Question 1

Citing three examples, discuss how insurance plans differ.

Accepted Answer

Insurance plans can differ in several wa

Question 2

The term used to describe the relationship between ICD-10 and CPT codes, demonstrating medical necessity, is

Accepted Answer

A)  code verification. 
B)  billing processes. 
C)  code linkage. 
D)  medical necessity application. 
A)  code verification. 
B)  billing processes. 
C)  code linkage. 
D)  medical necessity application.

Question 3

Of the following, which would be included on a remittance advice or explanation of benefits?

Accepted Answer

A)  total charges for a patient's account 
B)  subscriber's address 
C)  effective date of insurance 
D)  employer's information 
A)  total charges for a patient's account 
B)  subscriber's address 
C)  effective date of insurance 
D)  employer's information

Question 4

Daniel Burke, a patient of Dr. Etherington, had a minor procedure performed in the office on May 5. His insurance paid a portion of Dr. Etherington's bill, but the insurance company denied payment for the procedure itself. Because of an administrative error, the office is not holding Mr. Burke responsible for the balance. Is it still necessary for that service to be included on the patient's account? Why or why not?

Accepted Answer

Yes, regardless of whether payment is re

Question 5

Which is true of ACOs?

Accepted Answer

A)  There are currently two models: Medicare Shared Savings and Advance Payment Model. 
B)  Sharing of patient information through an EHR is necessary. 
C)  Data can be in structured or unstructured form. 
D)  Participation in an ACO is voluntary. 
A)  There are currently two models: Medicare Shared Savings and Advance Payment Model. 
B)  Sharing of patient information through an EHR is necessary. 
C)  Data can be in structured or unstructured form. 
D)  Participation in an ACO is voluntary.

Question 6

The primary person covered by an insurance plan is the

Accepted Answer

A)  patient. 
B)  prescriber. 
C)  subscriber. 
D)  provider. 
A)  patient. 
B)  prescriber. 
C)  subscriber. 
D)  provider.

Question 7

Mrs. Lam was sent from her doctor's office to the outpatient laboratory for a urinalysis. Her insurance company denied the claim, stating that the procedure was not necessary. The healthcare professional reviewed the claim and saw that a urinalysis was ordered, and the diagnosis listed on the encounter form was upper respiratory infection. Why was this claim denied?

Accepted Answer

This claim was denied because a diagnosi

Question 8

Why was it necessary to convert from ICD-9 to ICD-10?

Accepted Answer

The ICD-9 coding system was outdated as

Question 9

Dr. Simmons' office has been notified that they are being audited due to a complaint that was filed by a Medicare patient regarding their billing practices. The audit will be conducted by the

Accepted Answer

A)  Office of Civil Rights. 
B)  Centers for Medicare and Medicaid Services. 
C)  Internal Revenue Service. 
D)  Office of Inspector General. 
A)  Office of Civil Rights. 
B)  Centers for Medicare and Medicaid Services. 
C)  Internal Revenue Service. 
D)  Office of Inspector General.

Question 10

The out-of-pocket payment amount that a policyholder must meet before insurance coverage begins is called the

Accepted Answer

A)  deductible. 
B)  coinsurance. 
C)  co-pay. 
D)  balance. 
A)  deductible. 
B)  coinsurance. 
C)  co-pay. 
D)  balance.

Question 11

An alphanumeric code that corresponds to each diagnosis made by the care provider, and is included on every claim form is known as what kind of code?

Accepted Answer

The answer of An alphanumeric code that corresponds to each...

Question 12

Dr. Markunas saw Drew Panek in his office today. Drew was diagnosed with strep pharyngitis. The diagnosis is otherwise known as which element of a SOAP note?

Accepted Answer

The answer of Dr. Markunas saw Drew Panek in his...

Question 13

The actual claim process begins when the patient

Accepted Answer

A)  is discharged. 
B)  makes the appointment. 
C)  is seen by the care provider. 
D)  pays the bill. 
A)  is discharged. 
B)  makes the appointment. 
C)  is seen by the care provider. 
D)  pays the bill.

Question 14

The type of insurance plan that promotes quality, cost-effective healthcare by monitoring patients, encouraging preventive care, and requiring performance measures of physicians is known as

Accepted Answer

A)  Medicare Part 
B)  managed care. 
C)  fee-for-service. 
D)  consumer driven. 
A)  Medicare Part 
B)  managed care. 
C)  fee-for-service. 
D)  consumer driven.

Question 15

All of the insurance companies and the individual plans of patients in a medical practice are included in what database of the practice's practice management software?

Accepted Answer

library of

Question 16

Explain the factors that are taken into account when assigning an evaluation and management (E&M) code.

Accepted Answer

When assigning an evaluation and managem

Question 17

As of October 1, 2015, the coding system used to code diagnoses in any healthcare setting is

Accepted Answer

A)  ICD-9-CM. 
B)  HCPCS level 2. 
C)  CPT. 
D)  ICD-10-CM. 
A)  ICD-9-CM. 
B)  HCPCS level 2. 
C)  CPT. 
D)  ICD-10-CM.

