Medical Office Procedures
Review Questions
Course Introduction
Medical Office Procedures is a foundational course designed to introduce students to the administrative tasks and best practices essential for the effective operation of a medical office. The course covers topics such as patient scheduling, medical record management, billing and coding, insurance processing, telephone and correspondence etiquette, privacy and confidentiality regulations (including HIPAA), and the use of electronic health records (EHR). Emphasis is placed on developing practical skills in communication, organization, and problem-solving to ensure smooth patient flow and support healthcare professionals in delivering quality care.
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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Sample Questions
Q1) It is commonplace to find administrative duties shared by a number of specialists in the physician's office.
A)True
B)False
Answer: True
Q2) Which level of education is generally required for one who seeks employment as an insurance coder?
A) College diploma.
B) High school diploma.
C) Completion of an accredited program for coding certification.
D) No specific level of education is required.
Answer: C
Q3) Electronic claims submissions are a format of the past.
A)True
B)False
Answer: False
Q4) Illegal coding practices are subject to penalties, fines, and/or imprisonment.
A)True
B)False
Answer: True
Page 3
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Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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Sample Questions
Q1) A health care coverage carrier, clearinghouse, or physician who transmits health information in electronic form in connection with a transaction covered by HIPAA.
A)Health care provider
B)Clearinghouse
C)Covered entity
D)Business associate
E)Privacy officer, privacy official
Answer: C
Q2) The key individual who oversees an organization's compliance program is referred to as the _________________.
Answer: compliance officer
Q3) Confidential information includes
A) everything that is heard about a patient.
B) everything that is read about a patient.
C) everything that is seen regarding a patient.
D) all of the above.
Answer: D
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Chapter 3: Basics of Health Insurance
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Sample Questions
Q1) The hospital insurance system and supplementary medical insurance for those older than 65 years of age, created by the 1965 Amendments to the Social Security Act.
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: I
Q2) If the premium of an insurance policy is not paid, a ____________________ from 10 to 30 days is usually given before insurance coverage is canceled.
Answer: grace period
Q3) An insurance policy is a legally enforceable agreement called a/an
Answer: contract
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Page 5
Chapter 4: Medical Documentation and the Electronic Health Record
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Sample Questions
Q1) WNL is the abbreviation for _________________________.
Q2) Levels of evaluation and management services are based on type(s) of physical examination that may be
A) limited.
B) complete.
C) problem focused.
D) both a and b
Q3) The key to substantiating procedure and diagnostic code selections for proper reimbursement is
A) the information on the daysheet.
B) supporting documentation in the electronic health record.
C) the data on the patient's information sheet.
D) the data checked off on the patient's encounter form.
Q4) The word chronic should be used instead of recurrent for a medical condition that persists over a long period.
A)True
B)False
Q5) If a professional liability claim is filed by a patient, good ____________________ helps establish a strong defense.
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Chapter 5: Diagnostic Coding
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115 Verified Questions
115 Flashcards
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Sample Questions
Q1) A patient is being evaluated in the office for an anterior cruciate ligament (ACL) tear. Which term should NOT be used to code the diagnosis?
A) "Suspected" ACL tear
B) "Likely" ACL tear
C) "Rule out" tear
D) All of the above
Q2) External cause codes are used
A) when a person who is not currently sick encounters health services for some specific purpose.
B) to show cause of injury.
C) to code neoplasms.
D) to code hypertension.
Q3) 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.
Q4) Symbols, punctuation marks, indentations, and other similar rules for determining the appropriate diagnosis code are referred to as _____.
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Chapter 6: Procedural Coding
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40 Flashcards
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Sample Questions
Q1) What is the name of the book that contains a coded listing of procedures with unit values that indicate the relative value of various services?
A) ICD-10-CM
B) CPT
C) RVS
D) HCPCS
Q2) What is the name of the book used in the physician's office to code procedures?
A) Clinical Procedure Terminology (CPT)
B) Current Procedural Terminology (CPT)
C) International Classification of Diseases, Tenth Revision, Clinical Modifications (ICD-10-CM)
D) Systematized Nomenclature of Human and Veterinary Medicine (SNOMED International)
Q3) Insurance companies go by the rule: "If it is not documented, then it was not ____________________."
Q4) A listing of accepted charges or established allowances for specific medical procedures is called a/an ____________________.
