Course Introduction
Medical Office Procedures
Final Exam Questions
Medical Office Procedures is a course designed to introduce students to the administrative functions and daily operations essential for efficient management of a medical office setting. The course covers topics such as patient scheduling, file management, electronic health records, billing and coding, insurance processing, and effective communication with patients and healthcare staff. Emphasis is placed on practical skills, professional ethics, confidentiality, and compliance with healthcare regulations. By the end of the course, students will be prepared to support healthcare teams and ensure smooth workflow in various medical administrative environments.
Recommended Textbook Health Insurance Today A Practical Approach 5th Edition by Janet I. Beik AA BA Med
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Page 2
Chapter 1: The Origins of Health Insurance
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Sample Questions
Q1) The two basic types of health insurance plans are indemnity and managed care.
A)True
B)False
Answer: True
Q2) Media coverage is instrumental in keeping healthcare costs down.
A)True
B)False Answer: False
Q3) Under the new healthcare law,ACOs agree to manage all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least 3 years.
A)True
B)False
Answer: True
Q4) The new healthcare reform laws make it more difficult for Americans to qualify for state Medicaid programs.
A)True
B)False
Answer: False
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Chapter 2: Tools of the Trade: A Career as a Health (Medical)Insurance
Professional
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40 Flashcards
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Sample Questions
Q1) Professional ethics are moral principles that are associated with a specific vocation.
A)True
B)False Answer: True
Q2) There are as many different insurance claim forms as there are insurance companies.
A)True
B)False Answer: False
Q3) One can typically expect to perform various duties when one becomes a health insurance professional.
A)True
B)False Answer: True
Q4) The basic goal of a health insurance professional is to ensure that providers and patients get paid correctly in a timely manner.
A)True
B)False
Answer: True
Page 4
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Chapter 3: The Legal and Ethical Side of Medical Insurance
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Sample Questions
Q1) When a society tends to be hasty in bringing lawsuits,it is said to be:
A) illegal.
B) litigious.
C) diligent.
D) formidable.
Answer: B
Q2) It is illegal for the health insurance professional to make any documentation entries in a patient's health record.
A)True
B)False
Answer: False
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
Q4) Legal form is only applicable in __________ contracts.
Answer: written
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Chapter 4: Types and Sources of Health Insurance
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Sample Questions
Q1) The traditional kind of health insurance wherein patients can choose any provider or hospital they wish and change physicians at will is:
A) indemnity.
B) fee-for-service.
C) managed care.
D) both a and b
Q2) 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.
Q3) Illnesses or injury that occurred before the start of a health insurance contract.
Q4) SSDI is an insurance program that only individuals older than 65 can qualify for.
A)True
B)False
Q5) A periodic fee that is paid to an insurer for healthcare coverage.
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Chapter 5: Claim Submission Methods
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70 Flashcards
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Sample Questions
Q1) Direct claim submission is considered the best method if most claims are being sent to a single carrier.
A)True
B)False
Q2) If the decision is made to go direct to the carrier,there will be multiple _______ that occur when a computer is programmed to automatically connect to another computer.
Q3) One category that may be exempt from mandatory electronic claim submission is a/an:
A) chiropractor.
B) oral surgeon.
C) small provider.
D) veterinarian.
Q4) CMS has published its rules for making electronic claims attachments in the:
A) NUBC instruction manual.
B) Federal Register.
C) GAO annual publication.
D) none of these; CMS does not publish such rules.
Q5) Explain how claim attachments can be sent electronically using such software as FastAttach .
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Chapter 6: Traditional Fee For Service/Private Plans
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Sample Questions
Q1) Blue Cross and Blue Shield policies are strictly fee-for-service plans.
A)True
B)False
Q2) Medicare supplemental insurance is intended to cover some costs that Medicare does not pay.
A)True
B)False
Q3) The two basic categories of health insurance are FFS and:
A) managed care.
B) group insurance.
C) individual policies.
D) health savings accounts.
Q4) A document prepared by the carrier that gives details of how the claim was adjudicated is called a/an ________________.
Q5) Medicare fiscal intermediaries (FIs)and carriers are now more commonly referred to as Medicare administrative contractors (MACs).
A)True
B)False
Q6) Explain the term "reasonable and customary."
Page 8
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Chapter 7: Unraveling the Mysteries of Managed Care
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Sample Questions
Q1) ____________________ pertains to medical necessity and appropriateness only and does not,in all instances,guarantee payment.
Q2) HMOs normally do not have ____________________ or plan limits.
