_____is an agreement made between the insurance company and the insured to send payments directly to the physician.
Assignment of Benefits 0.0%
Coordination of Benefits 100.0%
Preauthorization 0.0%
Pre-Existing Conditions 0.0%
CPT Codes are updated ________.
once every 2 years 100.0%
annually 0.0%
whenever changes are necessary 0.0%
None of the above 0.0%
Electronic Medical Claims (EMC) help to ___________.
get the carrier more quickly than the paper claims 0.0%
pay more quickly than the paper claims 0.0%
notify more quickly in case the claim is rejected 0.0%
All of the above 100.0%
Fill up the blank: National Provider Identifier is a _____ digit number.
8 0.0%
9 0.0%
10 100.0%
4 0.0%
How is the patient identified in case of Champva?
VA File # 0.0%
Sponsor's SSN 0.0%
SSN 100.0%
Medicare # 0.0%
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...
4231 0.0%
4213 0.0%
3421 0.0%
3214 100.0%
If the patient deductible is $600, and the deductible met is $400, the coverage is 60/40 and the physician's charge is $95, how much should the patient pay?
$200 0.0%
$95 0.0%
$360 0.0%
$240 100.0%
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?
$26 0.0%
$15 100.0%
$27 0.0%
$60 0.0%
In which box are the CPT codes entered on the CMS-1500 Form?
Box 24A 50.0%
Box 24D 50.0%
Box 24B 0.0%
Box 24C 0.0%
In which of the following methods will you bill your clients for giving your services as a medical biller?
By using a set fee 0.0%
By billing on a percentage of the claims submitted 100.0%
By percentage of collections 0.0%
All of the above 0.0%
It is necessary to attach a document called _________ when submitting a secondary claim.
Benefits of Explanation 0.0%
Certificate of Medical Necessity 0.0%
Explanation of Medical Necessity 0.0%
Explanation of Benefits 100.0%
State whether true or false: HIPAA provides protections for both Group Health Plans and Individual Coverage.
State whether true or false: Ideal practice management software should have good reporting and multi-tasking capabilities.
The 'Group' in the 'Group Health Insurance Card' refers to the _________.
employer 100.0%
the name of the insured 0.0%
the name of the insurance company 0.0%
third party administrator 0.0%
The component 'National Identifier Standards' fall under which of the following components of HIPAA?
Program 0.0%
Administrative Simplification 0.0%
Accountability 100.0%
Portability 0.0%
What are modifiers?
They are used to add more information about a ICD-9 CM code 0.0%
They help in establishing "medical necessity" 0.0%
They are used to add more information about a CPT code 0.0%
They are an indicator to show that a procedure is linked to more than one diagnosis 100.0%
What are the main benefits of electronic claims?
They provide a quicker means of reimbursement 100.0%
They facilitate quicker submission of claims 0.0%
They involve more paper work 0.0%
They lessen the interaction with the consulting physician 0.0%
What do the CPT codes refer to?
The disease that the patient is suffering from 0.0%
The diagnoses performed on the patient 0.0%
The procedures performed by a physician or a practitioner 100.0%
The names of the medicines prescribed by the practitioner 0.0%
What does the bottom of the CMS 1500 Form report?
Provider 0.0%
Procedure 0.0%
Diagnostic and Charge Information 0.0%
All of the above 100.0%
None of the above 0.0%
What does the UB-04 form include?
National Provider Identifier 100.0%
Taxonomy 0.0%
Guarantor Information 0.0%
Additional Codes 0.0%
What is a benefit?
It is the function that a product performs 0.0%
It is what a feature does for a product 100.0%
It is the additional profits earned by a company 0.0%
It is the discount that a customer gets on a product 0.0%
What is a covered entity?
Any private organization or a government agency 0.0%
The organizations which maintain and upgrade ICD-9-CM codes 0.0%
The healthcare providers which are linked to PPOs 100.0%
The healthcare bodies covered by HIPAA 0.0%
What is a deductible?
A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year 0.0%
The percentage that the policy will pay for a covered procedure 0.0%
The percentage that the policy will pay for diagnostic, lab and x-ray procedures 0.0%
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% 100.0%
What is a write off?
