Deck 10: Physician Medical Billing

Question 1

Clearinghouses charge providers based on which type of payment system?

A) A percentage of each claim's dollar value
B) A flat fee per claim
C) Per diem
D) Both A and B

Answer 1

Both A and B

Question 2

The policy in most medical offices is to request that the patient sign and update a release of information form:

A) at every visit.
B) once per year.
C) every 2 years.
D) every 3 years.

Answer 2

once per year.

Question 3

Most physicians bill insurance carriers by completing paper or electronic versions of which form?

A) Verification of benefits form
B) CMS-1500 claim form
C) UB-04 claim form
D) Superbill

Answer 3

CMS-1500 claim form

Question 4

A patient information form typically includes:

A) demographic information.
B) employment information.
C) insurance information.
D) all of the above.

Question 5

A claim can only be submitted to an insurance carrier on the patient's behalf if the patient has signed a(n):

A) assignment of benefits form.
B) explanation of benefits form.
C) patient information form.
D) release of information form.

Question 6

The form used by the provider to document ICD-10-CM and CPT codes for routine services is referred to as a(n):

A) encounter form.
B) charge slip.
C) superbill.
D) all of the above.

Question 7

If a patient wishes insurance payments to be made directly to the provider, the patient must sign which type of form?

A) Assignment of benefits form
B) Explanation of benefits form
C) Patient information form
D) Release of information form

Question 8

An audit/edit report from a clearinghouse will show all of the following EXCEPT:

A) claims that need corrections.
B) claims that are missing information.
C) claims forwarded to the insurance carrier.
D) paid claims.

Question 9

A company that receives claims from providers, audits them, and forwards them on to insurance carriers is a(n):

A) billing service.
B) independent auditing firm.
C) clearinghouse.
D) third-party administrator.

Question 10

Most providers submit medical claims:

A) using paper forms and optical scanners.
B) by mailing paper forms.
C) electronically.
D) by faxing paper forms.

Question 11

The majority of income in a physician's office comes from:

A) bank loans.
B) payments from insurance companies.
C) payments from patients.
D) private donations.

Question 12

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):

A) assignment of benefits form.
B) patient information form.
C) release of information form.
D) verification of benefits form.

Question 13

A UB-04 claim form is used by:

A) physician offices.
B) hospitals.
C) surgeons.
D) therapists.

Question 14

An advantage of filing claims electronically is:

A) lower administrative costs.
B) fewer claim rejections.
C) faster payment.
D) all of the above.

Question 15

A company that provides data processing and claims processing services to physician's offices is a(n):

A) billing service.
B) independent auditing firm.
C) clearinghouse.
D) third-party administrator.

Question 16

Electronic claims can be submitted:

A) directly to the carrier.
B) through a clearinghouse.
C) through a billing service.
D) all of the above.

Question 17

To submit claims to an insurance carrier, a billing service requires:

A) the patient's personal and insurance information.
B) a copy of the patient's insurance card.
C) the encounter form documenting the diagnosis and services provided.
D) all of the above.

Question 18

The individual who purchases an insurance policy is known as the:

A) employee.
B) guarantor.
C) patient.
D) policyholder.

Question 19

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.

Question 20

A disadvantage of filing electronic claims is:

A) increased claim rejections.
B) increased administrative costs.
C) inability to create an electronic attachment.
D) inability to audit claims.

Question 21

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.

Question 22

Examples of standard code sets recognized under HIPAA include:

A) CPT codes.
B) HCPCS codes.
C) ICD-10-CM codes.
D) all of the above.

Question 23

Components of the Administration Simplification subsection of HIPAA include all of the following EXCEPT:

A) transaction and code sets.
B) compliance and auditing guidelines.
C) uniform identifiers.
D) privacy and security rules.

Question 24

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.

Question 25

Which of the following statements are true about optical character recognition (OCR) devices?

