Medical Office Procedures
Review Questions
Course Introduction
Medical Office Procedures introduces students to the fundamental administrative skills required in healthcare settings. The course covers topics such as patient reception, appointment scheduling, medical records management, billing and insurance processing, telephone techniques, and effective communication within a medical office environment. Emphasis is placed on professional behavior, confidentiality, regulatory compliance (including HIPAA), and the use of electronic health records (EHR). By the end of the course, students will be equipped with the knowledge and practical skills necessary to efficiently manage the daily workflow and support the operations of a modern medical office.
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) Respondeat superior, which literally means "let the master answer," is also known as ____________________ liability.
Answer: vicarious
Q2) Why are multiskilled health practitioners (MSHPs) in demand?
A) They are cross-trained to provide more than one function.
B) They are often competent in more than one discipline.
C) They offer more flexibility to their employer.
D) All of the above.
Answer: D
Q3) Reporting incorrect information to Medicare.
A)Illegal
B)Unethical
C)Both illegal and unethical
Answer: A
Q4) The earliest written code of ethical principles of medicine is called the ____________________.
Answer: Code of Hammurabi
Q5) Physicians are paid on the basis of _________________________ units.
Answer: relative value
3
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Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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Sample Questions
Q1) Billing Medicare beneficiaries at a higher rate than other patients.
A)Abuse
B)Fraud
Answer: A
Q2) 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
Q3) A HIPAA compliance exception to the right of privacy and privileged communication is a patient's records pertaining to his or her industrial accident case.
A)True
B)False
Answer: True
Page 4
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Chapter 3: Basics of Health Insurance
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93 Flashcards
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Sample Questions
Q1) Many Health Insurance Claim Forms contain a/an ______________________________ that directs the insurance company to pay benefits directly to the provider of care on whose charge the claim is based.
Answer: assignment assignment (of benefits statement) assignment of benefits statement
Q2) When does the physician/patient contract begin?
A) After the physician has examined the patient for the first time
B) When the patient steps into the examination room to be treated C) When the physician accepts the patient and agrees to treat the patient
D) When the patient verbally agrees to accept the advice of the physician
Answer: C
Q3) The efficient medical insurance specialist usually groups together all outstanding charges of patients who have the same type of insurance and processes these insurance claims at the same time.
A)True
B)False
Answer: True
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Chapter 4: Medical Documentation and the Electronic
Health Record
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Sample Questions
Q1) Review of medical events in the patient's family, including diseases that may be hereditary, is known as a/an ____________________.
Q2) PFSH is the abbreviation for ___________________________________.
Q3) Provider who is the medical staff member legally responsible for the care and treatment given to a patient.
A)Attending physician
B)Consulting physician
C)Ordering physician
D)Referring physician
E)Treating or performing physician
Q4) 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
Q5) Identify three ways that a physician may withdraw formally from further provision of care to a patient when the patient is noncompliant.
Q6) The abbreviation HPI stands for ______________________________.
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Chapter 5: Diagnostic Coding
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115 Flashcards
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Sample Questions
Q1) When a condition is documented as both acute and chronic, only the acute code should be reported.
A)True
B)False
Q2) Which of the following is NOT a reason why medical practices have adopted computer-assisted coding?
A) Shortage of coders
B) Adoption of electronic health records
C) Constant changes in code numbers and rules
D) Future elimination of coding staff
Q3) Which statement is true regarding neoplasms?
A) They are new growths.
B) They may be malignant.
C) They may be benign.
D) All of the above.
Q4) A term used as the name of a disease, structure, operation, or procedure, usually derived from the name of a place or a person who discovered or described it first, is an acronym.
A)True
B)False
Page 7
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Chapter 6: Procedural Coding
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Sample Questions
Q1) When a service is rendered that is not listed in the CPT codebook,
A) list 00000 on the insurance claim form and send supporting documentation that clearly identifies the procedure that was done.
B) write the description of service on the claim form in place of the code.
C) you cannot bill for unlisted services.
D) use a code with a description stating "unlisted."
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) The two-digit modifier -57 means
A) prolonged E/M services.
B) reduced services.
C) decision for surgery.
D) mandated services.
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Page 8
Chapter 7: The Paper Claim: Cms-1500 02-12
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78 Verified Questions
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Sample Questions
Q1) The NUCC is charged with the task of ________ national instructions for completion of the CMS-1500 claim form.
Q2) Effective ___________, the revised paper claim form (02-12) is required for use by all providers.
Q3) OCR is the acronym for
A) open code resource.
B) optical character recognition.
C) optical code recognition.
D) online claim recall.
Q4) What is the date that the symptoms first presented for the condition treated?
Q5) The CMS-1500 paper claim can be purchased through a medical office supply company or through the ____.
Q6) 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
Q7) Where were the services provided to this patient?
Q8) The paper claim form was revised in 1990 and printed in red ink to allow ______ of claims.
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Chapter 8: The Electronic Claim
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Sample Questions
Q1) For insurance claims to be submitted electronically, a signed agreement by the physician with the carriers involved is necessary.
A)True
B)False
Q2) An automatic logoff that prevents unauthorized users from accessing a computer is a/an __ safeguard.
Q3) The objective of HIPAA Transaction and Code Set regulations was to standardize code sets, claim forms, and processes used in health care facilities which would reduce administrative costs.
A)True
B)False
Q4) 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
Q5) Under HIPAA, if a provider submits claims to Medicare and has 10 or more employees, the provider is considered a ___ and must comply with electronic transmission requirements to Medicare.
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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Sample Questions
Q1) Overdue payment on an insurance claim is referred to as ____________________.
Q2) The highest level of a Medicare redetermination is with an administrative law judge hearing.
