Office Financial Management, Billing, Insurance

1. The main purpose for verifying a patient's insurance coverage at every visit is to

Prevent claim rejection due to ineligibility or non-active status.

2. Which of the following must be filled out by the patient in order to forward payment to the physician's office

Assignment of benefits

3. Which of the following documents does the provider or facility need to submit in order to receive reimbursement from an insurance company?

CMS-1500

4. Which of the following forms is used by the medical office to ensure that insurance payments are made directly to the physician?

Assignment of benefits

5. Which of the following is the most likely cause of the deposits not agreeing with the credits on the day sheet or the patient ledgers?

Payment is misplaced.

6. When posting an insurance payment via an EOB, the amount that is considered contractual is the

A. insurance allowed amount.

B. NON-PAR payment allowable.

C. co-insurance.

D. patient responsibility.

Insurance allowed amount.

7. A list of all account balances and the amounts owed to the medical practice at the end of the day is called an

A. accounts receivable report.

B. aging summary analysis.

C. accounts payable report.

D. insurance aging report.

Accounts receivable report

8. When following up on a denied claim, a medical office assistant should have which of the following information available when speaking with the insurance company? (Select the three (3) correct answers).

A. patient's claim number

B. physician's NPI

C. date the claim was denied

D. patient's mailing address

E. patient's insurance ID number

Patient's claim number, physician's NPI, patient's insurance ID number

9. A medical office assistant's knowledge of a statute of limitations for collecting an overdue account is an example of managing the collections process while complying with

A. AMA guidelines.

B. practice management guidelines.

C. state and federal guidelines.

D. HIPAA guidelines.

State and federal guidelines.

10. A patient has refused to pay for a medical procedure that was performed six months ago. The medical procedure was not listed under the patient's schedule of benefits, and she is now fully responsible for all costs. Her account has now been turned over to a collection agency. This scenario is most likely an example of failure of the medical office assistant to properly

A. code the procedure.

B. bill the procedure.

C. explain the non-coverage billing policies.

D. explain the statute of limitations.

Explain the non-coverage billing policies.

11. The medical office assistant receives payments in full from both a primary private insurance company and a 65-year-old patient. At the end of the day she realizes there was an overpayment on the patient's account. Which of the following should the overpayment be refunded to?

A. the patient

B. the insurance company

C. Medicare

D. the physician

The patient

12. The process of finding out if a service or procedure is covered under a patient's insurance policy is called

A. predetermination.

B. preauthorization.

C. precertification.

D. preexisting.

Precertification.

13. A patient comes into a provider's office with a diagnosis CHF due to a medical emergency. The provider admits the patient to a local hospital for care. Which Medicare plan will cover the hospital admission?

A. Medicare Part A

B. Medicare Part B

C. Medicare Part C

D. Medicare Part D

Medicare Part A

14. ASCA requires that hospital claims submitted to Medicare Part A and B must be submitted electronically, but will accept non-electronic claims on behalf of providers that

A. have been in business for less than 90 days.

B. employ less than 25 full-time employees.

C. also participate in the Medicaid program.

D. offer both inpatient and outpatient services.

Employ less than 25 full-time employees

15. A patient presents to the provider's office with a complaint of a migraine. The patient has Medicare and Medicaid. The patient also has a Worker's Compensation claim with a diagnosis of head injury. After the provider assesses the patient, the final diagnosis is a concussion. Where should this claim be submitted first?

A. Medicare

B. the patient's employer

C. Worker's Compensation

D. Medicaid

Worker's Compensation

16. Which is the correct procedure for keeping a Worker's Compensation patient's financial and health records when the same physician is also seeing the patient as a private patient?

A. The same financial record may be used, but a separate health record must be maintained.

B. The same health record may be used, but a separate financial record must be maintained.

C. The same financial and health records may be used.

D. Separate financial and health records must be used.

Separate financial and health records must be used.

17. A medical office assistant is reviewing a chart with the following documentation: indigent patient presented with a complaint of itchy, red bumps on her chest and neck. Diagnosis: Urticaria, Procedure: Expanded Office Visit. The reference manual that would contain the term Urticaria and the associated code is the

A. Current Procedural Terminology (CPT)

B. Health Care Financing Administration Common Procedure Coding System (HCPCS)

C. Centers for Medicare and Medicaid Services (CMS)

D. International Classification of Diseases (ICD)

International Classification of Diseases (ICD)

18. The provider prescribed and ordered a wheelchair for a patient with a below-the-knee amputation. Which of the following manuals should the medical office assistant use to code these services?

A. ICD-CM

B. CPT

C. HCPCS

D. CPT-assistant

HCPCS

19. Request for payment under the terms of a health insurance policy is referred to as which of the following?

A. deductible

B. claim

C. preauthorization

D. copayment

Claim

20. Premiums are payments made systematically to insurance companies in exchange for which of the following?

A. kickbacks

B. benefits

C. referrals

D. adjustments

Benefits

21. Which of the following is the predetermined amount of total eligible charges a patient must pay before insurance plan benefits begin?

