitted electronically.
A)True
B)False
Q3) What is the most important task the health insurance professional is responsible for?
Q4) HIPAA Standards Version ____ addresses many of the limitations in the former version and supports the reporting of national provider identifiers (NPIs)and the new ICD-10 codes.
A) 4010
B) 5010
C) ASCII X19
D) 4010A1
Q5) Names,addresses,Social Security numbers,and employment information are referred to as demographics.
A)True
B)False
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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) The plan types within managed care plans include all of the following,except:
A) health savings accounts.
B) point-of-service (POS) plans.
C) preferred provider organizations (PPOs).
D) health maintenance organizations (HMOs).
Q2) If the health insurance professional needs to know a particular carrier's rules for completing the CMS-1500,the best thing to do is to:
Q3) Employers cannot be "self-insured."
A)True
B)False
Q4) A system of payments established by the Centers for Medicare and Medicaid Services (CMS)to reimburse healthcare providers for treating Medicare patients.
Q5) Providers who do not contract with a particular insurance carrier are called nonPARs. A)True B)False
Q6) A document prepared by the carrier that gives details of how the claim was adjudicated is called a/an ________________.
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Page 8
Chapter 7: Unraveling the Mysteries of Managed Care
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50 Verified Questions
50 Flashcards
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Sample Questions
Q1) The formal term for a written complaint submitted by an individual covered by a special plan or policy is called a:
A) letter.
B) grievance.
C) complaint. D) dispatch.
Q2) One of the major goals of the Affordable Care Act is to provide quality,affordable care for all Americans.
A)True
B)False
Q3) Healthcare reform will likely eliminate most managed care arrangements.
A)True
B)False
Q4) Managed care has had little impact on healthcare in general in the United States.
A)True
B)False
Q5) MCOs tend to focus on ____________________ care,or keeping the patient well,thus avoiding expensive treatment later on.
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Chapter 8: Understanding Medicaid
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87 Verified Questions
87 Flashcards
Source URL: https://quizplus.com/quiz/12091
Sample Questions
Q1) Every time a claim is sent to Medicaid,a document is generated explaining how the claim was adjudicated,or how the payment was determined,which is called a:
A) crossover.
B) explanation of services.
C) payment resolution.
D) remittance advice.
Q2) The Medicaid program,referred to in the past as Aid to Families with Dependent Children (AFDC),is now called:
Q3) Facilities that receive additional payments to ensure that communities have access to certain high-cost services such as trauma and emergency care and burn services are called ______________.
Q4) To qualify for Medicaid,the individual must be at least 65 years of age. A)True
B)False
Q5) An individual who is eligible for SSI is not entitled to receive Social Security benefits. A)True
B)False
Q6) List four possible methods for verifying Medicaid eligibility.
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Chapter 9: Conquering Medicares Challenges
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105 Verified Questions
105 Flashcards
Source URL: https://quizplus.com/quiz/12092
Sample Questions
Q1) When a Medicare claim is filed,the beneficiary receives a document explaining the claim adjudication called a/an:
A) SPRA.
B) MSN.
C) ABN.
D) EOB.
Q2) For durable medical equipment (DME)to qualify for Medicare payment,it must be ordered by a physician for use in the home and items must be reusable.
A)True
B)False
Q3) Medicare HICNs are typically in the format of nine numeric characters followed by one alpha character.
A)True
B)False
Q4) An individual must be eligible for Part A or B to enroll in a Medicare Advantage plan.
A)True
B)False
Q5) Define a remittance advice,and describe the information it contains.
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Chapter 10: Military Carriers
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80 Verified Questions
80 Flashcards
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Sample Questions
Q1) Active duty,retired,or deceased service members are called
Q2) ADSMs enrolled in Prime receive most care at military treatment facilities (MTFs).
A)True
B)False
Q3) The name of the firm that processes about 65% of claims and handles customer service for the TRICARE healthcare program is _____________________.
Q4) CHAMPVA follows the same claims filing deadline as TRICARE.
A)True
B)False
Q5) Providers who accept assignment on CHAMPVA claims must accept the CHAMPVA allowable rate as payment in full and cannot balance bill.
A)True
B)False
Q6) If the needed treatment is not available at an MTF,TRICARE eligibles must always obtain a nonavailability statement (NAS).
A)True
B)False
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Chapter 11: Miscellaneous Carriers: Workers Compensation and Disability Insurance
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55 Verified Questions
55 Flashcards
Source URL: https://quizplus.com/quiz/12094
Sample Questions
Q1) The national website that provides workers compensation news and information for employees,employers,insurers,and medical providers is:
A) the Online Workers' Comp Service Center.
B) Centers for Medicare and Medicaid Services.
C) Disability and Health Team.
D) Americans with Disabilities.
Q2) Name the two distinct roles of the attending physician in workers' compensation claims.
Q3) Which of the following employers are not required to provide workers' compensation insurance to their employees?
A) Employers with fewer than three full-time employees
B) Individuals who are business partners
C) Volunteers
D) All of the above
Q4) In which era did workers' compensation get its start?