Q5) Deliberate manipulation of CPT codes for increased payment is called ____________________.
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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) Does the patient have another health insurance plan that would provide secondary coverage?
Q2) In 2012, the CMS-1500 claim form was revised to version 02-12 to accommodate A) the change in the name of the Health Care Financing Administration.
B) reporting of NPI numbers.
C) ICD-10 diagnosis codes.
D) Optical scanning.
Q3) To practice medicine within a state, a physician must obtain a physician's state
Q4) The objective of the Administrative Simplification Compliance Act was to improve the administration of the Medicare program by increased efficiencies resulting from
Q5) What is the diagnosis code that was submitted on this claim form, describing the condition the patient was treated for?
Q6) The paper claim form was revised in 2005 to allow reporting of ___ for physicians.
Q7) Was the condition related to an auto accident?
Q8) Who is the physician who treated this patient?
Page 9
Q9) What is the date that the symptoms first presented for the condition treated?
Q10) The diagnosis field of the CMS-1500 claim form is referred to as Block ___.
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Chapter 8: The Electronic Claim
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Sample Questions
Q1) The HIPAA Security Rule addresses security of electronic PHI in which area?
A) Administrative safeguards
B) Technical safeguards
C) Physical safeguards
D) All of the above
Q2) A provider is not considered a covered entity under HIPAA under which of the following circumstances?
A) The provider has fewer than 10 employees and submits claims only on paper to Medicare.
B) If the provider submits electronic transactions to any payer.
C) If the provider submits paper claims to Medicare and has more than 10 employees.
D) None of the above.
Q3) Supplemental documents that provide additional medical information to a claim are referred to as
A) claim attachments.
B) advanced beneficiary notices.
C) claim reports.
D) add-on reports.
Q4) Name three advantages of using a clearinghouse to bill insurance companies.
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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Sample Questions
Q1) The patient's health insurance card specifies all benefits and coverages.
A)True
B)False
Q2) An insurance claim that is processed without following specific insurance carrier instructions is considered a/an ____________________ claim.
Q3) What should be done if an insurance claim denial is received because a billed service was not a program benefit?
A) Rebill with a letter of explanation from the physician.
B) Write-off the amount on the patient's ledger.
C) Send the patient a statement with a notation of the response from the insurance company.
D) Appeal the decision with a statement from the physician.
Q4) The ______________________ manages complaints about delays in settling insurance claims, illegal cancellations or terminations of an insurance policy, and problems about insurance premium rates.
Q5) The highest level of a Medicare redetermination is with an administrative law judge hearing.
A)True
B)False
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Chapter 10: Office and Insurance Collection Strategies
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Sample Questions
Q1) 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
Q2) The part of the legal system that allows laypeople to settle a legal matter without use of an attorney is the
A) people's court.
B) justice court.
C) small claims court.
D) all of the above.
Q3) All discounted fees need to be noted on the patient's ____________________.
Q4) Contracting a medical billing service for insurance claim submission is called
A) statement service.
B) centralized billing.
C) outsourcing.
D) cycle billing.
Q5) The term ____________________ is used when accounts are billed at spaced intervals during the month.
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Chapter 11: The Blue Plans, Private Insurance, and Managed Care Plans
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Sample Questions
Q1) A primary care physician who controls patient access to specialists is called a/an
Q2) When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known as A) fee-for-service.
B) capitation.
C) usual charges.
D) customary fees.
Q3) When a capitated patient's services go over a certain amount and the physician can begin asking the patient to pay (fee-for-service), this arrangement is provided in a ___________________ section of the managed care contract or agreement.
Q4) 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
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) An explanation of benefits document for a patient under the Medicare program is referred to as the
A) Medicare remittance advice document.
B) reimbursement report.
C) summary payment report.
D) explanation of Medicare benefits.
Q2) Medicare transmits Medigap claims electronically for participating physicians when Medigap information is provided on the original Medicare claim.
A)True
B)False
Q3) Medicare Part B
A) diagnostic tests.
B) hospital rooms.
C) hospice care.
D) nursing facility care.
Q4) The Medicare HCPCS coding system has ____________________ levels.
Q5) A Medicare nonparticipating physician may bill no more than the Medicare
Q6) Medicare outpatient coverage is referred to as Part ____________________.