It is a percentage of the charge or the dollar amount that the patient will pay to the provider for every encounter/visit 0.0%
It is the difference between the actual fee and the permitted fee 0.0%
It is the denial of a claim 100.0%
It is the ongoing fee paid to the insurance company by the insured 0.0%
What is an accident rider?
A 100% coverage that is not subject to co-payment or deductible in the event that the patient seeks emergency treatment 100.0%
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% 0.0%
The remaining deductible amount not yet incurred by the insured party or family 0.0%
A specified amount of annual out-of-pocket expense for covered medical services that the insured must incur and pay each policy year 0.0%
What is contained in the release of information (ROI) form?
Name and signature of the patient 0.0%
The details of the information being transmitted 100.0%
The name of the medical biller 0.0%
None of the above 0.0%
What is needed to file Worker's Compensation and Auto Insurance Claims?
Patient Relationship to Insured 0.0%
Patient's Name 0.0%
Patient Address & Telephone Number 0.0%
Claim Number 100.0%
What is not a part of the diagnosis information?
Macro Code 100.0%
Description 0.0%
Insurance Information 0.0%
Gender Specific Indication 0.0%
ICD9 0.0%
What is not one of the eligibility criteria for Medicare?
You should be 65 or more than 65 years of age 0.0%
You should have retired on Social Security, Railroad Retirement, or federal government retirement programs 100.0%
It is meant for individuals who have been legally disabled for more than 2 years or who are suffering from end-stage renal disease 0.0%
You should be a resident of the United States 0.0%
What is the full form of AIDA?
Attention, Interest, Desire And Action 100.0%
Action, Interest, Desire And Advertising 0.0%
Action, Interest, Desire And Attention 0.0%
None of the above 0.0%
What is the length of the standard CPT codes?
7 100.0%
4 0.0%
5 0.0%
2 0.0%
What is the need for insurance verification?
To determine the accuracy of the patient information and the insurance card 100.0%
To determine how the insurance will consider and/or pay for the services rendered 0.0%
To charge the patient for their portion appropriately 0.0%
To make the patient's information public 0.0%
What is the role of a clearing house while submitting claims electronically?
A clearing house acts as an intermediary between the billing center and the insurance carrier 0.0%
A clearing house allows the billing center to correct the errors in the rejected claim only once 0.0%
A clearing house posts the final payments to the referring physician's clinic 0.0%
A clearing house performs an initial computerized review of the claim submitted and sends the claim to the insurance carrier 100.0%
What is the way to determine the primary and secondary policy if a child is covered under both parent's policies?
Application of the "birthday rule" 0.0%
Application of the "insurance rule" 100.0%
The policy of both the mother and the father would be considered primary 0.0%
The policy of both the mother and the father would be considered secondary 0.0%
What things should you emphasize on while selecting an attorney when starting your own medical billing business?
You should look at his years of experience 0.0%
He should be able to develop a Compliance Plan in accordance with HIPAA protocols 100.0%
You should look at the attorney's ability to speak legal jargon with you 0.0%
You should look at his knowledge base about the entire legal system of your country 0.0%
Which are the disclosures exempted from minimum necessary?
Permissive Disclosures 0.0%
Disclosure of Protected Health Information 0.0%
Disclosure of de-identified information 100.0%
None of the above 0.0%
Which body is responsible for implementing the Privacy Rules
The Office of Civil Rights 0.0%
The American Medical Association 100.0%
World Health Organization 0.0%
All of the above 0.0%
Which date format is used on the CMS 1500 Form?
mm/dd/ccyy 100.0%
mm/dd/yy 0.0%
yy/mm/dd 0.0%
The date is not required 0.0%
Which is a more efficient and less time consuming method to submit your claims?
Through direct submissions 0.0%
Through HIPAA 0.0%
Through clearing houses 0.0%
All of the above 100.0%
Which of the following are required to organize your office as a medical biller?
Computer 0.0%
CMS- 1500 forms 0.0%
Printed/ online coding resources 0.0%
Patient statement forms 0.0%
All of the above 100.0%
Which of the following aspects does administrative safeguards focus on?
Administrative functions that ought to be applied to meet security standards 0.0%
Methods that should be applied to meet physical standards 0.0%
Administrative functions that prevent access to technical data 0.0%
All of the above 100.0%
Which of the following components of HIPAA have been put into effect?
