What is a benefit?
a. It is the function that a product performs
b. It is what a feature does for a product
c. It is the additional profits earned by a company
d. It is the discount that a customer gets on a product
Which of the following are required to organize your office as a medical biller?
a. Computer
b. CMS- 1500 forms
c. Printed/ online coding resources
d. Patient statement forms
e. All of the above
What is not a part of the diagnosis information?
a. Macro Code
b. Description
c. Insurance Information
d. Gender Specific Indication
e. ICD9
Which of the following is not a feature of Managed Care Plans?
a. Charging a nominal fee from the members
b. Eradicating unwanted services
c. Charging a standard fee for healthcare provider and hospital services
d. Itemizing each service and charging to the patient's account
Which are the disclosures exempted from minimum necessary?
a. Permissive Disclosures
b. Disclosure of Protected Health Information
c. Disclosure of de-identified information
d. None of the above
Which of these is not a kind of third-party reimbursement?
a. Fee-for-service
b. Capitation
c. Episode of Care
d. Managed care plans
What do the CPT codes refer to?
a. The disease that the patient is suffering from
b. The diagnoses performed on the patient
c. The procedures performed by a physician or a practitioner
d. The names of the medicines prescribed by the practitioner
What is an accident rider?
a. A 100% coverage that is not subject to co-payment or deductible in the event that the patient seeks emergency treatment
b. The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%
c. The remaining deductible amount not yet incurred by the insured party or family
d. A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
In which of the following methods will you bill your clients for giving your services as a medical biller?
a. By using a set fee
b. By billing on a percentage of the claims submitted
c. By percentage of collections
d. All of the above
Electronic Medical Claims (EMC) help to ___________.
a. get the carrier more quickly than the paper claims
b. pay more quickly than the paper claims
c. notify more quickly in case the claim is rejected
d. All of the above
_____________is an agreement made between the insurance company and the insured to send payments directly to the physician.
a. Assignment of Benefits
b. Coordination of Benefits
c. Preauthorization
d. Pre-Existing Conditions
What is the need for insurance verification?
a. To determine the accuracy of the patient information and the insurance card
b. To determine how the insurance will consider and/or pay for the services rendered
c. To charge the patient for their portion appropriately
d. To make the patient's information public
Which of the following is the code for anesthesia (type of service code)?
a. X*
b. 99
c. 07
d. 15
National Provider Identifier is a _____ digit number.
a. 8
b. 9
c. 10
d. 4
State whether true or false:
Ideal practice management software should have good reporting and multi-tasking capabilities.
Ideal practice management software should have good reporting and multi-tasking capabilities.
a. True
b. False
The component 'National Identifier Standards' fall under which of the following components of HIPAA?
a. Program
b. Administrative Simplification
c. Accountability
d. Portability
Which of the following information is needed to complete the CMS 1500 form?
a. Patient Information
b. Insurance/Payment Information
c. Guarantor Information
d. Diagnostic Information (ICD-9 Codes)
e. All of the above
What is the full form of AIDA?
a. Attention, Interest, Desire And Action
b. Action, Interest, Desire And Advertising
c. Action, Interest, Desire And Attention
d. None of the above
Which of the following components of HIPAA have been put into effect?
a. Portability and Administrative Simplification
b. Portability and Accountability
c. Accountability and Program
d. Administrative Simplification and Program
What are modifiers?
a. They are used to add more information about a ICD-9 CM code
b. They help in establishing "medical necessity"
c. They are used to add more information about a CPT code
d. They are an indicator to show that a procedure is linked to more than one diagnosis
The 'Group' in the 'Group Health Insurance Card' refers to the _________.
a. employer
b. the name of the insured
c. the name of the insurance company
d. third party administrator
What things should you emphasize on while selecting an attorney when starting your own medical billing business?
a. You should look at his years of experience
b. He should be able to develop a Compliance Plan in accordance with HIPAA protocols
c. You should look at the attorney's ability to speak legal jargon with you
d. You should look at his knowledge base about the entire legal system of your country
What is a write off?
a. It is a percentage of the charge or the dollar amount that the patient will pay to the provider for every encounter/visit
b. It is the difference between the actual fee and the permitted fee
c. It is the denial of a claim
d. It is the ongoing fee paid to the insurance company by the insured
What is a covered entity?
a. Any private organization or a government agency
b. The organizations which maintain and upgrade ICD-9-CM codes
c. The healthcare providers which are linked to PPOs
d. The healthcare bodies covered by HIPAA
Which is a more efficient and less time consuming method to submit your claims?
a. Through direct submissions
b. Through HIPAA
c. Through clearing houses
d. All of the above
It is necessary to attach a document called _________ when submitting a secondary claim.
a. Benefits of Explanation
b. Certificate of Medical Necessity
c. Explanation of Medical Necessity
d. Explanation of Benefits
Which of these does not cover preventive care services?
a. POS
b. PPOs
c. HMOs
d. None of the above
Which of the following is not a coding convention?