Page 14
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Chapter 13: Medicaid and Other State Programs
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Sample Questions
Q1) The Omnibus Budget Reconciliation Act
A) helped set up a Medicaid fund for each state.
B) provided assistance for the blind who are below the poverty level and who are covered under the Medicare program.
C) provided assistance for the aged and disabled who are receiving Medicare and whose incomes are below the poverty level.
D) set up counseling centers for those on Medicaid and Medicare.
Q2) Medicaid is available to the needy and low-income people such as
A) the blind.
B) the disabled.
C) the aged (65 years or older).
D) all of the above.
Q3) The group of Medicaid recipients referred to as ____________________ includes all cash recipients of the Aid to Families with Dependent Children, certain other AFDC-related groups, most cash recipients of the Supplemental Security Income program, and other SSI-related groups.
Q4) The two Medicaid eligibility classifications are the ____________________ needy group and the ____________________ needy class.
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Page 15
Chapter 14: Tricare and Veterans Health Care
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Sample Questions
Q1) Enrollment in TRICARE Prime is for
A) 1 month at a time.
B) 1 year at a time.
C) as long as the beneficiary would like to remain in the plan.
D) none of the above.
Q2) TRICARE/CHAMPVA is usually the second payer when a beneficiary is enrolled in other health insurance plans.
A)True
B)False
Q3) TRICARE, formerly known as CHAMPUS, is funded through A) the U.S. Congress.
B) individual states.
C) individual regions.
D) military contributions.
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) Individuals who qualify for TRICARE are known as ____________________.
Q6) Who determines eligibility in the CHAMPVA program?
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) Minors are not covered by workers' compensation.
A)True
B)False
Q2) When coding for the office visit, patient injury, or illness evaluation and creating a report, use CPT code 99945, 99966, or 99980.
A)True
B)False
Q3) OSHA stands for
A) Occupational Services and Health Administration.
B) Outpatient Safety and Health Association.
C) Occupational Standards and Health Association.
D) Occupational Safety and Health Administration.
Q4) All state workers' compensation laws are compulsory.
A)True
B)False
Q5) Sometimes a patient is released to ____________________ work to effect a transition between the period of inactivity due to disability and a return to full duty, especially when heavy work is involved.
Q6) Name the five types of workers' compensation benefits.
Page 17
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Sample Questions
Q1) When an employer provides disability income insurance and the employee leaves the company, the insurance terminates unless the employee is disabled.
A)True
B)False
Q2) In a life insurance policy, a feature that provides for twice the face amount of the policy to be paid if death results from accidental causes is called
Q3) The first state to provide a successful State Disability Insurance program was
A) Alabama.
B) California.
C) Iowa.
D) Rhode Island.
Q4) In 1956, the U.S. Congress established a program under Title II of the Social Security Act for long-term disability known as
A) Civil Service Retirement System.
B) Federal Employees Retirement System.
C) Social Security Disability Insurance.
D) Supplemental Security Income.
Q5) 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) The __________________________________________________ is used to list procedural codes for Medicare patients on hospital insurance claims that are not in the CPT book.
Q2) PAT is an abbreviation for ____________________.
Q3) MS-DRGs are weighted to reflect the average costs for inpatient care.
A)True
B)False
Q4) ICD-10-PCS codes contain
A) at least two digits.
B) three to five characters.
C) seven characters.
D) five digits.
Q5) The MS-DRG system is designed to increase reimbursement for sicker patients.
A)True
B)False
Q6) Insurances from different states have the same standards for reimbursement.
A)True
B)False
Q7) An unethical practice of upcoding a patient's DRG category for a more severe diagnosis to increase reimbursement is called _____________________.
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) A claims assistance professional should promote and market to A) family practitioners, surgeons, and psychiatrists.
B) podiatrists, chiropractors, and physical therapists.
C) small hospitals and clinics.
D) Medicare recipients.
Q2) An employer may evaluate the application itself to determine whether the applicant can follow ____________________.
Q3) In completing an application for employment, abbreviations are not used unless space is extremely limited.
A)True
B)False
Q4) The preferred type of résumé for an insurance billing specialist to submit is one using A) chronologic format.
B) functional format.
C) combination format.
D) basic format.
Q5) It is discriminatory for an employer to ask if an applicant smokes. A)True
B)False
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