A) 1700s
B) 1800s
C) 1900s
D) 2000s
13
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Chapter 12: Diagnostic Coding
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132 Verified Questions
132 Flashcards
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Sample Questions
Q1) For bilateral sites,the last character of the six-character diagnostic code indicates: A) etiology.
B) utility.
C) morphology.
D) laterality.
Q2) In ICD-9,Supplementary Classification of Factors Influencing Health Status and Contact with Health Services are
A) E codes
B) V Codes
C) Combination codes
D) NOS codes
Q3) If the patient record shows a diagnosis of some type of tumor,the histology of the tumor is identified with a __________ code.
A) combination
B) morphology
C) manifestation
D) default
Q4) The abbreviation ICD-10-CM stands for ____________________.
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Page 14
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 AMA developed and published the first CPT manual in 1966.
A)True
B)False
Q2) Five-digit CPT codes accompanied by descriptive terms and used for reporting services performed by healthcare professionals are Level _____ codes.
A) I
B) II
C) III
D) IV
Q3) A physician may not bill for a consultation unless another physician formally requests his or her opinion about the treatment.
A)True
B)False
Q4) HIPAA has directed CMS to adopt uniform standards for coding systems to be used for reporting all healthcare transactions,thus eliminating Level II codes.
A)True
B)False
Q5) The CPT index is organized by ____________ listed alphabetically.
Page 15
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Chapter 14: The Patient
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74 Verified Questions
74 Flashcards
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Sample Questions
Q1) Computerized patient accounting typically begins with inputting demographic patient data.
A)True
B)False
Q2) When a new patient telephones for an appointment,giving the individual (over the phone)a range of what the initial fee will be is prohibited.
A)True
B)False
Q3) The defendant is the party:
A) suing someone.
B) making the argument in court.
C) being sued.
D) making the judgment.
Q4) List three future trends in the patient-practice relationship.
Q5) According to HIPAA,any individual or business involved in transferring data or carrying out transactions related to patient-protected health information is considered a/an __________.
Q6) The __________________ applies to individuals or businesses that offer or extend consumer credit if certain conditions are met.
Page 16
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Chapter 15: Keys to Successful Claims Management
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60 Verified Questions
60 Flashcards
Source URL: https://quizplus.com/quiz/12098
Sample Questions
Q1) Participating providers can balance bill,but nonparticipating providers for commercial claims are not allowed to.
A)True
B)False
Q2) A common error that can cause a claim to be rejected is:
A) incorrect patient ID number.
B) missing physician's EIN number.
C) invalid CPT or ICD codes.
D) all of the above
Q3) Real Time Claims Adjudication (RTCA)allows instant adjudication of an insurance claim.
A)True
B)False
Q4) What are the basic rules for appealing a claim?
Q5) The National Correct Coding Initiative (NCCI)develops correct coding methods for CMS that are intended to reduce overpayments that result from improper coding.
A)True
B)False
Q6) Explain how the Health Care Claim Status Inquiry/Response system works.
Page 17
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Chapter 16: The Role of Computers in Health Insurance
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65 Verified Questions
65 Flashcards
Source URL: https://quizplus.com/quiz/12099
Sample Questions
Q1) Standards for electronic healthcare transactions changed from Version 4010/4010A1 to Version 5010 in January of 2012,which accommodates the ______________ codes.
Q2) List two concerns with electronic medical records.
Q3) The use of standard transaction formats and code sets is required by CMS (formerly HCFA)for electronically transmitted health information from providers,health plans,and healthcare clearinghouses.
A)True
B)False
Q4) According to ASCA,no claim payment will be made under either Parts A or B of the Medicare program unless the claim is submitted electronically with a few exceptions. A)True
B)False
Q5) The Secretary of HHS grants a "waiver" for the electronic claims submission mandate for "unusual circumstances." Identify two of these "unusual circumstances."
Q6) Patient accounting systems can be set up to receive automatic ERA payments. A)True
B)False
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Page 18
Chapter 17: Reimbursement Procedures: Getting Paid
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72 Verified Questions
72 Flashcards
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Sample Questions
Q1) A hospital's all-inclusive daily rates,as calculated by department,are referred to as
Q2) 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.
Q3) Most patient accounting systems available today are capable of performing the same basic system functions.
A)True
B)False
Q4) The acronym for the system designed to explain the amount and type of resources used in an outpatient encounter is ______.
Q5) HIPAA standards do not address rules related to the format of electronic transactions.
A)True
B)False
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Chapter 18: Hospital Billing and the UB-04
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89 Verified Questions
89 Flashcards
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Sample Questions
Q1) There are currently 17 separate divisions in the ICD-10-PCS system.
A)True
B)False
Q2) The HIPAA Privacy Rule prohibits providers from talking to other providers about their patients.
A)True
B)False
Q3) Like ICD-9-CM Volume 1 and 2,Volume 3 contains a/an ___________ and a __________,and the formats of these two sections are the same.
Q4) United States hospitals that contract with Blue Cross and Blue Shield organizations are referred to as:
A) member hospitals.
B) cost outliers.
C) swing bed hospitals.
D) acute care hospitals.
Q5) Most medical clinics in the United States provide outpatient services only.
A)True
B)False
Q6) List at least four elements that informed consent is typically based on:
Page 20
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