Medical Office Procedures
Study Guide Questions
Course Introduction
Medical Office Procedures is a comprehensive course designed to introduce students to the administrative and clerical tasks essential for successfully operating a medical office. The course covers key topics such as patient scheduling, telephone techniques, medical record management, billing and insurance processing, confidentiality practices, and effective communication. Emphasis is placed on the use of electronic health records (EHR), compliance with healthcare regulations (such as HIPAA), and professional behavior in a healthcare setting. By the end of the course, students will gain practical skills and knowledge necessary to support healthcare professionals and ensure efficient, patient-centered office operations.
Recommended Textbook Insurance Handbook for the Medical Office 14th Edition by Marilyn Fordney
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Chapter 1: Role of an Insurance Billing Specialist
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Sample Questions
Q1) Rules of etiquette for e-mail and cell telephone calls fall under the Health Insurance Portability and Accountability Act.
A)True
B)False
Answer: True
Q2) Unbundling services when an available single code includes all services.
A)Illegal
B)Unethical
C)Both illegal and unethical
Answer: C
Q3) Illegal coding practices are subject to penalties, fines, and/or imprisonment.
A)True
B)False
Answer: True
Q4) Electronic claims submissions are a format of the past.
A)True
B)False Answer: False
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Chapter 2: Compliance, Privacy, Fraud, and Abuse in Insurance Billing
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Sample Questions
Q1) What does "safe harbor" refer to?
Answer: Business and service arrangements that are protected from prosecution under the Anti-Kickback statute.
Q2) Health care organizations are encouraged to have a(n) ________________ policy to allow effective lines of communication whereby staff feel secure to report questionable or suspicious activities relating to fraud and abuse.
Answer: open door
Q3) To bill Medicare beneficiaries at a higher rate than other patients is considered A) negligence.
B) abuse.
C) fraud.
D) illegal.
Answer: B
Q4) A billing practice such as excessive referrals to other providers for unnecessary services is considered ________________________.
Answer: medical billing abuse
Q5) What is the goal of the Medicare Integrity Program (MIP)?
Answer: Identify and reduce Medicare overpayments.
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Chapter 3: Basics of Health Insurance
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Sample Questions
Q1) An organization that provides a wide range of comprehensive health care services for a specified group at a fixed periodic payment.
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: G
Q2) When a contract is not manifested by direct words but is deduced from the circumstance, the general language, or the conduct of the patient, it is referred to as a/an ____________________ contract.
Answer: implied
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Page 5
Chapter 4: Medical Documentation and the Electronic Health Record
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Sample Questions
Q1) How long the symptom/pain has been present and how long it lasts when the patient has it.
A)Location
B)Quality
C)Severity
D)Duration
E)Timing
F)Context
G)Modifying factors
H)Associated signs and symptoms
Q2) Identify three ways that a physician may withdraw formally from further provision of care to a patient when the patient is noncompliant.
Q3) A reference list of all staff members' names, job titles, signatures, and initials is known as a/an ____________________.
Q4) As a health insurance claims professional, you may be required to _______ information from a medical record to justify a Health Insurance Claim Form after professional services are rendered.
Q5) A disease that runs a short but relatively severe course is referred to as
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Chapter 5: Diagnostic Coding
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Sample Questions
Q1) 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.
Q2) Terms enclosed in parentheses following the main term are referred to as
A) nonessential modifiers.
B) essential modifiers.
C) exclusions.
D) fifth digits.
Q3) What ICD-10-CM code would be reported on the insurance claim form for an old myocardial infarction that is healed?
Q4) Diagnostic codes on an insurance claim explain
A) the patient's condition that was treated during the visit.
B) the professional services provided during the visit.
C) the supplies that were provided to the patient.
D) the provider's identification.
Q5) Certain codes that should never be reported at the same time are indicated by the convention ___.
Page 7
Q6) Provide the appropriate ICD-10-CM code for bursitis of the elbow.
