Medical Practice Management
Exam Answer Key
Course Introduction
Medical Practice Management introduces students to the essential principles and practices involved in efficiently running a modern medical office or clinic. The course covers topics such as healthcare administration, financial management, human resource management, legal and ethical considerations, patient billing, scheduling, and the implementation of electronic health records. Emphasis is placed on leadership skills, compliance with regulatory requirements, enhancing patient satisfaction, and strategies for improving operational effectiveness. Students will develop practical skills to navigate the complex environment of medical practice and effectively support healthcare providers in delivering high-quality patient 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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65 Verified Questions
65 Flashcards
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Sample Questions
Q1) Physicians are legally responsible for any actions of their employees performed within the context of their employment; therefore, an employee cannot be sued or brought to trial.
A)True
B)False Answer: False
Q2) Working in a physician's office as an insurance billing specialist carries greater responsibilities than operating a self-owned insurance billing business.
A)True
B)False Answer: False
Q3) An insurance billing specialist uses general skills in following an employer's established policies when dealing with the health care contract.
A)True
B)False Answer: True
Q4) An NPP is a ______________________________.
Answer: non-physician practitioner
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Page 3
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) List five of the disciplinary standards resulting from misconduct.
Answer: Verbal warning; written warning; written reprimand; suspension or probation; demotion; termination of employment; restitution of any damages; referral to federal agencies for criminal prosecution.
Q2) What action could happen if an employee knowingly submits a fraudulent Medicare or Medicaid claim at the direction of the employer and subsequently the medical practice is audited?
A) Only the employee could be brought into litigation because it was he or she who actually performed the fraudulent act.
B) The employee could be exempt from litigation because the employee acted at the direction of the employer.
C) The employee and the employer could be brought into litigation by the state or federal government.
D) The employee and the employer could be brought into litigation by the local authorities and court.
Answer: C
Q3) 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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93 Verified Questions
93 Flashcards
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Sample Questions
Q1) 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
Q2) Parents of a college student who is living away from home are liable for the medical expenses incurred by their financially dependent child.
A)True
B)False
Answer: False
Q3) In a managed care plan, the participating provider is also referred to as:
Answer: A preferred provider
Q4) The amount that must be paid each year by the insured before policy benefits begin is known as the ____________________.
Answer: deductible
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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) Skin repairs are coded according to the sum of the length of the repairs in centimeters.
A)True
B)False
Q2) Services rendered by a physician whose opinion is requested by another physician for evaluating a patient's illness.
A)Concurrent care
B)Consultation
C)Continuity of care
D)Counseling
E)Critical care
F)Emergency
G)Referral
Q3) WNL is the abbreviation for _________________________.
Q4) Private insurance carriers have the right to claim refunds in the event of accidental miscoding.
A)True
B)False
Q5) The abbreviation HPI stands for ______________________________.
Q6) PFSH is the abbreviation for ___________________________________. Page 6
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Page 7
Chapter 5: Diagnostic Coding
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115 Verified Questions
115 Flashcards
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Sample Questions
Q1) An external cause code may never be sequenced in the first position.
A)True
B)False
Q2) Which of the following is the correct order of steps to take in ICD-10-CM coding?
A) Locate the main term in the Alphabetic Index, verify the code in the Tabular List, read any instructions in the Tabular List, check for exclusion notes, and assign the code.
B) Locate the main term in the Tabular List, verify the code in the Alphabetic Index, read any instructions in the Alphabetic Index, and assign the code.
C) Locate the diagnosis by the adjective in the Alphabetic Index, verify the code in the Tabular List, and assign the code.
D) Locate the diagnosis by the main term in the Alphabetic Index, read any instructions pertaining to the term, and assign the code.
Q3) When payer guidelines indicate that a service may not be a covered benefit, based on the diagnosis reported, it is recommended that the patient sign a ____.
Q4) Provide the appropriate ICD-10-CM code for eczematous dermatitis.
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Chapter 6: Procedural Coding
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40 Flashcards
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Sample Questions
Q1) A medical practice can have more than one fee schedule unless specific state laws restrict this practice.
A)True
B)False
Q2) When there is a choice of two or three somewhat similar codes, the insurance claims examiner will choose the highest-paying code.
