Question 1

____ is an identifying code assigned when preauthorization is required.

Accepted Answer

A)  Prior chart number 
B)  Prior authorization number 
C)  Prior register number 
D)  Prior record number 
A)  Prior chart number 
B)  Prior authorization number 
C)  Prior register number 
D)  Prior record number B

Question 2

In the PMP, a patient's visit for a new complaint is set up as a separate _____.

Accepted Answer

A)  file 
B)  case 
C)  category 
D)  classification 
A)  file 
B)  case 
C)  category 
D)  classification B

Question 3

What is recorded on the encounter form?

Accepted Answer

A)  insurance contact information 
B)  physician information code 
C)  patients work information 
D)  diagnosis and procedures codes 
A)  insurance contact information 
B)  physician information code 
C)  patients work information 
D)  diagnosis and procedures codes D

Question 4

Another term for the insured is ____.

Accepted Answer

A)  dependent 
B)  endorser 
C)  cosigner 
D)  subscriber 
A)  dependent 
B)  endorser 
C)  cosigner 
D)  subscriber

Question 5

A retired patient who has Medicare is covered by a spouse's employer's plan and the spouse is still employed. Which plan is primary?

Accepted Answer

A)  Medicare 
B)  Medicaid 
C)  spouse's plan 
D)  the plan with the lowest deductible 
A)  Medicare 
B)  Medicaid 
C)  spouse's plan 
D)  the plan with the lowest deductible

Question 6

All communications with payer representatives should be ___.

Accepted Answer

A)  discussed with the physician 
B)  discussed with the office manager 
C)  documented 
D)  recorded 
A)  discussed with the physician 
B)  discussed with the office manager 
C)  documented 
D)  recorded

Question 7

A(n) _____ is a document a patient signs to guarantee payment when a referral authorization is pending.

Accepted Answer

A)  guarantee waiver 
B)  documentation waiver 
C)  endorsement waiver 
D)  referral waiver 
A)  guarantee waiver 
B)  documentation waiver 
C)  endorsement waiver 
D)  referral waiver

Question 8

HIPAA X12N 270/271 is ____.

Accepted Answer

A)  HIPAA Eligibility for Service Form 
B)  HIPAA Eligibility for a Health Plan electronic transaction form 
C)  HIPAA Eligibility for Health Care at Hospital form 
D)  HIPAA Eligibility For Health Care Out-of State Form 
A)  HIPAA Eligibility for Service Form 
B)  HIPAA Eligibility for a Health Plan electronic transaction form 
C)  HIPAA Eligibility for Health Care at Hospital form 
D)  HIPAA Eligibility For Health Care Out-of State Form

Question 9

Which of the following is not a type of information that is important to gather when a patient is new to the practice?

Accepted Answer

A)  preregistration and scheduling information 
B)  medical history 
C)  assignment of benefits 
D)  license plate number 
A)  preregistration and scheduling information 
B)  medical history 
C)  assignment of benefits 
D)  license plate number

Question 10

When a medical assistant at the specialist practice handles a referred patient, which of the following must the medical assistant do?

Accepted Answer

A)  check the patient age 
B)  verify the patient chart number at the primary physician 
C)  check that the patient has a referral number 
D)  verify that the patient has a driver's license 
A)  check the patient age 
B)  verify the patient chart number at the primary physician 
C)  check that the patient has a referral number 
D)  verify that the patient has a driver's license

Question 11

The practice management program (PMP) contains _____.

Accepted Answer

A)  database of patients 
B)  database of resources 
C)  catalog of codes 
D)  catalog of research 
A)  database of patients 
B)  database of resources 
C)  catalog of codes 
D)  catalog of research

Question 12

Under the HIPAA Privacy Rule, under what conditions can a provider release patients' PHI without prior authorization?

Accepted Answer

A)  treatment, payment, and health care operations (TPO) purposes 
B)  requested by an office manager 
C)  requested by the patients spouse 
D)  research, compensation and examination purposes 
A)  treatment, payment, and health care operations (TPO) purposes 
B)  requested by an office manager 
C)  requested by the patients spouse 
D)  research, compensation and examination purposes

Question 13

Payers want the name of the patient on a claim _____.

Accepted Answer

A)  to skip middle initials 
B)  to include nicknames 
C)  to be the same as on the patients social security card 
D)  to be exactly as it is shown on the insurance card 
A)  to skip middle initials 
B)  to include nicknames 
C)  to be the same as on the patients social security card 
D)  to be exactly as it is shown on the insurance card

Question 14

A provider that does not have a participation agreement with a plan is _____.

Accepted Answer

A)  uninsured 
B)  unprofessional 
C)  unethical 
D)  out-of-network 
A)  uninsured 
B)  unprofessional 
C)  unethical 
D)  out-of-network

Question 15

If the plan is an HMO that requires a primary care provider (PCP), the general or family practice must verify which of the following?

