Question 1

You are working at a practice and need to get prior approval from a payer. Which of the following HIPAA transactions would you use to do so?

Accepted Answer

A)  Referral Certification and Authorization 
B)  Eligibility for a Health Plan 
C)  Coordination of Benefits 
D)  Health Care Payment 
A)  Referral Certification and Authorization 
B)  Eligibility for a Health Plan 
C)  Coordination of Benefits 
D)  Health Care Payment

Question 2

What are the procedures that ensure billable services are recorded and reported for payment called?

Accepted Answer

A)  documentation 
B)  communications 
C)  coordination of benefits 
D)  charge capture 
A)  documentation 
B)  communications 
C)  coordination of benefits 
D)  charge capture

Question 3

Ms. Lowell arrives for an appointment on February 8, 2017. She last visited the practice on May 14, 2016, and is scheduled to see the same physician. What should you, medical office receptionist, ask Ms. Lowell to do upon arrival?

Accepted Answer

A)  Just have a seat and wait for the physician. 
B)  Review and update the information on file, in case there are changes. 
C)  Complete all forms required for new patients. 
D)  Call her insurance company to verify coverage. 
A)  Just have a seat and wait for the physician. 
B)  Review and update the information on file, in case there are changes. 
C)  Complete all forms required for new patients. 
D)  Call her insurance company to verify coverage.

Question 4

A provider such as a pathologist who does not have face-to-face interaction with a patient is called a(n)

Accepted Answer

A)  indirect provider. 
B)  incident-to provider. 
C)  direct provider. 
D)  physician assistant. 
A)  indirect provider. 
B)  incident-to provider. 
C)  direct provider. 
D)  physician assistant.

Question 5

What information does RTA allow the practice to view?

Accepted Answer

A)  the amount the patient will owe 
B)  the amount the health plan will pay 
C)  the amount the health plan will pay and amount patient will owe 
D)  RTA does not have anything to do with payment 
A)  the amount the patient will owe 
B)  the amount the health plan will pay 
C)  the amount the health plan will pay and amount patient will owe 
D)  RTA does not have anything to do with payment

Question 6

To make sure that all patients can follow the financial policy, it should be

Accepted Answer

A)  displayed on a wall in exam rooms only. 
B)  included in new patient information packet only. 
C)  displayed on the wall of the reception area or included in new patient information packet. 
D)  displayed on the wall of reception area only. 
A)  displayed on a wall in exam rooms only. 
B)  included in new patient information packet only. 
C)  displayed on the wall of the reception area or included in new patient information packet. 
D)  displayed on the wall of reception area only.

Question 7

A patient arrives for an appointment and you need to locate his insurance information. You would use which of the following documents to find it?

Accepted Answer

A)  patient information form 
B)  medical history form 
C)  notice of privacy practices 
D)  acknowledgment of receipt of privacy practices 
A)  patient information form 
B)  medical history form 
C)  notice of privacy practices 
D)  acknowledgment of receipt of privacy practices

Question 8

What type of provider is required to have patients sign an acknowledgment?

Accepted Answer

A)  nonparticipating provider 
B)  indirect provider 
C)  direct provider 
D)  pathologist 
A)  nonparticipating provider 
B)  indirect provider 
C)  direct provider 
D)  pathologist

Question 9

Patients may have fill-in-the-gap insurance called

Accepted Answer

A)  secondary insurance. 
B)  None of these are correct. 
C)  primary insurance. 
D)  supplemental insurance. 
A)  secondary insurance. 
B)  None of these are correct. 
C)  primary insurance. 
D)  supplemental insurance.

Question 10

Examine the types of information below and determine which type is NOT important to collect from a new patient.