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Chapter 6: Procedural Coding
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Sample Questions
Q1) The CPT code for office services provided on an emergency basis is A) 99302.
B) 99312. C) 99282.
D) 99058.
Q2) In a UCR system, payment can be extremely high for a rarely performed but highly complex procedure because there may be no history of billed charges from other physicians on which to base payment.
A)True
B)False
Q3) UCR (usual, customary, reasonable) is used mostly in reference to managed care services.
A)True B)False
Q4) The E/M code 99203 is considered a level ____________________ code.
Q5) Some managed care plans develop "internal codes" for use by the plan only to code specific procedures.
A)True
B)False
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Chapter 7: The Paper Claim: Cms-1500 02-12
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Sample Questions
Q1) A dirty claim is one that had coffee spilled on it before it was sent to the insurance carrier.
A)True
B)False
Q2) To practice medicine within a state, a physician must obtain a physician's state
Q3) An insurance claim that is submitted with errors.
A)Clean claim
B)Dirty claim
C)Electronic claim
D)Incomplete claim
E)Invalid claim
F)Paper claim
G)Pending claim
H)Rejected claim
Q4) Abstraction of technical information from patient records may be necessary to support medical ___.
Q5) The objective of the Administrative Simplification Compliance Act was to improve the administration of the Medicare program by increased efficiencies resulting from
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Chapter 8: The Electronic Claim
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Sample Questions
Q1) A group of insurance claims sent at the same time from one facility is known as a
A) bundle.
B) group file.
C) batch.
D) package.
Q2) List the three ways in which clearinghouses are paid.
Q3) Encrypted data often look like gibberish to unauthorized users.
A)True
B)False
Q4) Make follow-up calls to resolve reasons for rejections.
A)Daily
B)Weekly
C)End of month
D)Daily or weekly
Q5) Medical data which are compiled and produced in the specific format used throughout the health care industry and sent in electronic files are HIPAA ___ transactions.
Q6) HIPAA requires employers to obtain ___ numbers to identify themselves during the process of enrolling employees into a health plan.
Page 10
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Chapter 9: Receiving Payments and Insurance Problem
Solving
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Sample Questions
Q1) In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is
A) $100 or more.
B) $300 or more.
C) $500 or more.
D) $1000 or more.
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) The ______________________ manages complaints about delays in settling insurance claims, illegal cancellations or terminations of an insurance policy, and problems about insurance premium rates.
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Page 11
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) One person or one department should handle all billing questions.
A)True
B)False
Q3) When a physician continues to treat a patient with an overdue account, the courts have viewed this as an extension of credit; therefore, patients who fall into this delinquent status should be referred elsewhere.
A)True
B)False
Q4) Under federal regulations, a list of the most common services the physician offers, including procedure code numbers with a description of each service and its price, must be posted in the office waiting room.
A)True
B)False
Q5) Assets or debts that have been determined to be uncollectible and are therefore taken off (debited) the accounting books as a loss are called
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Chapter 11: The Blue Plans, Private Insurance, and Managed Care Plans
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Sample Questions
Q1) A copayment in a managed care plan is usually a fixed dollar amount (predetermined fee).
A)True
B)False
Q2) Medicare-eligible patients are not involved with HMOs or prepaid health plans.
A)True
B)False
Q3) Referral of a patient recommended by one specialist to another specialist is known as
A) primary care.
B) secondary care.
C) concurrent care.
D) tertiary care.
Q4) How does an HMO receive payment for the services its physicians provide?
A) Fee-for-service
B) Usual, customary, and reasonable charges
C) Allowable charges
D) Prepaid health plan
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Q5) A primary care physician who controls patient access to specialists is called a/an
Chapter 12: Medicare
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Sample Questions
Q1) The Civil Monetary Penalties Law carries a sanction for a penalty of ____________________ for a physician who fails to electronically transmit or manually submit a Medicare claim.
Q2) An NPI number issued to a provider by CMS is the acronym for _________________________.
