Question 1

Which of the following is a common reason why insurance claims are rejected?

Accepted Answer

A)  When a procedure listed is not an insurance benefit 
B)  Lack of insurance coverage on date of service 
C)  Not obtaining preauthorization for the service 
D)  Claim was sent to the wrong insurance plan 
A)  When a procedure listed is not an insurance benefit 
B)  Lack of insurance coverage on date of service 
C)  Not obtaining preauthorization for the service 
D)  Claim was sent to the wrong insurance plan D

Question 2

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

Accepted Answer

A)  Two 
B)  Three 
C)  Four 
D)  Six 
A)  Two 
B)  Three 
C)  Four 
D)  Six C

Question 3

Match block 14 with the appropriate content as it relates to completing the CMS-1500 form. (Select all that apply.)

Accepted Answer

A)  National provider identification number 
B)  Preauthorization number 
C)  Date of current illness, injury, or pregnancy 
D)  Diagnosis or nature of illness or injury 
E)  Name of referring provider
F) Hospitalization dates related to current services 
A)  National provider identification number 
B)  Preauthorization number 
C)  Date of current illness, injury, or pregnancy 
D)  Diagnosis or nature of illness or injury 
E)  Name of referring provider
F) Hospitalization dates related to current services C

Question 4

The medical assistant should do everything possible to prevent claim __________.

Accepted Answer

rejection
The medica

Question 5

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 6

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 7

Electronic data interchange is

Accepted Answer

A)  transferring data back and forth between two or more entities. 
B)  sending information to one insurance carrier. 
C)  sending information to one clearinghouse for processing. 
D)  None of the above 
A)  transferring data back and forth between two or more entities. 
B)  sending information to one insurance carrier. 
C)  sending information to one clearinghouse for processing. 
D)  None of the above

Question 8

The abbreviation often used in blocks 12, 13, and 31 is __________.

Accepted Answer

SOF
The abbreviation

Question 9

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 10

A(n) __________ claim has been completed accurately and completely.

Accepted Answer

clean
A clean claim

Question 11

A claim that is missing information and is returned to the provider for correction and resubmission is called a(n) __________ claim.

Accepted Answer

incomplete
A claim that is mis

Question 12

A secondary health plan is noted in which block?

Accepted Answer

A)  11a 
B)  11b 
C)  11c 
D)  11d 
A)  11a 
B)  11b 
C)  11c 
D)  11d

Question 13

The assignment of benefits is located in block

Accepted Answer

A)  12. 
B)  13. 
C)  27. 
D)  33. 
A)  12. 
B)  13. 
C)  27. 
D)  33.

Question 14

Insurance information should be collected on the first visit.

Accepted Answer

A) True 
 B)False

Question 15

The primary insurance policy information is contained in block __________.

Accepted Answer

11
The primary insur

Question 16

Which of the following is a fixed amount per visit and is typically paid at the time of medical services?

Accepted Answer

A)  Co-payment 
B)  Deductible 
C)  Co-insurance 
D)  Both A and B 
A)  Co-payment 
B)  Deductible 
C)  Co-insurance 
D)  Both A and B

Question 17

Procedures performed on the patient are found in what block?

Accepted Answer

A)  24a 
B)  24b 
C)  24d 
D)  24e 
A)  24a 
B)  24b 
C)  24d 
D)  24e

Question 18

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 19

The date in block 14 is the date

Accepted Answer

A)  of the filing of the claim. 
B)  of the onset of the illness. 
C)  the patient signed the claim. 
D)  the provider signed the claim. 
A)  of the filing of the claim. 
B)  of the onset of the illness. 
C)  the patient signed the claim. 
D)  the provider signed the claim.

Question 20

Claims that are done by direct billing first go to a clearinghouse.

Accepted Answer

A) True 
 B)False

Exam 15: Medical Billing and Reimbursement

Which of the following is a common reason why insurance claims are rejected?

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

Match block 14 with the appropriate content as it relates to completing the CMS-1500 form. (Select all that apply.)

The medical assistant should do everything possible to prevent claim __________.

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

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

Electronic data interchange is

The abbreviation often used in blocks 12, 13, and 31 is __________.

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

A(n) __________ claim has been completed accurately and completely.

A claim that is missing information and is returned to the provider for correction and resubmission is called a(n) __________ claim.

A secondary health plan is noted in which block?

The assignment of benefits is located in block

Insurance information should be collected on the first visit.

The primary insurance policy information is contained in block __________.

Which of the following is a fixed amount per visit and is typically paid at the time of medical services?

Procedures performed on the patient are found in what block?

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

The date in block 14 is the date

Claims that are done by direct billing first go to a clearinghouse.

Competency-Based Education and the Medical Assistant Student

The Medical Assistant and the Healthcare Team

Professional Behavior in the Workplace

Therapeutic Communications

Medicine and Law

Medicine and Ethics

Technology and Written Communication in the Medical Office

Telephone Techniques

Scheduling Appointments and Patient Processing

Daily Operations in the Ambulatory Care Setting

The Health Record

Basics of Diagnostic Coding

Basics of Procedural Coding

Basics of Health Insurance

Patient Accounts, Collections, and Practice Management

Banking Services and Procedures

Supervision and Human Resources Management

Medical Practice Marketing and Customer Service

Infection Control

Patient Assessment

Patient Education

Nutrition and Health Promotion

Vital Signs

Assisting with the Primary Physical Examination

Principles of Pharmacology

Pharmacology Math

Administering Medications

Safety and Emergency Practices

Assisting in Ophthalmology and Otolaryngology

Assisting in Dermatology

Assisting in Gastroenterology

Assisting in Urology and Male Reproduction

Assisting in Obstetrics and Gynecology

Assisting in Pediatrics

Assisting in Orthopedic Medicine

Assisting in Neurology and Mental Health

Assisting in Endocrinology

Assisting in Pulmonary Medicine

Assisting in Cardiology

Assisting in Geriatrics

Principles of Electrocardiography

Assisting with Diagnostic Imaging

Assisting in the Clinical Laboratory

Assisting in the Analysis of Urine

Assisting in Blood Collection

Assisting in the Analysis of Blood

Assisting in Microbiology and Immunology

Surgical Supplies and Instruments

Surgical Asepsis and Assisting with Surgical Procedures

Career Development and Life Skills

Filters