1. Is a co-payment an out of pocket expense?
2. What is Dx refer to?
- Diagnosis code
- Post-mortem diagnosis
- Bill cancellation
- Cancelled diagnosis
3. What is a premium?
- The copay
- Name-brand medication
- Paying extra for a private hospital room
- The amount paid for an insurance policy
4. True or false? Sometimes multiple treatments will fall under one billing code.
5. What does COB commonly refer to?
- Course of Body
- Coordination of Benefits
- Cost of Billing
- Cost on Bottom
6. What do the CPT codes refer to?
- The disease that the patient is suffering from
- The procedures performed by a physician or a practitioner
- The names of the medicines prescribed by the practitioner
- The procedures performed by Medical biller
- The diagnoses performed on the patient
7. HIPAA stands for:
- Health Insurance Portability Accountability Act
- Health Insurance Protected Act of America
8. In which month do commercial insurance and Medicare deductibles start each year?
9. If a physician uses an open-panel HMO, can they see non-HMO patients?
10. Hospital beds, wheelchairs and oxygen equipment would be considered examples of:
11. True or False? AWP laws are state laws that require health insurance companies to accept into their PPO and HMO networks any provider willing to agree to the insurance company’s terms and conditions.
12. True or False? ERISA includes PPOs, POS, and HMO benefit plans.
13. True or false? Undercoding is illegal.
14. What does UCR stand for?
- Unusual Chronic Illness
- Ultra Conservative Response
- Unique Client Referral
- Usual, customary, or reasonable
15. What could POS exactly stand for in Medical Billing?
- Polycystic Ovary Syndorme
- Point of Service
- Place of Service
16. What are modifiers used for?
- They are used to add more information about a ICD10 CM code
- They are used to add more information about a ICD-9 CM code
- They are an indicator to show that a procedure is linked to more than one diagnosis
- They help in establishing “medical necessity”
- They are used to add more information about a CPT code
17. True or False? The difference between the Medicare and Medicaid allowable is that Medicaid does NOT pay a percentage of the allowed amount.
18. Level II HCPCS codes are formatted as a single letter followed by _________.
- five numeric digits and one letter
- Four numeric digits
- Two numeric digits and 2 letters
- Two numeric digits and three letters
19. How many digits are in a National Provider Identifier?
20. Medical care, other than those provided by the physician or hospital, which are related to a patient’s care, are called:
- Extraneous services
- All of these are correct
- Ancillary care
- Focused care
21. What is a challenge of processing medical bills off site?
- It is illegal to process medical bills off site
- None of these
- The biller may not be able to contact the physician
- Governmental regulations
22. True or False? Med pay is a form of no-fault insurance.
23. True or false? An individual on an HMO plan would need a referral to get a yearly mammogram.
24. Medicare Advantages Plans cover consultation codes?
25. In DME claims which of the following is necessary: Referring physician or Ordering physician?
- Referring Physician
- Ordering Physician
26. True or False? A Medicaid MCO provides comprehensive services to Medicaid beneficiaries, but not commercial or Medicare enrollees.
27. A Remittance Advice statement is most similar to a(n):
- HMO extension
28. The exact abbreviation of RA in medical billing terminology?
- Regular Appointment
- Rheumatoid Arthritis
- Right Atrium
- Remittance Advice
- Remote Agent
29. The predetermined (flat) fee, a patient usually has to pay on each office visit is a:
30. What organ is measured in an EKG/ECG?
31. Which of these would be a valid reasons for a claim to be denied?
- All are valid reasons
- The service was not covered under the patient’s health insurance contract.
- The service was considered as not being medically necessary
- The medical condition was deemed by the insurance company as being preexisting
32. A patient on an HMO plan typically needs a _________ to receive care from a specialist.
33. Place of service codes on claims are there to define?
- The place of service where services were rendered
- The type of service
- The time of service
- The payment qualifier
34. Which federal law strengthens the privacy of a patient’s PHI and allows a patient to review their medical record?
35. The federal law that allows a worker to continue to purchase employer paid health insurance for up to 18 months if they lose their job or your coverage is otherwise terminated is known as:
36. True or False? Tertiary insurance is intended to cover gaps in coverage the primary and secondary insurance may not cover.
37. This health insurance coverage is available to an individual and their dependents after becoming unemployed – either due to voluntary or involuntary termination of employment for reasons other than gross misconduct.
- Medicare Insurance
- Co – Insurance
- COBRA Insurance
38. Which of these are NOT standard statuses of a claim in a typical EOB?
39. Health Insurance Claim (HICN) is a number assigned by the Social Security Administration to an individual identifying him/her as a _______ beneficiary
40. A type of health coverage that typically allows a patient to go to any doctor or provider without permission is known as:
- Contractor insurance
- Descriptor insurance
- On-call fees
41. Which of the following would you likely use if billing Medicare?
42. Which part of Medicare is the drug prescription coverage?
- Part A
- Part D
- Part B
- Part C
43. The Employer Identification Number is also known as the:
- Social Security Identification Number
- Health Department Identification Number
- Employer Group Health Plan
- Federal Tax Identification Number
44. An illegal practice of assigning an ICD-9 diagnosis code that does not agree with the patient records for the purpose of increasing the reimbursement from the insurance payor is called:
- Code banking
- ICD skimming
45. The ICD-9-CM coding classification to identify health care for reasons other than injury or illness is
46. Who is eligible for Medicare part C
- An individual who has an HMO plan
- An individual who pays all premiums
- An individual who is covered under Parts A and B
- An individual who has a supplemental Plan
47. The form the provider uses to document the treatment and diagnosis for a patient visit which typically includes ICD-9 diagnosis and CPT procedural codes is the:
- IPC-450 form
- Advanced payment form
- Focused item bill
48. Health insurance coverage which is contracted to supplement Medicare coverage is called:
- HMO extension
49. The HIPAA approved standard paper claim form submitted to insurance companies to have the outpatient health benefit or the contracted provider visit paid is the:
- HIPAA 1450
- CMS 1500
- CMS 1450
- HIPAA 1500
50. Which one of the following was known as Medicare + Choice?
- Part C
- Part D
- Part A
- Part B
51. The average amount Medicare will pay a provider or hospital for a procedure is the:
52. Tricare was formerly known as
- None of the above
- Civilian Health and Medical Program of the Uniformed Services(CHAMPUS)
- Humana Military Healthcare Services
- United States Department of Defense Military Health System
- Civilian Health and Medical Program of the United States(CHAMPUS)
53. Coding for a name-brand medication when a generic brand was used is called __________.
54. The difference between the summarized income rate and the summarized cost rate over a given valuation period is the:
- Cost restraints
- Actuarial Balance
- Administrative discrepancy
55. Submitting several CPT treatment codes when only one code is necessary is called:
- Facility charges
56. A health benefit plan allowing the patient to choose to receive a service from a group of contracted providers is a:
57. The form which is specifically used to bill dental services is called?
- HCFA 1500 form
- ADA form
- UB-04 form
- Dental Claim form
58. The federal law that was originally created to safeguard an employees retirement benefits is abbreviated as:
59. Will Medicare accept a UB-92 form?
60. What is the abbrevation for SSI?
- None of the above
- Social Security Information
- Supplemental Security Income
- Social Security Income
- Supplemental Security Information
61. This type of workers compensation would be described as: abnormal conditions or disorders caused by exposure to enviromental factors. Examples of these could be exposure to a chemical, inhalation, ingestion or direct exposure.
- Occupational illness
- Occupational Safety and Health Administration
- State Workers Compensation
- Federal Employment Liability Act
- Industrial accident
62. According to the MBAA, up to _____ % of US medical bills contain errors.
63. A ________ limits the amount of out-of-pocket expenses a patient will have to pay for TRICARE-covered medical services.
- TRICARE cap
- catastrophic cap
- Care ceiling
- HMO cap
64. What is COBRA insurance?
- It is a slang term used to describe uninsured emergency room patients
- Insurance available to individuals after they become unemployed
- Insurance for exotic injuries
- It is an insurance plan specific to the military
65. The date the insurance policy is set to begin or when benefits or covered services are allowed is most commonly known as the:
- Float date
- Effective date
- Startup date
- Coverage blanket date
66. The amount paid, often in monthly installments, for an insurance policy by the employer or patient themselves, is the:
67. In medical billing, what is the function of a clearinghouse?
- It calculates total patient bills
- It runs background checks on patient credit history
- It checks bills for errors then transmits them to the insurance company
- It processes all of the payments
68. ________ billing is when a patient is charged for the difference between what a doctor bills and what the provider and insurance company agree upon.
69. What is capitation?
- The hierarchy of payments
- A payment scheduling method
- A system that pays physicians and nurses a set amount per enrolled patient assigned to them
- The process of cutting down the price of a medical bill
70. When submitting a secondary claim, what is the name of the document that must be attached?
- Certificate of codding
- Benefits of Explanation
- Explanation of Medical Necessity
- Explanation of Benefits
- Certificate of Medical Necessity
71. What is the purpose of an Advanced Beneficiary Notice?
- To alert a patient that Medicare may deny payment for a specific procedure or treatment
- To alert a patient to a change in their premium payments
- To confirm receipt of a patient’s payment
- To alert the hospital to changes in Medicare’s coverage policies
72. With the implementation of HIPAA, all the following systems became mandatory EXCEPT:
73. What is a clearing house?
- Hygienic Place
- Payment clearing authority
- All of these
- None of these
- Intermediary between provider and insurance
74. Which of the following is an agreement made between the insurance company and the insured to send payments directly to the physician?
- Coordination of Benefits
- Assignment of Benefits
- Pre-Existing Conditions
75. Charging for services that are not medically necessary are included under:
- Custodial care
- Low cost alternatives
- Information models
76. The claim form for billing for facility fees which replaces the UB92 form is the _______ form.
- CMS 1450
77. True or false? The coder should NOT correct any errors in a bill.
78. A 3-digit number used on hospital bills to tell the insurer where the patient was when they received treatment, or what type of item a patient received, is the:
- SMI code
- Revenue Code
- Medical Code
- Policy identification number
79. Which one of the following is the largest Blue Cross Blue Shield member?
80. If a provider is non-par, any allowed claim amount that is ______ billed charges should be unacceptable.
- less than
- more than
- equal to