Accepted Answer

A)  patient/guarantor and insurance data 
B)  availability for future appointments 
C)  medical history 
D)  preregistration and scheduling information 
A)  patient/guarantor and insurance data 
B)  availability for future appointments 
C)  medical history 
D)  preregistration and scheduling information

Question 11

A "self-pay" patient is one who

Accepted Answer

A)  is not the policyholder. 
B)  owes a copayment. 
C)  is a dependent of a policyholder. 
D)  is uninsured. 
A)  is not the policyholder. 
B)  owes a copayment. 
C)  is a dependent of a policyholder. 
D)  is uninsured.

Question 12

When should the insurance specialist update the encounter form?

Accepted Answer

A)  every week 
B)  every six months 
C)  every month 
D)  when codes change 
A)  every week 
B)  every six months 
C)  every month 
D)  when codes change

Question 13

The document patients sign to signify that they have read and understood how the provider will protect their PHI is the

Accepted Answer

A)  Medical History Form. 
B)  Assignment of Benefits. 
C)  Acknowledgment of Receipt of Notice of Privacy Practices. 
D)  Patient Information Form. 
A)  Medical History Form. 
B)  Assignment of Benefits. 
C)  Acknowledgment of Receipt of Notice of Privacy Practices. 
D)  Patient Information Form.

Question 14

Under what rule is a child's primary coverage determined based upon which parent's day of birth is earlier in the calendar year?

Accepted Answer

A)  custody rule 
B)  birthday rule 
C)  gender rule 
D)  parent rule 
A)  custody rule 
B)  birthday rule 
C)  gender rule 
D)  parent rule

Question 15

A patient with no previous balance presents for an encounter and wants to know what their bill will be. Calculate the patient's estimated balance if they will receive a non-covered service worth $127.

Accepted Answer

A)  $127 
B)  $142 
C)  $112 
D)  $15 
A)  $127 
B)  $142 
C)  $112 
D)  $15

Question 16

What is set up in the practice management program when a patient's chief complaint is different than the one for a previous encounter?

Accepted Answer

A)  identification number 
B)  new case 
C)  chart number 
D)  none of these are correct; nothing needs to be set up 
A)  identification number 
B)  new case 
C)  chart number 
D)  none of these are correct; nothing needs to be set up

Question 17

Determine by which of the following means a practice may receive a "self-refer."

Accepted Answer

A)  the patient comes for specialty care without a referral number when one is required 
B)  the patient cannot self refer 
C)  the patient requests a referral number from their physician and gives it to the practice 
D)  the patient is issued a referral number from their health plan 
A)  the patient comes for specialty care without a referral number when one is required 
B)  the patient cannot self refer 
C)  the patient requests a referral number from their physician and gives it to the practice 
D)  the patient is issued a referral number from their health plan

Question 18

A provider who directly treats a patient is called a(n)

Accepted Answer

A)  physician assistant. 
B)  direct provider. 
C)  indirect provider. 
D)  incident-to provider. 
A)  physician assistant. 
B)  direct provider. 
C)  indirect provider. 
D)  incident-to provider.

Question 19

If an employed patient has coverage under two insurance plans, one from a current employer and one from a previous employer, the primary plan is

Accepted Answer

A)  the plan in effect for the patient the longest. 
B)  either plan, depending on coverage. 
C)  the previous employer's plan. 
D)  the current employer's plan. 
A)  the plan in effect for the patient the longest. 
B)  either plan, depending on coverage. 
C)  the previous employer's plan. 
D)  the current employer's plan.

Question 20

What is another name for the HIPAA Eligibility for a Health Plan transaction?

Accepted Answer

A)  X12 837 
B)  ABN 
C)  X12 278 
D)  X12 270/271 
A)  X12 837 
B)  ABN 
C)  X12 278 
D)  X12 270/271

You are working at a practice and need to get prior approval from a payer. Which of the following HIPAA transactions would you use to do so?

What are the procedures that ensure billable services are recorded and reported for payment called?

Ms. Lowell arrives for an appointment on February 8, 2017. She last visited the practice on May 14, 2016, and is scheduled to see the same physician. What should you, medical office receptionist, ask Ms. Lowell to do upon arrival?

