Question 1

The medical assistant should always follow office __________ for claim review and signatures.

Accepted Answer

A)  rules 
B)  policies 
C)  conventions 
D)  directions 
A)  rules 
B)  policies 
C)  conventions 
D)  directions B

Question 2

How many diagnoses can be reported on the CMS-1500?

Accepted Answer

A)  Four 
B)  Eight 
C)  Twelve 
D)  Sixteen 
A)  Four 
B)  Eight 
C)  Twelve 
D)  Sixteen C

Question 3

Which of the following steps is needed to obtain precertification?

Accepted Answer

A)  Call provider services phone number on the back of the patient's health insurance ID card. 
B)  Provide the insurance company with procedures/services requested and the diagnoses. 
C)  Document the outcome of the call in the patient's health record. 
D)  All of the above 
A)  Call provider services phone number on the back of the patient's health insurance ID card. 
B)  Provide the insurance company with procedures/services requested and the diagnoses. 
C)  Document the outcome of the call in the patient's health record. 
D)  All of the above D

Question 4

The physician's office place-of-service code is

Accepted Answer

A)  9. 
B)  10. 
C)  11. 
D)  12. 
A)  9. 
B)  10. 
C)  11. 
D)  12.

Question 5

A set dollar amount that the policyholder must pay before the insurance company starts to pay for services is the definition of

Accepted Answer

A)  copayment. 
B)  deductible. 
C)  co-insurance. 
D)  adjudicate. 
A)  copayment. 
B)  deductible. 
C)  co-insurance. 
D)  adjudicate.

Question 6

The insured's address in block 7 refers to the __________ address.

Accepted Answer

A)  patient's 
B)  spouse's 
C)  policyholder's 
D)  insurance carrier's 
A)  patient's 
B)  spouse's 
C)  policyholder's 
D)  insurance carrier's

Question 7

To examine claims for accuracy and completeness before they are submitted is to _________ the claims.

Accepted Answer

A)  correct 
B)  audit 
C)  revise 
D)  reject 
A)  correct 
B)  audit 
C)  revise 
D)  reject

Question 8

A set dollar amount that the patient must pay for each office visit is the definition of

Accepted Answer

A)  copayment. 
B)  deductible. 
C)  co-insurance. 
D)  adjudicate. 
A)  copayment. 
B)  deductible. 
C)  co-insurance. 
D)  adjudicate.

Question 9

The medical assistant should __________ the front and back of the patient's insurance card.

Accepted Answer

A)  annotate 
B)  highlight 
C)  copy 
D)  None of the above 
A)  annotate 
B)  highlight 
C)  copy 
D)  None of the above

Question 10

Patients belonging to a MCO usually are required to get a referral from their ____ before seeing a specialist.

Accepted Answer

A)  HMO 
B)  EPO 
C)  PCP 
D)  CMS 
A)  HMO 
B)  EPO 
C)  PCP 
D)  CMS

Question 11

When the birthday rule is used to determine which policy is primary and which is secondary, it is the policy of the person who is the oldest that is considered primary.

Accepted Answer

A) True 
 B)False

Question 12

The patient's name is found in block

Accepted Answer

A)  1. 
B)  2. 
C)  3. 
D)  4. 
A)  1. 
B)  2. 
C)  3. 
D)  4.

Question 13

If the ICD-10-CM codes and the CPT/HCPCS codes do not match the claim will not show __________.

Accepted Answer

A)  eligibility 
B)  precertification 
C)  medical necessity 
D)  capitation 
A)  eligibility 
B)  precertification 
C)  medical necessity 
D)  capitation

Question 14

The first step in filing a claim with a third-party is

Accepted Answer

A)  verify all charges and fees. 
B)  proof read the claim information. 
C)  complete the precertification process. 
D)  obtain accurate billing information from the patient. 
A)  verify all charges and fees. 
B)  proof read the claim information. 
C)  complete the precertification process. 
D)  obtain accurate billing information from the patient.

Question 15

The Federal Tax ID number (Box 25) for the provider filing the claim can be presented as

Accepted Answer

A)  Social Security Number (SSN). 
B)  Employer Identification Number (EIN). 
C)  National Provider Identification (NPI). 
D)  Both A and B 
E)  All of the above 
A)  Social Security Number (SSN). 
B)  Employer Identification Number (EIN). 
C)  National Provider Identification (NPI). 
D)  Both A and B 
E)  All of the above

Question 16

When completing the CMS-1500 form, which section contains information about the patient and the insured?

Accepted Answer

A)  Section 1 
B)  Section 2 
C)  Section 3 
D)  Section 4 
A)  Section 1 
B)  Section 2 
C)  Section 3 
D)  Section 4

Question 17

Meeting the stipulated requirements to participate in the healthcare plan is the definition of

Accepted Answer

A)  eligibility. 
B)  precertification. 
C)  medical necessity. 
D)  capitation. 
A)  eligibility. 
B)  precertification. 
C)  medical necessity. 
D)  capitation.

Question 18

The physician's signature is located in block

Accepted Answer

A)  12. 
B)  13. 
C)  31. 
D)  33. 
A)  12. 
B)  13. 
C)  31. 
D)  33.

Question 19

Abuse is knowingly and willfully executing or attempting to execute a scheme to defraud any healthcare benefit program. Fraud is an unintended action that results in an overpayment to the healthcare provider.

Accepted Answer

A)  Both statements are true. 
B)  Both statements are false. 
C)  The first statement is true and the second statement is false. 
D)  The first statement is false and the second statement is true. 
A)  Both statements are true. 
B)  Both statements are false. 
C)  The first statement is true and the second statement is false. 
D)  The first statement is false and the second statement is true.

Question 20

Which of the following methods can be used to determine a patient's eligibility for insurance?

Accepted Answer

A)  Calling the provider services number on the back of the health insurance ID 
B)  Using the provider web portal sponsored by the patient's health insurance company 
C)  Both A and B 
D)  None of the above 
A)  Calling the provider services number on the back of the health insurance ID 
B)  Using the provider web portal sponsored by the patient's health insurance company 
C)  Both A and B 
D)  None of the above

Exam 26: Billing and Reimbursement

The medical assistant should always follow office __________ for claim review and signatures.

How many diagnoses can be reported on the CMS-1500?

Which of the following steps is needed to obtain precertification?

The physician's office place-of-service code is

A set dollar amount that the policyholder must pay before the insurance company starts to pay for services is the definition of

The insured's address in block 7 refers to the __________ address.

To examine claims for accuracy and completeness before they are submitted is to _________ the claims.

A set dollar amount that the patient must pay for each office visit is the definition of

The medical assistant should __________ the front and back of the patient's insurance card.

Patients belonging to a MCO usually are required to get a referral from their ____ before seeing a specialist.

When the birthday rule is used to determine which policy is primary and which is secondary, it is the policy of the person who is the oldest that is considered primary.

The patient's name is found in block

If the ICD-10-CM codes and the CPT/HCPCS codes do not match the claim will not show __________.

The first step in filing a claim with a third-party is

The Federal Tax ID number (Box 25) for the provider filing the claim can be presented as

When completing the CMS-1500 form, which section contains information about the patient and the insured?

Meeting the stipulated requirements to participate in the healthcare plan is the definition of

The physician's signature is located in block

Abuse is knowingly and willfully executing or attempting to execute a scheme to defraud any healthcare benefit program. Fraud is an unintended action that results in an overpayment to the healthcare provider.

Which of the following methods can be used to determine a patient's eligibility for insurance?

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