A)True
B)False
Q3) Mrs. Burke is a 54-year-old patient seen by her physician for an annual routine physical examination. She has no complaints or symptoms. A nonautomated urinalysis with microscopy and bilateral screening mammography were done. Code for the office visit, urinalysis, and mammography.
Q4) The CPT codebook includes a description of the number of follow-up days that are allowed after surgery at no additional charge.
A)True
B)False
Q5) Coding and billing numerous CPT codes to identify procedures that are usually described by a single code 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) When submitting a letter to an insurance company to explain unusual circumstances that should be considered when processing the claim, it should be sent to the attention of the ______.
Q2) Most insurance companies accept the CMS-1500 claim form except TRICARE and the Blue Plans.
A)True
B)False
Q3) List all services on the insurance claim form, including "no charge" services.
A)True
B)False
Q4) What is the diagnosis code that was submitted on this claim form, describing the condition the patient was treated for?
Q5) OCR guidelines for the CMS-1500 claim form state
A) it can be photocopied by the physician's office to save the expense of buying huge quantities.
B) it can be submitted with handwritten information.
C) it should not be photocopied because it cannot be scanned.
D) enter all information in lowercase letters.
Q6) The diagnosis field of the CMS-1500 claim form is referred to as Block ___.
Page 10
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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) Medicaid, Medicare, and TRICARE use which system to eliminate the need for a clearinghouse?
Q2) The encounter form's procedure and diagnostic codes should be audited annually to determine if code changes have been made and if the form needs to be updated accordingly.
A)True
B)False
Q3) Practice management systems can be "rented" over the Internet.
A)True
B)False
Q4) Encrypted data often look like gibberish to unauthorized users.
A)True
B)False
Q5) Update practice management system with payer information.
A)Daily
B)Weekly
C)End of month
D)Daily or weekly
Q6) HIPAA requires employers to obtain ___ numbers to identify themselves during the process of enrolling employees into a health plan.
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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) 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.
Q2) If the medical practice receives payment from an insurance company that is more than the contract rate, it is called a/an ____________________.
Q3) Routine use of too many nonspecific diagnostic codes may result in downcoding.
A)True
B)False
Q4) For Medicare patients whose secondary insurance is Medicaid:
A) Medicaid is billed separately.
B) Medicare reimburses both the primary and secondary payments.
C) The balance is adjusted because the Medicaid fee schedule is less than Medicare.
D) The patient is sent a statement for the secondary insurance balance.
Q5) Generally, if a bill has not been paid, the physician rebills the patient every ____________________ days.
Page 12
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Chapter 10: Office and Insurance Collection Strategies
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87 Verified Questions
87 Flashcards
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Sample Questions
Q1) When collecting fees, your goal should always be to
A) leave the impression that you are a nice person.
B) collect at least one half the fee.
C) collect the full amount.
D) collect as much as possible.
Q2) Refunds may be made by check on accounts in which payment was made by credit card.
A)True
B)False
Q3) What is the name of the federal act that prohibits discrimination in all areas of granting credit?
A) Equal Credit Opportunity Act
B) Fair Credit Reporting Act
C) Fair Credit Billing Act
D) Truth in Lending Act
Q4) It is legal to offer patients a cash discount when the entire fee is paid at the time of service.
A)True
B)False
Q5) The collection abbreviation OOT means ____________________.
Page 13
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Chapter 11: The Blue Plans,
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41 Verified Questions
41 Flashcards
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Sample Questions
Q1) When a managed care plan requires the primary care physician to seek approval before referring a patient to a specialist, it is called obtaining
Q2) When a physician sees a patient more than is medically necessary, it is called A) buffing.
B) turfing. C) churning.
D) stirring.
Q3) UR is the abbreviation for ____________________, which is necessary to control costs in the health care setting.
Q4) The term turfing means to transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer.
A)True B)False
Q5) 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
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Q6) The abbreviation MCO stands for ______________________________.
Chapter 12: Medicare
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75 Verified Questions
75 Flashcards
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Sample Questions
Q1) Patients who elect Medicare Part B coverage pay annually increasing basic premium payments.
A)True
B)False
Q2) Medicare provides insurance for disabled workers of any age.
A)True
B)False
Q3) Medicare covers some services by chiropractors.