Accepted Answer

A)  the patient has paid their premium 
B)  the patient is assigned to the PCP as of the date of service 
C)  the insurance company has contacted the patient 
D)  the pharmacy has been selected 
A)  the patient has paid their premium 
B)  the patient is assigned to the PCP as of the date of service 
C)  the insurance company has contacted the patient 
D)  the pharmacy has been selected

Question 16

PAR is the abbreviation for ____.

Accepted Answer

A)  participating provider 
B)  participating insurance 
C)  partaking provider 
D)  partaking insurance 
A)  participating provider 
B)  participating insurance 
C)  partaking provider 
D)  partaking insurance

Question 17

When an insured patient's policy does not cover a planned service, who is obligated to arrange for payment before services are given?

Accepted Answer

A)  the government 
B)  the administration 
C)  the patient 
D)  the management 
A)  the government 
B)  the administration 
C)  the patient 
D)  the management

Question 18

A ____ is the physician who refers a patient to another physician.

Accepted Answer

A)  specialist 
B)  secondary physician 
C)  referring physician 
D)  recommended physician 
A)  specialist 
B)  secondary physician 
C)  referring physician 
D)  recommended physician

Question 19

An additional policy that provides benefits is called ___.

Accepted Answer

A)  subordinate insurance 
B)  primary insurance 
C)  auxiliary insurance 
D)  secondary insurance 
A)  subordinate insurance 
B)  primary insurance 
C)  auxiliary insurance 
D)  secondary insurance

Question 20

Guideline that determines which parent has the primary insurance for a child is called ___.

Accepted Answer

A)  birthday rule 
B)  compensation rule 
C)  repayment rule 
D)  reward rule 
A)  birthday rule 
B)  compensation rule 
C)  repayment rule 
D)  reward rule

____ is an identifying code assigned when preauthorization is required.

In the PMP, a patient's visit for a new complaint is set up as a separate _____.

What is recorded on the encounter form?

Another term for the insured is ____.

A retired patient who has Medicare is covered by a spouse's employer's plan and the spouse is still employed. Which plan is primary?

All communications with payer representatives should be ___.

A(n) _____ is a document a patient signs to guarantee payment when a referral authorization is pending.

HIPAA X12N 270/271 is ____.

Which of the following is not a type of information that is important to gather when a patient is new to the practice?

When a medical assistant at the specialist practice handles a referred patient, which of the following must the medical assistant do?

The practice management program (PMP) contains _____.

Under the HIPAA Privacy Rule, under what conditions can a provider release patients' PHI without prior authorization?

Payers want the name of the patient on a claim _____.

A provider that does not have a participation agreement with a plan is _____.

If the plan is an HMO that requires a primary care provider (PCP), the general or family practice must verify which of the following?

PAR is the abbreviation for ____.

When an insured patient's policy does not cover a planned service, who is obligated to arrange for payment before services are given?

A ____ is the physician who refers a patient to another physician.

An additional policy that provides benefits is called ___.

Guideline that determines which parent has the primary insurance for a child is called ___.

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Diagnostic Coding

Procedural Coding

Payment Methods and Checkout Procedures

Health Care Claim Preparation and Transmission

Private Payers/Blue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobile/Disability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters

Exam 3: Patient Encounters and Billing Information

____ is an identifying code assigned when preauthorization is required.

In the PMP, a patient's visit for a new complaint is set up as a separate _____.

What is recorded on the encounter form?

Another term for the insured is ____.

A retired patient who has Medicare is covered by a spouse's employer's plan and the spouse is still employed. Which plan is primary?

All communications with payer representatives should be ___.

A(n) _____ is a document a patient signs to guarantee payment when a referral authorization is pending.

HIPAA X12N 270/271 is ____.

Which of the following is not a type of information that is important to gather when a patient is new to the practice?

When a medical assistant at the specialist practice handles a referred patient, which of the following must the medical assistant do?

The practice management program (PMP) contains _____.

Under the HIPAA Privacy Rule, under what conditions can a provider release patients' PHI without prior authorization?

Payers want the name of the patient on a claim _____.

A provider that does not have a participation agreement with a plan is _____.

If the plan is an HMO that requires a primary care provider (PCP), the general or family practice must verify which of the following?

PAR is the abbreviation for ____.

When an insured patient's policy does not cover a planned service, who is obligated to arrange for payment before services are given?

A ____ is the physician who refers a patient to another physician.

An additional policy that provides benefits is called ___.

Guideline that determines which parent has the primary insurance for a child is called ___.

From Patient to Payment Understanding Medical Insurance

Electronic Health Records, HIPAA, and Hitech: Sharing and Protectin

Diagnostic Coding

Procedural Coding

Payment Methods and Checkout Procedures

Health Care Claim Preparation and Transmission

Private Payers/Blue Cross and Blue Shield

Medicare

Medicaid

Tricare and Champva

Workers Compensation and Automobile/Disability Insurance

Claim Processing, Payments, and Collections

Hospital Insurance

Filters