Exam 11: Physician Medical Billing

The diagnosis code required in form locator 24E is the: A)ICD-9-CM code describing the patient condition. B)number of the diagnosis code listed in form locator 21 that points to the related service. C)number of diagnostic tests performed to justify the physician's diagnosis. D)diagnostic modifier, if applicable.

The Health Insurance Portability and Accountability Act (HIPAA) regulates protected health information while allowing appropriate use by all of the following entities EXCEPT: A)providers. B)health plans. C)clearinghouses. D)employers.

Examples of standard code sets recognized under HIPAA include: A)CPT codes. B)HCPCS codes. C)ICD-9(10)-CM codes. D)all of the above.

Most providers submit medical claims: A)using paper forms and optical scanners. B)by mailing paper forms. C)electronically. D)by faxing paper forms.

What are the four components of HIPAA's Administrative Simplification section?

Scrambling electronic information during transmission to prevent it from being intercepted or read by unauthorized users is a process known as: A)electronic data transmission. B)encryption. C)optical character recognition (OCR). D)transcription.

Confirmation of a patient's insurance coverage is usually done online, but when it is done by phone, the medical office specialist can record answers to questions on a worksheet called a(n):

If required information is missing from a claim form, the medical office specialist will have to correct the claim and resend it for payment.

What are some of the advantages of optical character recognition (OCR) in the processing of paper claims?

The CMS-1500 claim form used by physician offices was developed by: A)the American Medical Association (AMA). B)the Blue Cross/Blue Shield Association. C)the Centers for Medicare and Medicaid Services (CMS). D)representatives from all insurance carriers.

The person who purchases an insurance policy is known as the __________ .

The form a new patient completes when registering in a physician's office is known as a(n) __________ form.

The employer identification number (EIN) or federal tax ID number is issued by: A)the Centers for Medicare and Medicaid Services (CMS). B)the Internal Revenue Service (IRS). C)the Health Insurance Portability and Accountability Act (HIPAA). D)insurance carriers.

The patient information form is standardized and used by all physicians' offices.

The person who is ultimately responsible to pay the physician is known as the policyholder.

If an individual is covered under Plan A through her employment and is covered under Plan B through her spouse's employment: A)Plan A is primary, and Plan B is secondary. B)Plan B is primary, and Plan A is secondary. C)only Plan A will pay for her benefits. D)Plan B will pay all of the benefits.

Most claims to secondary insurance carriers are submitted electronically.

If an insured patient signs an Assignment of Benefits form, the insurance carrier will send payment directly to the: A)bank. B)guarantor. C)patient. D)physician.

Electronic claims can be submitted: A)directly to the carrier. B)through a clearinghouse. C)through a billing service. D)all of the above.