A) They transfer bar codes to the EHR.
B) They digitalize paper records.
C) They enable faster claims processing.
D) all of the above

Question 26

According to the birthday rule, if both parents cover dependent children under their insurance policies, the primary insurance is the policy:

A) that has been in force the longest.
B) of the older parent.
C) of the parent whose date of birth occurs earliest in the year.
D) that has the highest level of benefits.

Question 27

If needed information is missing from a claim when it is submitted to an insurance carrier, it is referred to as a(n):

A) clean claim.
B) dirty claim.
C) erroneous claim.
D) incomplete claim.

Question 28

The subsection of HIPAA that regulates electronic billing is known as the:

A) Electronic Data Interchange.
B) Administrative Simplification.
C) Privacy and Security Standard.
D) False Claims

Question 29

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 CMS.
D) representatives from all insurance carriers.

Question 30

The use of the CMS-1500 claim form is:

A) mandatory for all physician office claims.
B) mandatory for all Medicare claims but optional for private insurance carriers.
C) optional for all Medicare claims but mandatory for private insurance carriers.
D) optional for all physician office claims.

Question 31

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.

Question 32

The identification number issued to physicians who are authorized to practice medicine in a given state is the:

A) Social Security number.
B) federal tax identification number.
C) state license number.
D) employer identification number.

Question 33

A limited insurance policy purchased to cover part of the patient's expenses, such as coinsurance, for which the patient would otherwise be responsible, is:

A) secondary insurance.
B) supplemental insurance.
C) additional insurance.
D) optional insurance.

Question 34

Claims may require provider identification numbers for the:

A) ordering physician.
B) referring physician.
C) performing physician.
D) all of the above.

Question 35

A superbill contains all the following EXCEPT:

A) procedures.
B) treatments.
C) diagnosis.
D) weight.

Question 36

When health claims information is exchanged electronically, both the sender and the receiver must follow what HIPAA transaction standard?

A) 5010
B) CMS-1500
C) OCR
D) EMC

Question 37

What information should be filled out in form locator 28?

A) patient's account number.
B) total charges.
C) amount paid.
D) physician's federal tax ID number.

Question 38

If a patient has more than one insurance plan, the determination of how much will be paid by each is known as:

A) assignment of benefits.
B) the birthday rule.
C) coordination of benefits.
D) verification of benefits.

Question 39

If a patient is the primary policyholder on two insurance plans, the primary plan is considered:

A) the plan with the highest level of benefits.
B) the plan in effect for the longest period of time.
C) the plan that has the highest premium.
D) the plan in effect for the shortest period of time.

Question 40

According to HIPAA, covered entities for compliance issues include:

A) clearinghouses and billing services only.
B) health plans and providers only.
C) health plans, clearinghouses, billing services, and providers.
D) health plans and clearinghouses only.

Question 41

On universal claim forms for physician or hospital services, a form locator is a number printed on the form that serves as a unique identifier.

Question 42

If more than one physician is involved in a case, what priority order is used to determine the physician listed in form locator 17?

A) ordering provider, referring provider, supervising provider
B) referring provider, supervising provider, ordering provider
C) supervising provider, ordering provider, referring provider
D) referring provider, ordering provider, supervising provider

Question 43

On the CMS-1500 claim form, the abbreviation EIN refers to:

A) Employer Identification Number.
B) Employer Identifier for National Coverage.
C) Estimated Insurance Number for payment.
D) Examination Indicates Nothing.

Question 44

Medicaid's Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program in form locator 24H includes all the following reason codes EXCEPT:

A) AV.
B) ST.
C) MT.
D) NU.

Question 45

The CMS-1500 claim form is mandatory for all Medicare claims.

Question 46

The diagnosis code required in form locator 24E is the:

A) ICD-10-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.

Question 47

The source document used by a medical office specialist to enter patient encounter data into a computerized accounting system is the superbill.