Question 18

Which entity investigates suspected cases of fraud?

Accepted Answer

A)  Office of Inspector General 
B)  Drug Enforcement Agency 
C)  Centers for Medicare and Medicaid Services 
D)  HIPAA Monitoring Agencies 
A)  Office of Inspector General 
B)  Drug Enforcement Agency 
C)  Centers for Medicare and Medicaid Services 
D)  HIPAA Monitoring Agencies

Question 19

The last step in the revenue cycle is

Accepted Answer

A)  review coding compliance. 
B)  pre-register patients. 
C)  follow up payments and collections. 
D)  establish financial responsibility. 
A)  review coding compliance. 
B)  pre-register patients. 
C)  follow up payments and collections. 
D)  establish financial responsibility.

Question 20

A formal, written document that describes how a hospital or physician practice ensures that rules, regulations, and standards are being adhered to is called a/an

Accepted Answer

A)  OIG order. 
B)  OSHA plan. 
C)  compliance plan. 
D)  Qui Tam network. 
A)  OIG order. 
B)  OSHA plan. 
C)  compliance plan. 
D)  Qui Tam network.

Citing three examples, discuss how insurance plans differ.

The term used to describe the relationship between ICD-10 and CPT codes, demonstrating medical necessity, is

Of the following, which would be included on a remittance advice or explanation of benefits?

Which is true of ACOs?

The primary person covered by an insurance plan is the

Why was it necessary to convert from ICD-9 to ICD-10?

Dr. Simmons' office has been notified that they are being audited due to a complaint that was filed by a Medicare patient regarding their billing practices. The audit will be conducted by the

The out-of-pocket payment amount that a policyholder must meet before insurance coverage begins is called the

An alphanumeric code that corresponds to each diagnosis made by the care provider, and is included on every claim form is known as what kind of code?

Dr. Markunas saw Drew Panek in his office today. Drew was diagnosed with strep pharyngitis. The diagnosis is otherwise known as which element of a SOAP note?

The actual claim process begins when the patient

The type of insurance plan that promotes quality, cost-effective healthcare by monitoring patients, encouraging preventive care, and requiring performance measures of physicians is known as

All of the insurance companies and the individual plans of patients in a medical practice are included in what database of the practice's practice management software?

Explain the factors that are taken into account when assigning an evaluation and management (E&M) code.

As of October 1, 2015, the coding system used to code diagnoses in any healthcare setting is

Which entity investigates suspected cases of fraud?

The last step in the revenue cycle is

A formal, written document that describes how a hospital or physician practice ensures that rules, regulations, and standards are being adhered to is called a/an

An Overview of Prime Suites Practice Management and Electronic Health Record Software

Health Data Structure, Collection, and Standards

Content of the Health Recordadministrative Data

Content of the Health Recordthe Past Medical, Surgical, Family, and Social Histories

Content of the Health Recordthe Care Providers Responsibility

Privacy, Security, Confidentiality, and Legal Issues

Management of Information and Communication

Decision and Compliance Support: Utilizing the Database

Looking Aheadthe Future of Health Information and Informatics

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Exam 6: Financial Management: Insurance and Billing Functions

Citing three examples, discuss how insurance plans differ.

The term used to describe the relationship between ICD-10 and CPT codes, demonstrating medical necessity, is

Of the following, which would be included on a remittance advice or explanation of benefits?

Which is true of ACOs?

The primary person covered by an insurance plan is the

Why was it necessary to convert from ICD-9 to ICD-10?

Dr. Simmons' office has been notified that they are being audited due to a complaint that was filed by a Medicare patient regarding their billing practices. The audit will be conducted by the

The out-of-pocket payment amount that a policyholder must meet before insurance coverage begins is called the

An alphanumeric code that corresponds to each diagnosis made by the care provider, and is included on every claim form is known as what kind of code?

Dr. Markunas saw Drew Panek in his office today. Drew was diagnosed with strep pharyngitis. The diagnosis is otherwise known as which element of a SOAP note?

The actual claim process begins when the patient

The type of insurance plan that promotes quality, cost-effective healthcare by monitoring patients, encouraging preventive care, and requiring performance measures of physicians is known as

All of the insurance companies and the individual plans of patients in a medical practice are included in what database of the practice's practice management software?

Explain the factors that are taken into account when assigning an evaluation and management (E&M) code.

As of October 1, 2015, the coding system used to code diagnoses in any healthcare setting is

Which entity investigates suspected cases of fraud?

The last step in the revenue cycle is

A formal, written document that describes how a hospital or physician practice ensures that rules, regulations, and standards are being adhered to is called a/an

An Overview of Prime Suites Practice Management and Electronic Health Record Software

Health Data Structure, Collection, and Standards

Content of the Health Recordadministrative Data

Content of the Health Recordthe Past Medical, Surgical, Family, and Social Histories

Content of the Health Recordthe Care Providers Responsibility

Privacy, Security, Confidentiality, and Legal Issues

Management of Information and Communication

Decision and Compliance Support: Utilizing the Database

Looking Aheadthe Future of Health Information and Informatics

Filters