a. Punctuation
b. Articles
c. Connecting Words
d. Abbreviations
How is the patient identified in case of Champva?
a. VA File #
b. Sponsor's SSN
c. SSN
d. Medicare #
CPT Codes are updated ________.
a. once every 2 years
b. annually
c. whenever changes are necessary
d. None of the above
What is contained in the release of information (ROI) form?
a. Name and signature of the patient
b. The details of the information being transmitted
c. The name of the medical biller
d. None of the above
What is needed to file Worker's Compensation and Auto Insurance Claims?
a. Patient Relationship to Insured
b. Patient's Name
c. Patient Address & Telephone Number
d. Claim Number
Which of the following aspects does administrative safeguards focus on?
a. Administrative functions that ought to be applied to meet security standards
b. Methods that should be applied to meet physical standards
c. Administrative functions that prevent access to technical data
d. All of the above
What is a deductible?
a. A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year
b. The percentage that the policy will pay for a covered procedure
c. The percentage that the policy will pay for diagnostic, lab and x-ray procedures
d. The amount of out-of-pocket expenses that the insured/patient will have to incur in order for the policy to begin to pay at 100%
Which of the following is not a part of Patient Condition Information?
a. Name and UPIN of the physician that was referred
b. Patient date of birth
c. Diagnosis information
d. Insured ID Number
If the patient deductible is $700, and the deductible met is $685, the coverage is 80/20 and the physician's charge is $75, how much should the patient pay?
a. $26
b. $15
c. $27
d. $60
Which of the following is the first phase of the insurance claim life cycle?
a. Entering the data about claim information
b. Entering patient demographics in the claim form
c. Collecting claim data
d. Stating the name of the guarantor in the claim form
Identify the order of events after a claim reaches the insurance carrier:
1.Application of leftover deductible
2.Examining the procedures performed and the 'medical necessity' on these procedures
3.Application of 'allowable payments options' for every procedure performed
4.Review of the claim for proper formatting and information
2.Examining the procedures performed and the 'medical necessity' on these procedures
3.Application of 'allowable payments options' for every procedure performed
4.Review of the claim for proper formatting and information
a. 4231
b. 4213
c. 3421
d. 3214
State whether true or false:
HIPAA provides protections for both Group Health Plans and Individual Coverage.
HIPAA provides protections for both Group Health Plans and Individual Coverage.
a. True
b. False
What is not one of the eligibility criteria for Medicare?
a. You should be 65 or more than 65 years of age
b. You should have retired on Social Security, Railroad Retirement, or federal government retirement programs
c. It is meant for individuals who have been legally disabled for more than 2 years or who are suffering from end-stage renal disease
d. You should be a resident of the United States
Which of these is not a type of insurance coverage?
a. Medicare
b. Group Health/Medical Insurance
c. Workers Compensation
d. Campus
e. Medical
What is needed to file Worker's Compensation and Auto Insurance Claims?
a. Patient Relationship to Insured
b. Patient's Name
c. Patient Address & Telephone Number
d. Claim Number
What does the bottom of the CMS 1500 Form report?
a. Provider
b. Procedure
c. Diagnostic and Charge Information
d. All of the above
e. None of the above
Who among the following can also be a guarantor?
a. The patient
b. The physician
c. The insurance company
d. The medical biller
CPT Codes are updated ________.
a. once every 2 years
b. annually
c. whenever changes are necessary
d. None of the above
Why was the accountability component added to HIPAA?
a. To increase health care costs so that health care professionals earn more profits
b. To prevent health care fraud and abuse
c. To deny coverage to an individual who moves from one plan to another
d. To ensure that individuals get renewed coverage if he moves from one plan to another
What are the main benefits of electronic claims?
a. They provide a quicker means of reimbursement
b. They facilitate quicker submission of claims
c. They involve more paper work
d. They lessen the interaction with the consulting physician
Which of the following is not a coding convention?
a. Punctuation
b. Articles
c. Connecting Words
d. Abbreviations
Which body is responsible for implementing the Privacy Rules
a. The Office of Civil Rights
b. The American Medical Association
c. World Health Organization
d. All of the above
What is the length of the standard CPT codes?
a. 7
b. 4
c. 5
d. 2
What does the UB-04 form include?
a. National Provider Identifier
b. Taxonomy
c. Guarantor Information
d. Additional Codes
Why was HIPAA enacted into a law?
a. To implement portability requirements for individual and group health insurance plans
b. To decrease administrative cost and burdens of the legal industry
c. To ensure that individuals moving from one health plan to another does not get covered under the conditions of the already existing plan
d. None of the above
_____is an agreement made between the insurance company and the insured to send payments directly to the physician.
a. Assignment of Benefits
b. Coordination of Benefits
c. Preauthorization
d. Pre-Existing Conditions
Which of these is not a suitable marketing strategy for medical billing business?
a. Door-to-door marketing
b. Cold Calling
c. Mailing List
d. Business Networking