Question 48

Electronic claims are entered into a computer system and then printed out to be filed in the patient's medical record.

Question 49

Optical character recognition can recognize handwriting and text, which helps staff turn paper records into digital records quickly and efficiently.

Question 50

On the CMS-1500 claim form, the abbreviation MM indicates that:

A) more than one area of malignancy was located.
B) multiple tests were performed.
C) the month should be entered as two digits.
D) more information is needed before a diagnosis can be determined.

Question 51

On the CMS-1500 claim form, the abbreviation DD indicates that:

A) up to two diagnosis codes can be entered.
B) a doctor of dentistry performed the service.
C) the day of the month should be entered as two digits.
D) durable medical equipment (DME) was ordered.

Question 52

A referral or prior authorization number may still be required even if that insurance carrier provides secondary coverage for the patient.

Question 53

On the CMS-1500 claim form, the abbreviation NPI indicates that:

A) a condition was Not Present or Indicated upon examination.
B) the National Health Plan Identifier must be entered.
C) the National Provider Identifier must be entered.
D) the National Preferred Identifier for clearinghouses must be entered.

Question 54

Claims may require three provider identification numbers.

Question 55

Place of service codes used in form locator 24B include all of the following EXCEPT:

A) private residence.
B) urgent care facility.
C) operating room.
D) independent laboratory.

Question 56

On the CMS-1500 claim form, the abbreviation EMG indicates that:

A) an employer identifier number must be entered.
B) it must be noted if emergency services were provided.
C) it must be noted if preauthorization was obtained.
D) it must be noted if the service is considered emerging or experimental.

Question 57

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

Question 58

When completing the CMS-1500 form, providers and suppliers have the option of entering either a six- or eight-digit date format.

Question 59

The options provided in locator 1 on the CMS-1500 claim form include:

A) five government plans, group health plan, and other.
B) five government plans, group health plan, and individual plan.
C) four government plans and three private plans.
D) eight health plan options.

Question 60

Most providers submit healthcare claims electronically.

Question 61

When submitting a secondary claim, you must attach a copy of the primary carrier's EOB to the completed CMS-1500 or UB-04.

Question 62

The form that allows an insurance company to make payments directly to a physician on behalf of the patient is the ________ form.

Question 63

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

Question 64

Physicians bill insurance carriers using a universal form, the________ claim form.

Question 65

If form locator 20 is marked Yes because the physician referred the patient to an outside lab for some type of lab work, form locator 32 must also be completed.

Question 66

A claim that is missing information or contains incorrect information is referred to as a(n) ________ claim.

Question 67

To authorize the release of information, a patient must sign either form locator 9 on the CMS-1500 form or a consent document with similar wording to be retained in the office files.

Question 68

A company that receives claims from providers, audits them to check for errors, and forwards them to insurance carriers for payment is a(n) ________.

Question 69

If a patient is covered by more than one health plan, form locator 11d is answered Yes and form locators 9, 9a, and 9d must be completed.

Question 70

The form that specifies which information from the medical chart may be released and to whom is a(n) ________ form.

Question 71

The person who purchases an insurance policy is known as the________.

Question 72

Most claims to secondary insurance carriers are submitted electronically.

Question 73

Form locator 17, Name of referring provider or other source, can include the name of a relative or friend who referred the patient to the physician's office.

Question 74

A physician's Social Security number is always used on the CMS-1500 claim form.

Question 75

A signature stamp should never be used in place of the physician's original signature on a claim form.

Question 76

The person who is ultimately responsible for paying for medical services is known as the ________.

Question 77

The place of service code is mandatory for all claims submitted to Medicare.

Question 78

ICD-10 codes in form locator 21 should be listed in order of precedence with number 1 being the primary diagnosis.

Question 79

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

Question 80

If a patient has signed a consent document authorizing release of medical information to the insurance carrier, the notation "Signature on File" or "SOF" may be entered in form locator 12.