Q3) HIPAA requires all employers to provide healthcare coverage for their employees.
A)True
B)False
Q4) Managed care is a healthcare system where insurance companies attempt to control _____ healthcare.
A) cost of B) quality of C) access to D) all of the above
Q5) The two most common types of managed care organizations are ___________ and ____________.
Q6) Under the federal HMO act,an entity must have five characteristics to call itself an HMO.
A)True B)False
Q7) The new healthcare reform bill promotes __________.
Page 9
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Chapter 8: Understanding Medicaid
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Sample Questions
Q1) Under which federal act was the Medicaid program established?
Q2) List the qualifications one must have to qualify for SSI.
Q3) States that offer a medically needy program must cover pregnant women and their children regardless of age.
A)True
B)False
Q4) When an individual is covered under both Medicaid and Medicare and/or a private healthcare policy,the payer of last resort is always:
A) Medicare.
B) Medicaid.
C) Medigap.
D) the private insurer.
Q5) It is good practice to file all Medicaid claims:
A) in a timely manner.
B) within 2 years of the date of services.
C) after the patient has been released from medical care.
D) within 6 months.
Q6) What is Medicaid?
Q7) List four possible methods for verifying Medicaid eligibility.
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Chapter 9: Conquering Medicares Challenges
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Sample Questions
Q1) Only Medicare beneficiaries can file an appeal.
A)True
B)False
Q2) With all Medicare HMO options,enrollees are allowed to see out-of-network providers and receive services from specialists without first going through a primary care physician,called self-referring.
A)True
B)False
Q3) Medicare Part C was previously called ___________;it was renamed by The Medicare Prescription,Improvement,and Modernization Act of 2003 (MMA)and is now called ___________.
Q4) The CMS-1500 paper claim form cannot be used for Medicare claims submission. A)True
B)False
Q5) A physician,practitioner,facility,or supplier with fewer than 10 FTE employees is considered a:
A) PAR provider.
B) non-PAR provider.
C) small provider.
D) qualified provider.
11
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Chapter 10: Military Carriers
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Sample Questions
Q1) The 1966 amendments to the Dependents Medical Care Act initiated what later became CHAMPUS,which was replaced with TRICARE in 1998.
A)True
B)False
Q2) The three basic plans under TRICARE include all of the following,except:
A) Extra.
B) Global.
C) Prime.
D) Standard.
Q3) If the needed treatment is not available at an MTF,TRICARE eligibles must always obtain a nonavailability statement (NAS).
A)True
B)False
Q4) The deadline for submitting TRICARE claims is within _____ of services rendered,after which no payment is made.
A) 6 months
B) 1 year
C) 18 months
D) 2 years
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Chapter 11: Miscellaneous Carriers: Workers Compensation and Disability Insurance
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Sample Questions
Q1) Which of the following is not one of the responsibilities of the health insurance professional?
A) Filling out the necessary forms for the patient
B) Acquiring the necessary information for claims processing
C) Photocopying all forms for the patient's health record
D) Maintaining a well-documented health record
Q2) List and explain the two major classifications of disability coverage.
Q3) Disability income insurance replaces a portion of earned income when an individual is unable to do his or her work resulting from nonemployment-related injuries.
A)True
B)False
Q4) List the steps for filing a workers' compensation claim.
Q5) Name the two distinct roles of the attending physician in workers' compensation claims.
Q6) HIPAA permits covered entities to disclose PHI to workers' compensation insurers and/or employers without the individual's written authorization.
A)True
B)False
Page 13
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Chapter 12: Diagnostic Coding
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Sample Questions
Q1) Which of the following is not a reason for the proposed conversion from the ICD-9 to the ICD-10 coding system?
A) The ICD-9 system is running out of available code numbers in some chapters.
B) The ICD-10 system groups diagnostic codes with procedure codes.
C) In ICD-10, a single code can report a disease and its current manifestation.
D) ICD-10 codes identify laterality (side of the body affected) when applicable.
Q2) A code set is any set of codes used for encoding data elements.
A)True
B)False
Q3) In the outpatient setting,the term "_____________" (reason for the encounter)is now used instead of "principal diagnosis."
Q4) In ICD-10,codes longer than 3 characters always have a decimal point
A) between the 4th and 5th characters
B) between the 5th and 6th characters
C) after the first 3 characters
D) before the last character
Q5) The goal in diagnostic coding is to assign a code to the ____________________
Q6) ____________ requires that ICD-9-CM diagnosis codes be included on all Medicare claims billed to Part B carriers,with the exception of ambulance claims.
