Medical Office Procedures
Exam Bank
Course Introduction
Medical Office Procedures is a comprehensive course designed to introduce students to the administrative and clerical functions essential for effective healthcare office management. The curriculum covers topics such as patient scheduling, medical billing and coding, records management, insurance processing, telephone etiquette, and healthcare law and ethics. Emphasis is placed on developing professional communication skills, maintaining patient confidentiality, and utilizing electronic health record systems. Students will gain practical experience through simulated office scenarios, preparing them to efficiently support medical practitioners and deliver high-quality service in a fast-paced healthcare environment.
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) Medical etiquette refers to A) consideration for others.
B) moral principles or practices.
C) laws.
D) the Oath of Hippocrates.
Answer: A
Q2) Medical billing employees should be able to perform a variety of administrative duties pertaining to the business office.
A)True
B)False
Answer: True
Q3) It is acceptable practice for medical office personnel to use a patient's first name when speaking to the patient about his or her insurance.
A)True
B)False
Answer: False
Q4) The Greek physician known as the Father of Medicine devised the
Answer: Oath of Hippocrates
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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) Notes, papers, and memos regarding patient information should be disposed of using a shredding device.
A)True
B)False
Answer: True
Q2) Stealing money that has been entrusted to one's care is known as
Answer: embezzlement
Q3) The Security Rule that addresses electronic protected health information is divided into which three main sections?
Answer: Administrative safeguards, technical safeguards, and physical safeguards.
Q4) Forgiving the deductible or copayment for a Medicare patient.
A)Abuse
B)Fraud
Answer: B
Q5) Billing for services or supplies not provided is __________________.
Answer: fraud illegal
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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 amount that must be paid each year by the insured before policy benefits begin is known as the ____________________.
Answer: deductible
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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94 Verified Questions
94 Flashcards
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Sample Questions
Q1) WNL is the abbreviation for _________________________.
Q2) A consultation may take place in a home, office, hospital, or extended care facility. A)True B)False
Q3) The documentation of the patient's previous experiences with illnesses, operations, injuries, and treatments is known as the ____________________.
Q4) Under the Medicare incentive program for implementation of EHR, eligible providers will
A) earn incentive payments for up to 4 years if they have demonstrated MU.
B) earn incentive payments for up to 10 years if they have demonstrated MU.
C) be penalized through payment adjustments starting in 2013 if they have not demonstrated MU.
D) be penalized through payment adjustments starting in 2015 if they have not demonstrated MU.
Q5) An age-appropriate review of past and current activities of the patient (e.g., smoking or use of alcohol) is known as a/an ____________________.
Q6) The abbreviation HPI stands for ______________________________.
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) _____ codes are only reported by the provider who is initially treating a patient for an injury.
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) A patient was seen for a fever of unknown origin. List the appropriate ICD-10-CM code(s) for this condition.
Q4) Burns are reported based on the depth of the burn, the extent of the burn, and the agent that caused the burn.
A)True
B)False
Q5) 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.
Q6) Burns caused by chemicals are referred to as _____ in the Official Coding Guidelines.
Page 7
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Chapter 6: Procedural Coding
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40 Verified Questions
40 Flashcards
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Sample Questions
Q1) A listing of accepted charges or established allowances for specific medical procedures is called a/an ____________________.
Q2) When coding for x-ray films taken of both knees, list
A) the proper x-ray code twice and use the modifier -76 (repeat procedure by same physician) with the second code.
B) the proper x-ray code twice and use the modifier -51 (multiple procedure) with the second code.
C) the proper x-ray code once and modify it with -51 (multiple procedure).
D) the proper x-ray code twice and use the modifiers RT (right) with the first code and LT (left) with the second code.
Q3) When counseling and coordination of care dominate ____________________% of face-to-face physician/patient encounters, then time is considered the key to qualify for a particular level of E/M service.