A)True
B)False
Q4) Medicare Part A is administered by
A) the local Social Security Administration office.
B) a regional fiscal intermediary.
C) the Centers for Medicare and Medicaid Services.
D) the National Blue Cross Association.
Q5) The assignment on a patient with Medicare-Medicaid must always be accepted or Medicaid will not pick up the residual.
A)True
B)False
Q6) What does TEFRA stand for?
Page 15
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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) All states processing medical claims must bill using the CMS-1500 claim form.
A)True
B)False
Q2) To control escalating health care costs by curbing unnecessary emergency department visits and emphasizing preventive care, Medicaid reform has involved
A) increased state funding.
B) increased federal funding.
C) managed care programs.
D) fee-for-service programs.
Q3) 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.
Q4) The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act are federal legislation passed in _________________.
Q5) The ____________________ form accompanies all Medicaid payment checks.
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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) What payment does a participating provider agree to accept when assignment is accepted in a TRICARE case?
Q2) What does the Computer Matching and Privacy Protection Act of 1988 permit the government to do?
Q3) The physician who provides medical care at contracted rates to beneficiaries under the TRICARE Extra program is called a/an ____________________ provider.
Q4) Medical care that is cost-shared by both TRICARE Standard and a civilian source is known as
A) coordination of care.
B) conversion of care.
C) cooperative care.
D) competitive care.
Q5) Nonparticipating providers may choose to accept TRICARE assignment on a case-by-case basis.
A)True
B)False
Q6) The NAS is required for outpatient services that are within the catchment area. A)True
B)False
17
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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 proceeding in which an attorney asks a witness questions regarding a case and the witness answers under oath but not in open court is known as a/an A) arbitration. B) negotiation.
C) deposition. D) hearing.
Q2) Final determination involving settlement of an industrial accident is known as A) adjudication. B) settlement.
C) release.
D) discharge.
Q3) 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.
Q4) Under health reform legislation of 2010, what is the fee per employee for employers with more than 50 employees when the government subsidizes their workers' insurance coverage?
Q5) Name the five types of workers' compensation benefits.
Q6) Which types of employees fall under federal workers' compensation statutes?
Page 18
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Chapter 16: Disability Income Insurance and Disability Benefit Programs
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50 Verified Questions
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Sample Questions
Q1) When an illness or injury prevents an insured person from performing one or more of the functions of his or her regular job, the disability is called
A) partial disability.
B) residual disability.
C) total disability.
D) both a and b
Q2) The first state to provide a successful State Disability Insurance program was
A) Alabama.
B) California.
C) Iowa.
D) Rhode Island.
Q3) Provisions written into the insurance contract denying coverage or limiting the scope of coverage are called A) exceptions.
B) exclusions.
C) preexisting conditions.
D) denied benefits.
Q4) Who are the eight types of workers not covered by state disability?
Q5) What are six major government disability programs?
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Chapter 17: Hospital Billing
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Sample Questions
Q1) Insurances from different states have the same standards for reimbursement.
A)True
B)False
Q2) On the CMS 1450 (UB-04) claim form, the second digit of the four-digit bill code in Field 4 indicates the type of ____________________.
Q3) Medicare provides stop-loss called _____________________ in its regulations.
Q4) A patient who is covered under an HMO plan must have authorization prior to admission unless the patient is admitted for an emergency.
A)True
B)False
Q5) A review for additional Medicare reimbursement is called
A) DRG validation.
B) day outlier review.
C) cost outlier review.
D) procedure review.
Q6) On the CMS 1450 (UB-04) claim form, the patient's date of birth should be entered using six digits in block 14.
A)True
B)False
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Chapter 18: Seeking a Job and Attaining Professional Advancement
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Sample Questions
Q1) Cover letters should be A) customized.
B) typed for neatness.
C) addressed to a specific person. D) all of the above.
Q2) Accounts receivable bookkeeping experience would be listed on a résumé under the heading
A) skills. B) education.
C) professional experience. D) references.
Q3) An alien employee must have on file with his or her employer an Employment Eligibility Verification Form.
A)True B)False
Q4) A résumé that states the skills an individual is able to perform is ____________________.
Q5) ____________________ the résumé carefully for spelling, punctuation, grammatical, and typographic errors.
Q6) What should a cover letter end with? Page 21
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Page 22