A provider such as a pathologist who does not have face-to-face interaction with a patient is called a(n)

What information does RTA allow the practice to view?

To make sure that all patients can follow the financial policy, it should be

A patient arrives for an appointment and you need to locate his insurance information. You would use which of the following documents to find it?

What type of provider is required to have patients sign an acknowledgment?

Patients may have fill-in-the-gap insurance called

Examine the types of information below and determine which type is NOT important to collect from a new patient.

A "self-pay" patient is one who

When should the insurance specialist update the encounter form?

The document patients sign to signify that they have read and understood how the provider will protect their PHI is the

Under what rule is a child's primary coverage determined based upon which parent's day of birth is earlier in the calendar year?

A patient with no previous balance presents for an encounter and wants to know what their bill will be. Calculate the patient's estimated balance if they will receive a non-covered service worth $127.

What is set up in the practice management program when a patient's chief complaint is different than the one for a previous encounter?

Determine by which of the following means a practice may receive a "self-refer."

A provider who directly treats a patient is called a(n)

If an employed patient has coverage under two insurance plans, one from a current employer and one from a previous employer, the primary plan is

What is another name for the HIPAA Eligibility for a Health Plan transaction?

Introduction to the Medical Billing Cycle

Electronic Health Records, Hipaa, and Hitech: Sharing and Protecting Patients Health Information

Diagnostic Coding: Introduction to ICD-10-CM

Procedural Coding: CPT and HCPCS

Visit Charges and Compliant Billing

Health Care Claim Preparation and Transmission

Private Payers/BlueCross BlueShield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Disabilityautomotive Insurance

Payments Ras, Appeals, and Secondary Claims

Patient Billing and Collections

Hospital Billing and Reimbursement

CPT and HCPCS

Filters

Exam 3: Patient Encounters and Billing Information

You are working at a practice and need to get prior approval from a payer. Which of the following HIPAA transactions would you use to do so?

What are the procedures that ensure billable services are recorded and reported for payment called?

Ms. Lowell arrives for an appointment on February 8, 2017. She last visited the practice on May 14, 2016, and is scheduled to see the same physician. What should you, medical office receptionist, ask Ms. Lowell to do upon arrival?

A provider such as a pathologist who does not have face-to-face interaction with a patient is called a(n)

What information does RTA allow the practice to view?

To make sure that all patients can follow the financial policy, it should be

A patient arrives for an appointment and you need to locate his insurance information. You would use which of the following documents to find it?

What type of provider is required to have patients sign an acknowledgment?

Patients may have fill-in-the-gap insurance called

Examine the types of information below and determine which type is NOT important to collect from a new patient.

A "self-pay" patient is one who

When should the insurance specialist update the encounter form?

The document patients sign to signify that they have read and understood how the provider will protect their PHI is the

Under what rule is a child's primary coverage determined based upon which parent's day of birth is earlier in the calendar year?

A patient with no previous balance presents for an encounter and wants to know what their bill will be. Calculate the patient's estimated balance if they will receive a non-covered service worth $127.

What is set up in the practice management program when a patient's chief complaint is different than the one for a previous encounter?

Determine by which of the following means a practice may receive a "self-refer."

A provider who directly treats a patient is called a(n)

If an employed patient has coverage under two insurance plans, one from a current employer and one from a previous employer, the primary plan is

What is another name for the HIPAA Eligibility for a Health Plan transaction?

Introduction to the Medical Billing Cycle

Electronic Health Records, Hipaa, and Hitech: Sharing and Protecting Patients Health Information

Diagnostic Coding: Introduction to ICD-10-CM

Procedural Coding: CPT and HCPCS

Visit Charges and Compliant Billing

Health Care Claim Preparation and Transmission

Private Payers/BlueCross BlueShield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Disabilityautomotive Insurance

Payments Ras, Appeals, and Secondary Claims

Patient Billing and Collections

Hospital Billing and Reimbursement

CPT and HCPCS

Filters