Page 14
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Chapter 13: Procedural, Evaluation and Management, and HCPCS Coding
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Sample Questions
Q1) The time the healthcare provider spends in direct contact with a patient is called _____ time.
A) face-to-face
B) unit/floor
C) counseling
D) treatment
Q2) Like history-taking,there are four degrees of patient examination.Name these four degrees.
Q3) The most important thing to remember when using modifiers is that the health record must contain ______________ to support the modifier.
A) adequate documentation
B) signatures of two physicians
C) an operative report
D) proof of insurance coverage
Q4) There are two sets of criteria for assigning E&M codes-the 1995 and the 1997 guidelines.Explain each and discuss their differences.
Q5) Place of service is not a determining factor in E/M coding.
A)True
B)False
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Chapter 14: The Patient
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Sample Questions
Q1) A disbursement journal is the most basic of journals and is a chronologic listing of transactions.
A)True
B)False
Q2) Most services offered by a healthcare facility are not tangible,meaning they cannot be seen or felt;therefore patients look for surrogates,which include
A) other patients in the facility.
B) question and answer forms.
C) office location, size, and layout.
D) distance of the facility from the patient's house.
Q3) In a healthcare office,the form patients fill out providing name,address,employer,and health insurance information is typically called a/an:
A) patient survey form.
B) patient release form.
C) assignment of benefits.
D) patient information form.
Q4) List at least five types of a patient's identifiable information.
Q5) List five things a healthcare practice might do to increase its financial success.
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Chapter 15: Keys to Successful Claims Management
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60 Verified Questions
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Sample Questions
Q1) When it becomes necessary to include attachments with a paper claim,what provider information should appear on each document?
Q2) After the patient information form is completed,the health insurance professional should check it over to ensure the information is complete and legible.
A)True
B)False
Q3) What are the basic rules for appealing a claim?
Q4) When a claims error that could result in inaccurate reimbursement is discovered,a corrected claim should be prepared and submitted according to the payer's guidelines. A)True
B)False
Q5) Correct code initiative edits are the result of the National Correct Coding Initiative. A)True
B)False
Q6) Insurance companies usually have no time limits for filing appeals. A)True
B)False
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Page 17
Chapter 16: The Role of Computers in Health Insurance
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Sample Questions
Q1) With the advent of HIPAA,specific federal guidelines are now in place that provide security and protection for all healthcare information transmitted electronically.
A)True
B)False
Q2) Sum up the benefits of EDI.
Q3) An electronic file wherein patients' health information is stored in a computer system is called a/an _______________.
Q4) A "small provider" is a medical facility that has fewer than two practicing physicians.
A)True
B)False
Q5) To enroll in the Medicare (or other carrier)direct deposit program,the provider must contact the specific payer and ask for a/an:
A) identification number.
B) EFT enrollment form.
C) DDE questionnaire.
D) carrier-direct authorization.
Q6) List two concerns with electronic medical records.
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Page 18
Chapter 17: Reimbursement Procedures: Getting Paid
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Sample Questions
Q1) Bad debt write-offs are the same as contractual write-offs.
A)True
B)False
Q2) An agreement between the provider and a third-party payer whereby the provider agrees to accept the payer's allowed fee as payment in full for a particular service or procedure is referred to as:
A) patient equity.
B) balance billing.
C) a prospective payment.
D) a contractual write-off.
Q3) A common method of reimbursement used primarily by HMOs where the provider or healthcare facility is paid a fixed,per capita amount for each person enrolled in the plan without regard to the actual number or nature of services provided is called
Q4) The biggest challenge in developing an RVS-based payment schedule was patient diversity.
A)True
B)False
Q5) Define the term "cost outlier."
Q6) Name the three components that make up a relative value unit (RVU).
Page 19
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Chapter 18: Hospital Billing and the UB-04
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Sample Questions
Q1) Medicare Part A helps pay for:
A) hospital charges.
B) physician charges.
C) long-term healthcare.
D) all of the above
Q2) Commercial and private insurers typically negotiate contracts establishing inpatient payment methods on a month-to-month basis.
A)True
B)False
Q3) Patients who have not already seen a healthcare provider are usually not treated in an ASC.
A)True
B)False
Q4) Like ICD-10-CM codes,ICD-10-PCS codes contain _____ characters,which can be numbers or letters and are based on the type of procedure performed,the approach,body part,and other characteristics.
Q5) Name the five major hospital payers discussed in the book and explain how a health insurance professional can obtain the most recent claims completion guidelines for each.
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