Q4) CPT uses a basic ____________________-digit system for coding services rendered by physicians, plus ____________________-digit add-on modifiers.
Q5) The E/M code 99203 is considered a level ____________________ code.
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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) If several services are being billed on the same insurance claim form, you may "ditto" the dates on each line of service below the first line.
A)True
B)False
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 is known as the A) COMB-1.
B) basic paper claim.
C) attending physician's statement.
D) electronic claim.
Q4) Copies of submitted claim forms should be maintained in a ticker file and followed up on every ___ days.
Q5) A clean claim has no ___ and passes all electronic edits.
Q6) What is the date that the symptoms first presented for the condition treated?
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) What is an encoder?
Q2) A disadvantage of electronic claim submission is more time spent processing claims, which requires additional staffing.
A)True
B)False
Q3) What are the three kinds of information system safeguards and security measures?
Q4) Batch, scrub, edit, and transmit claims.
A)Daily
B)Weekly
C)End of month
D)Daily or weekly
Q5) Data that is made unintelligible to unauthorized parties is referred to as A) coded.
B) decoded.
C) encoded.
D) encrypted.
Q6) What does an electronic remittance advice (RA) do?
Q7) Name the organization that is responsible for issuance and maintenance of National Provider Identifiers.
Q8) A screen prompt is a __.
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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65 Verified Questions
65 Flashcards
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Sample Questions
Q1) Monitoring the activities of insurance companies and making sure that the interests of the policyholders are protected are the jobs of the insurance
Q2) If an insurance company admits that a patient signed an assignment of benefits document and that it inadvertently paid the patient instead of the physician, the insurance company should
A) advise the physician to write-off the amount as a bad debt.
B) pay the physician within 2-3 weeks and honor the assignment even before the company recovers its money from the patient.
C) pay the physician within 2-3 weeks after recovering the money from the patient.
D) notify the physician of the error and indicate in a letter that it will never happen again.
Q3) When receiving payment from a private insurance carrier, check the amount of payment on the EOB with the
A) patient's financial accounting record.
B) practice's daysheet.
C) copy of the CMS-1500 form.
D) patient's insurance contract.
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Page 11
Chapter 10: Office and Insurance Collection Strategies
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87 Verified Questions
87 Flashcards
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Sample Questions
Q1) You should not give patients the option of whether they would like to pay now or have a bill sent.
A)True
B)False
Q2) Most medical practices operate with a set of fees that must be applied to all patients in the practice.
A)True
B)False
Q3) What is the biggest change medical offices can expect from the Affordable Care Act?
A) A reduction in the cost of medications
B) The number of self-pay patients will decrease
C) Young adults under 26 can remain under their parent's health care plan
D) The elimination of the preexisting condition barrier
Q4) Information provided on the patient registration form will prove critical to any billing and collection efforts.
A)True
B)False
Q5) The collection abbreviation TTA means ____________________.
Q6) The collection abbreviation OOT means ____________________.
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Chapter 11: The Blue Plans, Private Insurance, and Managed Care Plans
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41 Verified Questions
41 Flashcards
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Sample Questions
Q1) In times past, physicians in private practice billed indemnity insurance plans and professional services were reimbursed on a fee-for-service basis.
A)True
B)False
Q2) Medicare-eligible patients are not involved with HMOs or prepaid health plans.
A)True
B)False
Q3) In an independent practice association (IPA), physicians are
A) paid salaries by their own independent group.
B) paid salaries by the practice association.
C) not employees and are not paid salaries.
D) not paid until the end of the year in which services were rendered.
Q4) 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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Q5) The abbreviation MCO stands for ______________________________.
Chapter 12: Medicare
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75 Flashcards
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Sample Questions
Q1) Medicare Part A
A) physician outpatient medical services.
B) blood transfusions.
C) physical therapy.
D) hospice care.
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) The Medicare Part A benefit period ends when a patient
A) is discharged from the hospital.