A. premium

B. coverage

C. deductible

D. copay

Deductible

22. Which part of Medicare covers office visits with a primary care provider?

A. Part A

B. Part B

C. Part C

D. Part D

Part B

23. The set dollar amount collected at the time of each visit for a patient's portion of health care costs is referred to as which of the following?

A. copayment

B. deductible

C. coinsurance

D. out-of-pocket maximum

Copayment

24. A provider who has a contractual agreement to accept an insurance company's pre-negotiated rate for health care services is considered to be

A. for-profit.

B. not-for-profit.

C. in-network.

D. non-network.

In-network.

25. A child is covered by the insurance policies of each of his parents: United Health Care and Blue Cross/Blue Shield. According to the birthday rule, which of the following plans should become the primary insurance?

A. the plan of the policyholder whose birthday comes first in the calendar year

B. the plan of the policyholder whose birthday comes last in the calendar year

C. the plan of the policyholder that is least expensive per month

D. the plan of the policyholder that has the lowest annual deductible

The plan of the policyholder whose birthday comes first in the calendar year

26. Which of the following actions should the medical assistant take when handling a workers' compensation claim?

A. Ensure the patient has obtained legal representation prior to seeking care.

B. Process the claim according to disability income insurance guidelines.

C. Promptly verify the patient's insurance coverage with their employer.

D. Bill the patient directly to collect outstanding reimbursement for treatment.

Promptly verify the patient's insurance coverage with their employer.

27. Which of the following patients below meet Medicare's eligibility criteria?

A. 45 year old man who suffered a back injury and hasn't been able to work for 9 months.

B. 61 year old woman who recently retired from the local school district.

C. 23 year old woman that has been blind since birth.

D. 53 year old man who received a liver transplant.

23 year old woman that has been blind since birth.

[This one had a picture]

28. A patient questions an outstanding balance when insurance coverage is active and the co-pay has been paid. Which of the following is the mostly likely reason the balance is the patient's responsibility?

A. deductible not met

B. premiums due

C. the birthday rule applies

D. pre-authorization not obtained

Deductible not met

29. The most effective method to manage patient statements and other financial invoices, and avoid payment delays is to

A. use a bimonthly billing system.

B. issue periodic reminders.

C. use a collection agency.

D. collect fees at the time of service.

Collect fees at the time of service.

30. When coding for a urine screen, under which of the following sections of the CPT® is this service line found?

A. E&M

B. pathology and lab

C. radiology

D. medicine

Pathology and lab

31. Which of the following information must be gathered when processing a credit card payment by telephone? (Select the three (3) correct answers.)

A. credit card number

B. expiration date

C. bank routing number

D. checking account number

E. CVC number

Credit card number, expiration date, CVC number

33. Which of the following insurance related forms includes a detailed description of benefits paid, reduced, or denied on a claim?

A. coordination of benefits

B. explanation of benefits

C. service benefit plan

D. assignment of benefits

Explanation of benefits

34. During an office visit, which of the following records accompanies each patient's chart and lists treatments and procedures with respective codes to assist in billing?

A. health information

B. encounter form

C. preauthorization

D. CMS-1500

Encounter form

35. When there is a professional discount awarded to a patient's account, the medical assistant should post the discounted amount under the

A. reference column.

B. balance column.

C. charges column.

D. adjustment column.

Adjustment column.

36. Daily transactions are posted onto a day sheet in order to

A. provide an overall financial status update.

B. accurately track office supply inventory.

C. monitor the accuracy of electronic health records.

D. ensure correct CPT codes are assigned.

Provide an overall financial status update.

37. The medical office assistant receives payments from both insurance company and patient. At the end of day she realizes there was an overpayment on the patient's account. Which of the following should the overpayment be refunded to?

A. the patient

B. the insurance

C. Medicaid

D. the physician

The patient

What is the ABA number on the check?

76-4/1049

40. Which of the following must be completed by the patient to authorize payment directly from the insurance company to the physician's office?

A. coordination of benefits

B. assignment of benefits

C. remittance advice

D. explanation of benefits

Assignment of benefits

41. A list of all account balances and the amounts owed to the medical practice at the end of the day is called a(n)

A. accounts receivable report.

B. aging summary analysis.

C. disbursement report.

D. insurance aging report.

Accounts receivable report.

42. Which of the following front office tasks performed by the medical assistant describes the translation of words into numbers so that insurance claims may be filed?