Q3) Nonparticipating physicians have an option regarding accepting assignment on the Medicare patient.
A)True
B)False
Q4) Medigap insurance may cover
A) all physician and hospital deductibles.
B) the deductible not covered under Medicare.
C) 80% of the Medicare allowed amount.
D) 75% of the Medicare allowed amount.
Q5) What is the amount of the check that Medicare sends to the physician?
Q6) Employee and employer contributions help pay for Medicare Part A health services.
A)True
B)False
Q7) What does TEFRA stand for?
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Chapter 13: Medicaid and Other State Programs
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Sample Questions
Q1) Medicaid is administered by the A) federal government.
B) federal government with partial state funding.
C) state government with partial federal funding.
D) state government.
Q2) The time limit to appeal a claim varies from state to state, but it is usually
A) 30-60 days.
B) 90-120 days.
C) 6 months.
D) 1 year.
Q3) Medicaid eligibility must always be checked for the A) month of service.
B) type of service.
C) year of service.
D) both a and b
Q4) State Children's Health Insurance Programs (SCHIPs)
A) operate with state funds.
B) operate with federal grant support under Title V of the Social Security Act.
C) operate through private donations solicited by volunteers.
D) are operational in only 25 states owing to lack of funds.
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Chapter 14: Tricare and Veterans Health Care
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Q1) 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.
Q2) 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 ____________________.
Q3) If a TRICARE Extra claim is submitted with several items and several dates of service, the time limit that would apply to the claim for filing would be
A) the last date of service listed on the claim.
B) the date on which the claim was signed.
C) individual time limits for each item on the claim.
D) the date of the first item listed on the claim.
Q4) What does the Computer Matching and Privacy Protection Act of 1988 permit the government to do?
Q5) Individuals who qualify for TRICARE are known as ____________________.
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Chapter 15: Workers Compensation
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Sample Questions
Q1) 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
Q2) In a PD claim, the physician's final report must include the words
A) compromise and stationary.
B) permanent and stationary.
C) stationary and release.
D) stationary and discharge.
Q3) The statutes for workers' compensation laws fall under A) federal compensation laws.
B) state compensation laws.
C) federal and state compensation laws.
D) state and county compensation laws.
Q4) Minors are not covered by workers' compensation.
A)True
B)False
Q5) A ____________________ report is sent to the insurance carrier after 2-4 weeks of treatment to give information on the current status of the patient.
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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Q1) 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
Q2) What are six major government disability programs?
Q3) For people trying to qualify for SSDI or SSI, determination is made by the physician.
A)True
B)False
Q4) The maximum amount of time for which benefits will be paid to the injured or ill person for a disability is called the
A) waiting period.
B) elimination period.
C) benefit period.
D) payment period.
Q5) State Disability Insurance benefits begin after the A) third consecutive day of disability.
B) fifth consecutive day of disability.
C) seventh consecutive day of disability.
D) tenth consecutive day of disability.
Q6) 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) Medicare's Inpatient Prospective Payment System has approximately _________ MS-DRGs.
A) 250
B) 300
C) 500
D) 745
Q3) A patient is considered an inpatient to the hospital on admission
A) to the emergency department.
B) for an overnight stay.
C) for an outpatient surgical procedure.
D) both b and c
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
Q5) What is QIO an abbreviation for?
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Q1) ____________________ the résumé carefully for spelling, punctuation, grammatical, and typographic errors.
Q2) In completing an application for employment, abbreviations are not used unless space is extremely limited.
A)True
B)False
Q3) Education and professional experience should be listed on a résumé in chronologic order.
A)True
B)False
Q4) Research has proved that the most likely person to get hired has been A) interviewed first.
B) interviewed last.
C) a walk-in interview.
D) none of the above.
Q5) An employer may evaluate the application itself to determine whether the applicant can follow ____________________.
Q6) What should a cover letter end with?
Q7) List five ways to search for a job.
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