B) has not been a bed patient in any hospital or nursing facility for 60 consecutive days.
C) has not been a bed patient in any hospital or nursing facility for 30 consecutive days.
D) has not been a bed patient in any hospital or nursing facility for 90 consecutive days.
Q4) A patient classified with ESRD may be provided benefits from Medicare. What does ESRD stand for?
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Chapter 13: Medicaid and Other State Programs
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55 Verified Questions
55 Flashcards
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Sample Questions
Q1) Basic Maternal and Child Health Program (MCHP) provisions offered in all states include
A) children with handicap needs who require orthopedic treatment or plastic surgery.
B) children with hearing problems.
C) children with mental retardation.
D) children with paralyzed muscles.
Q2) 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.
Q3) Home health care is never covered under Medicaid.
A)True B)False
Q4) 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.
Q5) Medicaid was legally established by Title ____________________ of the Social Security Act.
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Chapter 14: Tricare and Veterans Health Care
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53 Verified Questions
53 Flashcards
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Sample Questions
Q1) Individuals who qualify for TRICARE are known as ____________________.
Q2) An organization under contract to the government that handles insurance claims for care received under the TRICARE program is known as a/an
Q3) Individuals who qualify for TRICARE are known as subscribers.
A)True
B)False
Q4) The physician who is responsible for coordinating and managing all of the health care for the TRICARE Prime patient is referred to as a/an
A) PCM.
B) PCP.
C) gatekeeper.
D) HCF.
Q5) 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.
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Chapter 15: Workers Compensation
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57 Verified Questions
57 Flashcards
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Sample Questions
Q1) A ____________________ report is sent to the insurance carrier after 2-4 weeks of treatment to give information on the current status of the patient.
Q2) A narrative industrial medical report should include only objective findings and not subjective factors.
A)True
B)False
Q3) The form that contains authorization for the physician to treat the injured employee is the
A) Employer's Report of Occupational Injury.
B) Medical service order.
C) Physician's First Report of Occupational Injury or Illness.
D) Supplemental Report.
Q4) If a worker's occupation takes a person into another state, most compensation laws are ____________________ and effective outside the state by either specific provisions or court decision.
Q5) Chiropractic care is a medical benefit offered with state workers' compensation.
A)True B)False
Q6) Which types of employees fall under federal workers' compensation statutes?
Page 17
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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50 Verified Questions
50 Flashcards
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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) Medical requirements are the same for both the SSDI and SSI programs.
A)True
B)False
Q3) Nonindustrial disability insurance programs exist in only five states and Puerto Rico. A)True B)False
Q4) A ______________________________ (DDS) team composed of a physician/psychologist and disability examiner makes the determination regarding disability for the SSDI and SSI programs.
Q5) What are the four levels of the appeal process used if disagreement with determination of disability occurs?
Q6) What are six major government disability programs?
Q7) 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) A review for additional Medicare reimbursement is called
A) DRG validation.
B) day outlier review.
C) cost outlier review.
D) procedure review.
Q2) If a patient is being admitted to a hospital and refuses all preadmission testing, but a bill is sent to the insurance carrier for these services anyway, this is called
A) duplicate billing.
B) double billing.
C) phantom charges.
D) posting errors.
Q3) The hospital department that conducts an admission and concurrent review on all cases and prepares a discharge plan to determine whether admissions are justified is called the ____________________ department.
Q4) Information such as "condition is employment related" (code 02), listed in Fields 18 through 28 of the CMS 1450 (UB-04) claim form, is called a condition code.
A)True
B)False
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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41 Verified Questions
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Sample Questions
Q1) Under HIPAA, when a health care provider outsources billing, this individual is known as a
A) Certified Medical Billing Specialist.
B) Registered Medical Coder.
C) business associate.
D) billing associate.
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) A résumé may be posted in an online job information site or bulletin board on the Internet.
A)True
B)False
Q4) 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.
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