Portability and Administrative Simplification 0.0%
Portability and Accountability 100.0%
Accountability and Program 0.0%
Administrative Simplification and Program 0.0%
Which of the following correctly defines the Encounter Document?
It is a form consisting of patient demographics, patient condition and guarantor information 100.0%
It is a form listing the present diagnosis and the past medical condition of the patient 0.0%
It is a form listing the insurance coverage information of a patient 0.0%
It is a form listing the services performed on a patient in a date of service 0.0%
Which of the following does the acronym HIPAA stand for?
Health Insurance Program and Accountability Act of 1996 0.0%
Health Insurance Portability and Accountability Act of 1996 100.0%
Health Insurance Portability, Accountability, and Administrative Act of 1995 0.0%
Health Insurance Portability and Administrative Act of 1995 0.0%
Which of the following information is needed to complete the CMS 1500 form?
Patient Information 0.0%
Insurance/Payment Information 0.0%
Guarantor Information 0.0%
Diagnostic Information (ICD-9 Codes) 0.0%
All of the above 100.0%
Which of the following is not a coding convention?
Punctuation 0.0%
Articles 0.0%
Connecting Words 100.0%
Abbreviations 0.0%
Which of the following is not a feature of Managed Care Plans?
Charging a nominal fee from the members 0.0%
Eradicating unwanted services 100.0%
Charging a standard fee for healthcare provider and hospital services 0.0%
Itemizing each service and charging to the patient's account 0.0%
Which of the following is not a part of Patient Condition Information?
Name and UPIN of the physician that was referred 100.0%
Patient date of birth 0.0%
Diagnosis information 0.0%
Insured ID Number 0.0%
Which of the following is not necessarily a function performed by a medical biller?
Performing insurance benefits verification and referral tasks 0.0%
Abstracting and coding of services rendered from a patient's medical records 100.0%
Submitting claims on Electronic Data Interchange (EDI) 0.0%
Mailing patient's billing statements 0.0%
Which of the following is the code for anesthesia (type of service code)?
X* 0.0%
99 100.0%
07 0.0%
15 0.0%
Which of the following is the first phase of the insurance claim life cycle?
Entering the data about claim information 0.0%
Entering patient demographics in the claim form 0.0%
Collecting claim data 100.0%
Stating the name of the guarantor in the claim form 0.0%
Which of these does not cover preventive care services?
POS 0.0%
PPOs 100.0%
HMOs 0.0%
None of the above 0.0%
Which of these is not a kind of third-party reimbursement?
Fee-for-service 0.0%
Capitation 0.0%
Episode of Care 0.0%
Managed care plans 100.0%
Which of these is not a suitable marketing strategy for medical billing business?
Door-to-door marketing 100.0%
Cold Calling 0.0%
Mailing List 0.0%
Business Networking 0.0%
Which of these is not a type of insurance coverage?
Medicare 0.0%
Group Health/Medical Insurance 100.0%
Workers Compensation 0.0%
Campus 0.0%
Medical 0.0%
Which of these is not one of the co-operating parties which maintains and upgrades ICD-9-CM codes?
World Health Organization(WHO) 0.0%
American Hospital Association (AHA) 0.0%
HCFA 100.0%
National Center for Health Statistics 0.0%
Who among the following can also be a guarantor?
The patient 0.0%
The physician 100.0%
The insurance company 0.0%
The medical biller 0.0%
Why was HIPAA enacted into a law?
To implement portability requirements for individual and group health insurance plans 0.0%
To decrease administrative cost and burdens of the legal industry 0.0%
To ensure that individuals moving from one health plan to another does not get covered under the conditions of the already existing plan 100.0%
None of the above 0.0%
Why was the accountability component added to HIPAA?
To increase health care costs so that health care professionals earn more profits 0.0%
To prevent health care fraud and abuse 100.0%
To deny coverage to an individual who moves from one plan to another 0.0%
To ensure that individuals get renewed coverage if he moves from one plan to another 0.0%
Why were security standards created in HIPAA?
To provide easy accessibility to electronically transmitted health information to all users 100.0%
To provide a platform to safeguard only the electronic equipment and processes holding the health information 0.0%
To prevent unauthorized access of electronically stored and transmitted health information 0.0%
To safeguard electronically stored health information 0.0%