A. coding

B. annotating

C. indexing

D. alpha-numeric labeling

Coding

43. The medical assistant processes a patient's lab requisition for a HbA1c. The purpose of this test is to

A. evaluate a patient for iron deficiency anemia.

B. assess average blood sugar control in a patient with diabetes.

C. evaluate a patient with Chron's disease for active inflammation.

D. assess the electrolyte balance in a patient with dehydration.

Assess average blood sugar control in a patient with diabetes.

44. The patient is scheduled for an EGD. When assigning a CPT® code, the medical assistant understands which of the following body systems is primarily involved?

A. Cardiac

B. Endocrine

C. Reproductive

D. Gastrointestinal

Gastrointestinal

45. The patient with goiter has which of the following abnormalities?

A. thyroid gland enlargement

B. profound muscular weakness

C. lateral spine deformity

D. chronic back pain

Thyroid gland enlargement

46. Which of the following diagnostic procedures makes internal structures visible by recording the reflections of sound waves directed into the tissues?

A. MRI

B. CT Scan

C. KUB

D. ultrasound

Ultrasound

47. Which of the following forms should the medical assistant submit to request insurance reimbursement for a physician's office visit?

A. Assignment of Benefits

B. CMS-1500

C. Assumption of Liability

D. Explanation of Benefits

CMS-1500

48. The physician asks the medical assistant to choose an E/M code indicating 40 minutes were spent on an office visit that actually took less than 15 minutes. This is an example of which of the following?

A. adding a modifier

B. upcoding

C. unbundling

D. capitation

Upcoding

49. The provider prescribed and ordered a wheel chair for a patient with a below the knee amputation. Which of the following manuals should the medical office assistant use to code these services?

A. ICD-10-CM

B. CPT

C. HCPCS

D. CPT-assistant

HCPCS

50. A medical office assistant can recognize Current Procedural Terminology (CPT®) codes because they are

A. alpha-numeric codes.

B. five digit codes.

C. three, four, and five digit codes.

D. four digit codes.

Five digit codes.

51. When billing for durable medical equipment, a medical office assistant should use which of the following codes?

A. CPT

B. ICD

C. HCPCS

D. Level III

HCPCS

52. Which of the following should the medical assistant assign to a patient's main CPT® code, indicating unusual circumstances were present related to the procedure?

A. E/M code

B. modifier

C. symbol

D. V code

Modifier

53. A parent brings their four-year old in for a well-child exam. The medical assistant should assign an ICD-CM code beginning with which of the following?

A. E

B. M

C. V

D. +

V

54. The physician asks the medical assistant to fill out a CMS-1500 for a patient who came in for a 30 minute office visit and was treated for hypertension. Which of the following should the medical assistant use to locate the code for hypertension?

A. CPT

B. NPI

C. ICD-CM

D. HCPCS

ICD-CM

55. A medical office assistant is reviewing a chart with the following documentation: patient presented with a complaint of itchy, red bumps on her chest and neck. Diagnosis: Urticaria, Procedure: Expanded Office Visit. The coding reference manual that would contain the term Urticaria and the associated code is the

A. Current Procedural Terminology (CPT) code book

B. Health Care Financing Administration Common Procedure Coding System (HCPCS) code book

C. Centers for Medicare and Medicaid Services (CMS) code book

D. International Classification of Diseases (ICD) code book

International Classification of Diseases (ICD) code book

56. A physician has admitted a Medicare patient to the hospital for shortness of breath. After reviewing the patient's medical record, the hospital coder codes the admission as 99223. On which of the following claim forms should the hospital coder submit this patient's charges?

A. spend down

B. UB-04

C. ABN

D. CMS-1500

UB-04

57. Healthcare services for the evaluation and management of a disease consistent with the standard of care are considered to be

A. V codes.

B. a medical necessity.

C. upcoding.

D. part of the audit process.

a medical necessity.

58. Which part of Medicare covers hospitalization expenses?

Part A

59. Which of the following classifications of patient care is received at a medical facility on a walk-in basis, where an overnight stay is not required?

A. acute

B. outpatient

C. inpatient

D. long-term

outpatient

60. Which type of insurance begins direct payment to the patient after they have been injured and unable to work for a specific period of time?

Disability

61. Which of the following plans, funded by state and federal funds, exists to aid those with a limited or low income with health care costs?

A. Medicaid

B. Medicare

C. CHAMPVA

D. Blue Cross/Blue Shield

Medicaid

62. Which of the following prevents duplication of payment by more than one insurance carrier?

A. fee‑for‑service

B. precertification

C. coordination of benefits

D. preauthorization

Coordination of benefits

63. Which of the following government sponsored health insurance programs primarily serves older adults over 65 years of age?

A. TRICARE

B. Medicare

C. Medicaid

D. Workers' Compensation

Medicare

64. Which of the following health care benefit plans primarily serves active duty and retired uniformed military service members and their families?