A)True
B)False
Q3) A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an
A) inquiry.
B) tracer.
C) rebill.
D) both a and b
Q4) Approximately 50% of individuals pursue appeals on a denied insurance claim. A)True
B)False
Q5) If inadequate payment was received from an insurance company for a complicated procedure, the insurance billing specialist should file a/an ____________________ on behalf of the physician.
Q6) An insured person cannot bring legal action against an insurance company until ____________________ days after a claim is submitted to the insurance company. Page 11
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Chapter 10: Office and Insurance Collection Strategies
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Sample Questions
Q1) According to the FDCPA, debtors can never be contacted at work.
A)True
B)False
Q2) Messages included on statements to promote payment are called
A) billing messages.
B) statement slogans.
C) dun messages.
D) payment prompters.
Q3) In dealing with an estate claim, a call to the ____________________ can be made periodically to check on the status of the estate.
Q4) How many installments (excluding a down payment) must a payment plan have to require full written disclosure?
A) Three or more
B) Four or more
C) Five or more
D) Six or more
Q5) The best and most effective collection statements include a handwritten note.
A)True
B)False
Q6) The collection abbreviation TTA means ____________________.
Page 13
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Chapter
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Sample Questions
Q1) In a point-of-service (POS) program, members may choose to use a nonprogram provider at any time.
A)True
B)False
Q2) An organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a/an
A) health maintenance organization (HMO).
B) managed care organization (MCO).
C) preferred provider organization (PPO).
D) exclusive provider organization (EPO).
Q3) A physician-owned business that has the flexibility to deal with all forms of contract medicine and also offers its own plans is a/an
A) IPA.
B) PPO.
C) PPG.
D) POS.
Q4) 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) Medicare Part A is called supplementary medical insurance (SMI).
A)True
B)False
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) When Medicare payments are posted to a separate daysheet, what should the daysheet payment total agree with?
Q4) What is the amount of the check that Medicare sends to the physician?
Q5) The Part B Medicare annual deductible is
A) $60.
B) $162.
C) $150.
D) $760.
Q6) What does TEFRA stand for?
Q7) What is the courtesy adjustment?
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Q8) Medicare outpatient coverage is referred to as Part ____________________.
Chapter 13: Medicaid and Other State Programs
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Sample Questions
Q1) Medicaid managed care patient claims should be sent to the A) Medicaid fiscal agent or carrier.
B) state government office.
C) local Medicaid office.
D) managed care organization and not the Medicaid fiscal agent.
Q2) Medicaid is an established program of medical assistance in 46 states.
A)True
B)False
Q3) Emergency care and pregnancy services are exempt by law from copayment requirements.
A)True
B)False
Q4) Medicaid identification cards are usually issued every ____________________.
Q5) 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.
Q6) 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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Sample Questions
Q1) Enrollment in TRICARE Prime is voluntary.
A)True
B)False
Q2) In the TRICARE Extra plan, the individual enrolls yearly and pays an annual fee.
A)True
B)False
Q3) The time limit within which a TRICARE inpatient claim must be filed is
A) within 1 year from the date a service is provided.
B) by the end of the year in which the service is provided.
C) within 1 year from a patient's discharge from an inpatient facility.
D) by the end of the year following a patient's discharge from an inpatient facility.
Q4) The health maintenance organization provided for dependents of active duty military personnel is called
A) CHAMPUS.
B) TRICARE Prime.
C) TRICARE Extra.
D) TRICARE Standard.
Q5) All dependents ____________________ years of age or older are required to have a Uniformed Services (military) identification card.
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Chapter 15: Workers Compensation
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Sample Questions
Q1) Which types of employees fall under federal workers' compensation statutes?
Q2) The First Treatment Medical Report or Physician's First Report of Occupational Injury or Illness form should be signed
A) in ink by the physician's representative.
B) in ink by the physician.
C) using a certified signature stamp.
D) both a and b
Q3) The three types of disability claims are ____________, ________________, and _____________.
Q4) The reason for workers' compensation laws is
A) to ensure a prompt return to work of any injured or ill employee.
B) to provide income to the injured or ill worker.
C) to encourage maximum employer interest in safety.
D) all of the above.
Q5) 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.
Page 18
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Sample Questions
Q1) Disability income policies do not provide medical expense benefits.
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) If a claimant does not agree with the determination of disability, a _____________________-level appeal process is available.
Q4) Medical requirements are the same for both the SSDI and SSI programs.
A)True
B)False
Q5) State Disability Insurance (SDI) is also known as A) Unemployment Compensation Disability (UCD).
B) temporary disability insurance (TDI).
C) Social Security Disability Insurance (SSDI).
D) both a and b
Q6) If a state has State Disability Insurance, all types of workers are covered.
A)True
B)False
Q7) What are six major government disability programs? Page 19
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Page 20
Chapter 17: Hospital Billing
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Sample Questions
Q1) An averaging after a flat rate has been given to certain categories of procedures.
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) ______________________ are DRG cases that cannot be assigned properly because of an atypical situation.
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21
Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) It has been found that when applicants have similar skills and education, the decision to hire has been based on ____________________ at the interview.
Q2) The procedures and format for preparing an electronic résumé are the same as those for preparing a manual résumé.
A)True
B)False
Q3) The main goal of a cover letter is to
A) introduce yourself.
B) state a summary of your qualities.
C) secure an interview.
D) provide information on how you can be reached.
Q4) It is never acceptable to fax a résumé to a prospective employer.
A)True
B)False
Q5) In an interview, inquiries about all of the following are illegal EXCEPT: A) family planning.
B) dependents.
C) maiden name.
D) place of last employment.
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