A. TRICARE

B. Medicare

C. Medicaid

D. Federal Employees Health Benefits (FEHB) Program

TRICARE

65. Which of the following types of coverage provide protection up to a maximum limit in cases of catastrophic or prolonged illness?

A. basic medical

B. major medical

C. hospitalization

D. long-term care

Major medical

66. An added feature to a patient's insurance policy expanding or placing limits on standard coverage is a

A. referral.

B. rider.

C. deductible.

D. precertification

Rider

67. Employees of a major automobile manufacturer are provided health insurance under a master contract issued to their employer. Which of the following types of coverage does this reflect?

A. indemnity plan

B. group policy

C. coinsurance

D. fee-for-service plan

Group policy

68. Which of the following forms should be transmitted to obtain reimbursement following a physician's office visit for a patient with active Medicaid coverage?

A. CMS-1500

B. CMS-1450

C. Private Pay Agreement

D. UB-04

CMS-1500

69. For reimbursement purposes, the medical assistant should check to make sure that which of the following key pieces are provided on the insurance claim form?

A. ICD-10-CM and CPT codes

B. EOB and insurance premium

C. ICD-10-CM codes and insurance premium

D. EOB and CPT codes

ICD-10-CM and CPT codes.

70. When filing an electronic insurance claim, the medical assistant processes which of the following forms?

A. HIPAA waiver

B. encounter form

C. assignment of benefits

D. CMS-1500

CMS-1500

71. A patient sustained broken ribs in an automobile accident in which she was the passenger. After completion of an office follow up visit, which of the following should the medical office assistant submit the insurance claim to first?

A. the patient's primary health insurance

B. the patient's automobile insurance

C. the driver's automobile insurance

D. the driver's primary health insurance

Driver's automobile insurance

72. Which of the following patient documents should a medical office assistant refer to in order to complete the patient information question block section of the CMS-1500 form?

A. health history form

B. release form

C. HIPAA form

D. registration form

registration form

73. If a provider charges for services that were not performed, it is considered

A. a clerical error.

B. abuse.

C. fraud.

D. a HIPAA violation.

Fraud

74. A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim?

A. Medicare Part A

B. Medicare Part B

C. Medicare Part C

D. Medicare Part D

Medicare Part B

75. A patient presents to the provider's office with a complaint of persistent migraines three days after acquiring a head injury on the job. After the provider assesses the patient, the final diagnosis is a concussion. Which of the following actions should the medical assistant take next?

A. File a claim with the patient's primary insurance carrier.

B. Bill the patient's employer directly.

C. Determine if a workman's compensation claim has been filed.

D. Obtain payment directly from the patient at the time of service.

Determine if a workman's compensation claim has been filed.

76. Hospitalization benefits under insurance plans are usually limited to a total monetary amount or a maximum number of

A. patients.

B. days.

C. sickness.

D. hospitals.

Days.

77. Which is the correct procedure for keeping an industrial patient's financial and health records when the same physician is also seeing the person as a private patient?

A. The same financial record may be used but a separate health record must be maintained.

B. The same health record may be used but a separate financial record must be maintained.

C. The same financial and health records may be used.

D. Separate financial and health records must be used.

Separate financial and health records must be used.

78. A 64 year old indigent veteran (recently diagnosed disabled but has a part-time job) receiving outpatient peritoneal dialysis was referred to his federal primary care provider for stomatitis. The patient then went to his PCP for an assessment plan and IV antibiotics. The patient died at 2:00 pm the following day, on his 65th birthday. Which of the following entities should be billed for the medical expenses?

A. Medicare

B. Veterans Administration

C. Tricare

D. Medicaid

Tricare

79. Which of the following statements describes managed care?

A. Coverage is normally provided for elective procedures.

B. Cost-containment is a primary goal.

C. Pre-authorization is required for emergency care.

D. Pre-certification is not necessary for reimbursement.

Cost-containment is a primary goal.

80. Prior approval from an insurance company for the cost of services is known as which of the following?

A. preauthorization

B. informed consent

C. professional liability

D. assignment of benefits

preauthorization

81. A patient is referred to a specialist by the primary care provider. Pre-certification is required for this patient's specialty visit. Which of the following actions is required by the medical assistant to obtain authorization?

A. Contact the patient's specialist.

B. Have the patient submit a paper claim.

C. Contact the patient's insurance provider.

D. Submit the CMS 1500.

Contact the patient's insurance provider.

83. While a new patient is in the examination room with a physician who is explaining treatment options to the patient, the medical office assistant is contacting the insurance carrier to discuss the patient's insurance coverage. This scenario is an example of obtaining

Verification of benefits and eligibility for the patient.

84. The process of finding out if a service or procedure is covered under a patient's insurance policy is called

A. predetermination.

B. preauthorization.

C. precertification.

D. preexisting.

precertification.